Health disparities

We all know that there are differences in health and health services throughout geography. If you want to check the extent of such differences, I suggest you have a look at Interactive atlas of health inequalities that WHO has published. You can select the country and you´ll find the comparison.
The number of variables is limited, but is a first step in the right direction since OECD only publishes data at a state level.

On food and public health policies

Is the food industry in the driver's seat?

The role of stakeholders in health policy requires transparency. Otherwise any potential relationship may end in conflict with general interest. The appointment of high level officials in any regulatory body has to be clean, without doubts over conflicts of interest.
Have a look at this article at EJPH. Some months ago I highlighted my concerns about this here.

Years behind the leader

U.S. Health in International Perspective: Shorter Lives, Poorer Health

This latest report of IOM-NAS highlights the outcomes of a health system and poor health behaviours. The concern about the US population health is growing. I was astonished by this statement:

Demographers refer to this measure as 35q15, or the probability of dying in the 35 years following one’s 15th birthday. For females in the 16 peer countries, 35q15 was around 2 percent in 2007 but was approximately twice as high—4 percent—in the United States. This means that the probability of a 15-year-old U.S. female dying within 35 years was double the average for 16 peer high-income countries.
In all high-income countries, including the United States, 35q15 has been declining for more than half a century. But the relative position of the United States has deteriorated since the late 1950s, when it was near the average of its peers. These countries, on average, had reduced their 35q15 for females to the U.S. 2007 level of 4 percent almost 40 years earlier. In this sense, one can say that, in 2007, the United States was 40 years behind the average of its peers (and 50 years behind the leading peer country).

Forty years behind the leader! that's a lot. A great effort is needed to balance such situation. An important sailors alert: those that want fierce and unregulated competition without mandatory insurance should have these results in their mind. Is this really what they want?

PS. The cheapest ad for a company is the one you may watch on TV3,  i.e. yesterday on TN about prenatal genetic screening. Why do all the citizens have to pay for this advertisement through our taxes?

Stop the blame game

La renovación de la atención primaria desde la consulta

Nowadays, those in contact with physicians in publicly funded health care are used to hear about blaming over the politicians and managers, about health system . As this HBR blog states: "Playing the blame game never works". In general, the suggestion is:

• Don't blame others for your mistakes. 
• When you complain, do so constructively.
• Set an example by confidently taking ownership for failures.
• Always focus on learning. 
• Reward people for making mistakes. 

But what about the system?. If we focus on primary care, I've started reading "La renovación de la atención primaria desde la consulta" . The first chapter explains that innovation should start from the doctor's office, stop complaining. Sounds excellent, however some of our difficulties are systemic and somebody has to fix them.
I really suggest you read it, because when you arrive at chapter 8 and 9 you'll have an overall assessment of the current situation. Don't miss the opportunity to have a look at them.

A new tax conundrum

The anouncement of a potential increase in VAT rate for health care products that currently are under the reduced tax rate, a shift from 10% to 21%, represents the third step in a dangerous growth spiral for health expenditure. From 2010, VAT rates have grown 3 pp (from 7 to 10% the reduced rate) and 5 pp (from 16 to 21%).  For public health expenditure, these changes represented an increase in 1,1% or 45 m euro. Right now, the new rate could replicate past events. You can check this information in this recent report. I couldn't find a similar one for private sector.
This is a nonsense. The publicly funded hospitals have to pay a VAT that goes to the government for the goods and services they acquire and they can't put a tax on the services they provide. The hospital resources to pay the tax comes from public funds (the citizens taxes). The result is that hospitals need more funds to pay for more taxes that come from the same body that receives them!
Some years ago, hospitals were asking for VAT rate of 0%, and we all know that this is difficult to achieve under EU rules. Surprisingly a "minor" change in legislation last november has allowed the construction industry for VAT rate of 0%. The final buyer has to pay for the standard VAT amount, but those involved in the process don't have to.
Why does the UK have a reduced tax of 5% or tax exemption in health and we can't apply the same? 

 Dramophone by Caravan Palace

The outcomes and the process in health policy

The tobacco ban in Spain: how it happened, a vision from inside the government

Politicians and high level officials often complain about the constraints of the political process. Once they have set up a clear goal, the outcome is subject to a process that it is out of their control. Rather than considering such fact as a failure, this is only a fact that sometimes may happen and others not. The case of tobacco legislation is an interesting political proces that you can check at the latest issue of Journal of Epidemiology and Community Health. Ildefonso Hernández, the former Director General de Salud Pública explains his experience with enacting a law that has had and it is still having strong impact on tobacco consumption and health.
If you want to have a whole picture of the political process in general, I would suggest you this recent book published by the World Bank: Understanding Policy Change. It covers all the critical issues of the political process. A must read for potential politicians and those to blame for policy and politics.

Squeezing the lemon

Now we know that 5% of population has paid one third of pharmaceutical copayments that  started six months ago (one euro per prescription). About 45 m € have been collected. Just now, when a court from outside says that we have to withdraw such a measure. The issue is not about copayment, that is really working as expected, it's about power, about who sets the rules.
From the begining I considered that was a controversial measure. However, my impression is that it's effects will last. The decline in consumption, number of prescriptions, is a historical achievement: 21% in six months!. The question is, has this lower consumption had an impact on health?, if not, we have a serious problem of not taken such a measure before. Nowadays we don't know wether there were fewer prescriptions or less medicines dispensed. This fact is crucial and requires further scrutiny.
Up to now, over six months the top 5% consuming population has paid 36 € per person, it seems a very reasonable amount. The lemon has been squeezed reasonably.

A musical break with Caravan Palace