Plausible stories about the future

Sustainable Health Systems - Visions, Strategies, Critical Uncertainties and Scenarios

Last week the "health output" of the Davos World Economic Forum was a report on Sustainable Health Systems - Visions, Strategies, Critical Uncertainties and Scenarios. A quick look at the document will show you that the future could lie only in three scenarios. This is an easy way to limit what may happen. A reduccionist perspective I would say. Anyway, you may agree or disagree after reading it. The three options would be:

• In Health Incorporated, the boundaries of the health industry are redefined. Corporations provide new products and services as markets liberalize, governments cut back on public services and a new sense of conditional solidarity emerges.
• In New Social Contract, governments are responsible for driving health system efficiency and for regulating organizations and individuals to pursue healthy living.
• In Super-empowered Individuals, citizens use an array of products and services to manage their own health. Meanwhile, corporations compete for this lucrative market and governments try to address the consequences.

Fortunately the future will be more complex, an organized chaos at best, evolving from what we already see right now.

PS. Horrendous stories about the past.

Pharma confidential

We have just entered a new world. A confidential pricing market has been created!.  A complete new pharmaceutical market that Adam Smith couldn't realise. It's not a joke, it is what an official answered yesterday to the press. The Ministry can't explain the prices of prescription medicines not funded by NHS because they are confidential. The journalist was asking about the price of 400 medicines that were delisted from public coverage last September and why pharmaceutical firms have increased its price thrice. Does this make any sense? Do we need such regulator? Maybe a vacation is the best option . Last April a new regulation introduced the notified price, this is a free price that has to be notified for prescription medicines not funded by NHS. However, notified price it is not confidential price. That's the reason why we have to ask for compliance with the law, just that. The Comision Interministerial de Precios has not published any administered price since last June, and notified prices are considered confidential by the Ministry oficials.

On predictive modeling

A better understanding of population morbidity allows to predict how such population will evolve. Currently there is an increasing interest on chronic care and a specific program has been set up. The potential tools available to define chronic populations have been presented and you can check them in this document.Although we do need more details, it is a first step in the right direction. However, I'm not so sure about the split of chronic care from integrated care. Why now?

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.