12 d’agost 2018

Searching for principles to inform societal decisions

Health Economics from Theory to Practice: Optimally Informing Joint Decisions of Research,  Reimbursement and Regulation with Health System Budget Constraints and Community Objectives

Cost effectiveness analysis without a clear understanding of budget impact is a theoretical effort with limited consequences in practice. If you want a clear view of the whole process and go beyond cost-effectiveness, a new book tries to summarise the current state of the art.
I'm not so sure that the title "Health economics from theory to practice" really fits with content you expect, but think about a different title "cost-effectiveness from theory to practice" and this is precisely what you'll find.
This book provides a robust set of health economic principles and methods to inform societal decisions in relation to research, reimbursement and regulation (pricing and monitoring of performance in practice). We provide a theoretical and practical framework that navigates to avoid common biases and suboptimal outcomes observed in recent and current practice of health economic analysis, as opposed to claiming to be comprehensive in covering all methods. Our aim is to facilitate efficient health system decision making processes in research, reimbursement and regulation, which promote constrained optimisation of community outcomes from a societal perspective given resource constraints, available technology and processes of technology assessment. Importantly, this includes identifying an efficient process to maximize the potential that arises from research and pricing in relation to existing technology under uncertainty, given current evidence and associated opportunity costs of investment. Principles and methods are identified and illustrated across health promotion, prevention and palliative care settings as well as treatment settings. Health policy implications are also highlighted.
And the conclusion:
The framework and methods presented have been shown to enable optimising of joint research, reimbursement (adoption and financing) and regulatory (pricing and practice monitoring) processes and decision making. Jointly addressing these related decisions has been shown to be key in meeting current and future challenges of baby boomer ageing and more generally in identifying areas for policy reform to enable a pathway to budget-constrained optimisation of community net benefit. The bottom line for such reforms is that better use of existing programmes and technologies and associated research that reflect community preferences is required and particularly now in facing the challenge of budget-constrained successful ageing of the baby boomer cohort.

04 d’agost 2018

Why shopping for healthcare doesn't work

Austin Frakt says in his blog and NYT:
Each year, for well over a decade, more people have faced higher health insurance deductibles. The theory goes like this: The more of your own money that you have to spend on health care, the more careful you will be — buying only necessary care, purging waste from the system.
But that theory doesn’t fully mesh with reality: High deductibles aren’t working as intendedHe refers specifically to this NBER paper and the summary is :
We could provide physicians with price, quality and distance information for the services they recommend. Further, with financial bonuses, we could give physicians (instead of, or in addition to, patients) some incentive to identify and suggest lower-cost care. An alternative approach is for insurers to refuse to pay more than a reasonable price — like the market-average — for a health care service, though patients could pay the difference if they prefer a higher-priced provider.
Leaving decisions solely to patients, and just making them spend more of their own money, doesn’t work.
I you want to understand why shopping for healthcare doesn't work, have a look at this book:


03 d’agost 2018

Talent in healthcare

Talent Management in Healthcare Exploring How the World’s Health Service Organisations Attract,
Manage and Develop Talent

I've always thought that we devote too few efforts to understand current talent in health care and the ways for improving it. And a new book on this topic is really welcome. If you have a look at the index you'll be convinced that these are the issues to take into consideration:
1  No Health Service Without a Health Workforce
2 The Changing Landscape of Healthcare
3 Defining Talent in the Health Sector
4 The Boundaries of Talent Management
5 The Talent Management Evolution Matrix
6 Talent Strategy: Alignment and Integration
7 Succession Planning and Leadership Development
8 Whole Workforce Development
9 Attraction, Recruitment and Resourcing of Talent
10 Talent Management and Employee Engagement
11 Retaining Talent in Health Sector Organisations
12 The Role of the Board, the Executive Team, Line Managers and HR Professionals in Talent Management
13 Twenty Important Conclusions About Talent Management in the Health Sector


At least UK is really trying to define a new model, and the Topol Review summarises the whole effort. I suggest a close look at it. You'll find the interim report here.