20 de maig 2014
16 de maig 2014
Boards' oversight of quality
Hospital Board Oversight of Quality and Patient Safety: A Narrative Review and Synthesis of Recent Empirical Research
Usually we focus our debate more on cost than on quality. As far as cost measurement is easier, we are able to comment, critise the level of expenditures, wether it is low or high. Concerns about quality and safety should be up in the agenda.And in recent years there has been relevant efforts in this direction. However, since there is no aggregated measure on quality, we have to enter into specific details and justifications.
The determinants of quality and safety are diverse. However, if we look at the top of the organization, board of trustees implication is crucial. Unfortunately, this is not always the case, they are more prone to discuss bugets and investments.
At Milbank you'll find a review on how hospital boards that take care of quality and safety issues have better results:
Usually we focus our debate more on cost than on quality. As far as cost measurement is easier, we are able to comment, critise the level of expenditures, wether it is low or high. Concerns about quality and safety should be up in the agenda.And in recent years there has been relevant efforts in this direction. However, since there is no aggregated measure on quality, we have to enter into specific details and justifications.
The determinants of quality and safety are diverse. However, if we look at the top of the organization, board of trustees implication is crucial. Unfortunately, this is not always the case, they are more prone to discuss bugets and investments.
At Milbank you'll find a review on how hospital boards that take care of quality and safety issues have better results:
Recent empirical studies linking board composition and processes with patient outcomes have found clear differences between high- and lowperforming hospitals, highlighting the importance of strong and committed leadership that prioritizes quality and safety and sets clear and measurable goals for improvement. Effective oversight is also associated with well-informed and skilled board members. External factors (such as regulatory regimes and the publication of performance data) might also have a role in influencing boards, but detailed empirical work on these is scant.Is there anybody nearby boosting such role for boards?
15 de maig 2014
Inequality in the winner-take-all society (2)
The message of the former post was partial. It didn't raise suggestions for improvement in our unequal world. Fortunately, today's op-ed from Shiller adds some fresh air. He retrieves his book The New Financial Order: Risk in the 21st Century written a decade ago and proposes a new tool:
PS A year after Snowden leakage on how privacy has been systematically circumvented, check its impact in this report.
Inequality insurance would require governments to establish very long-term plans to make income-tax rates automatically higher for high-income people in the future if inequality worsens significantly, with no change in taxes otherwise. I called it inequality insurance because, like any insurance policy, it addresses risks beforehand.This is only one of the six proposals that he develops in such an interesting book.The idea maybe good, the implementation is for sure uncertain. Govenments should commit to efficient redistribution approaches (although up to now I haven't seen them). And beyond this, the constraint again is the same as yesterday: global coordination on tax pressure and on inequality insurance design.
PS A year after Snowden leakage on how privacy has been systematically circumvented, check its impact in this report.
14 de maig 2014
Inequality in the winner-take-all society
A recent op-ed by Joseph Stiglitz on "Innovation enigma" brought me to retrieve a book of 1995 by Robert H. Frank, "The Winner-Take-All Society: Why the Few at the Top Get So Much More Than the Rest of Us". Nowadays, the issue of raising inequality is on headlines, and often it is considered as a consequence of economic crisis.
Frank argued two decades years ago that more and more the current economy and other institutions are moving toward a state where very few winners take very much, while the rest are left with little. He attributes this, in part, to the modern structure of markets and technology. It was written before the impact of internet on business and it was a clear alert about what has happened.
Now Thomas Piketty in his book "Capital in the 21st century" argues additionally that when the rate of capital accumulation grows faster than the economy, then inequality increases. And inequality is not an accident but rather a feature of capitalism that can be reversed only through state intervention. The book thus argues that unless capitalism is reformed, the very democratic order will be threatened.
If you combine both perspectives, you must be convinced that it is not only an issue of state intervention, I can't imagine certain parts of global markets ("winner-take-all" ) being abolished or reformed without a global government. That's why I'm not sure about the size of the current threat and when it will explode.
Stiglitz adds an uncertain landscape for innovation, and therefore for future dynamic efficiency of markets (Shumpeter style).
Taking all these pieces together, there is no clear recommendation. Today I just want to state again that correlation is not causation. Inequality and crisis are a contemporary fact, though the trend goes back a long way and it is very much deeper. Avoiding reductionist perspectives is my first suggestion.
PS. Since the implications of wealth inequality and health are huge as I explained in this post, my today comment maybe adds more shades instead of light.
PS. "Health inequalities result from social inequalities. Action on health inequalities requires action across all the social determinants of health." The Marmot Review: Fair Society Healthy Lives
PS. If you want to know why Messi's salary has increased this week, have a look at Frank's book, the answer is there.
Frank argued two decades years ago that more and more the current economy and other institutions are moving toward a state where very few winners take very much, while the rest are left with little. He attributes this, in part, to the modern structure of markets and technology. It was written before the impact of internet on business and it was a clear alert about what has happened.
Now Thomas Piketty in his book "Capital in the 21st century" argues additionally that when the rate of capital accumulation grows faster than the economy, then inequality increases. And inequality is not an accident but rather a feature of capitalism that can be reversed only through state intervention. The book thus argues that unless capitalism is reformed, the very democratic order will be threatened.
If you combine both perspectives, you must be convinced that it is not only an issue of state intervention, I can't imagine certain parts of global markets ("winner-take-all" ) being abolished or reformed without a global government. That's why I'm not sure about the size of the current threat and when it will explode.
Stiglitz adds an uncertain landscape for innovation, and therefore for future dynamic efficiency of markets (Shumpeter style).
Taking all these pieces together, there is no clear recommendation. Today I just want to state again that correlation is not causation. Inequality and crisis are a contemporary fact, though the trend goes back a long way and it is very much deeper. Avoiding reductionist perspectives is my first suggestion.
PS. Since the implications of wealth inequality and health are huge as I explained in this post, my today comment maybe adds more shades instead of light.
PS. "Health inequalities result from social inequalities. Action on health inequalities requires action across all the social determinants of health." The Marmot Review: Fair Society Healthy Lives
PS. If you want to know why Messi's salary has increased this week, have a look at Frank's book, the answer is there.
12 de maig 2014
Predictive modeling in health care
Predicting Patients with High Risk of Becoming High-Cost Healthcare Users in Ontario (Canada)
Predicción del riesgo individual de alto coste sanitario para la identificación de pacientes crónicos complejos
Two articles appear on the same topic, published at the same time, in Canada and Catalonia (I am coauthor of the latter). The results of both studies are similar. Their goal is to identify those patients that will belong to the highest spenders next year.
Canada results:
I suggest you have a look at them, predictive modeling is one of the main current topics of health services research. Some people consider that it is under the umbrella of Big Data, although it was born before such a term was created.
PS. A must read. Bob Evans, and The Undisciplined Economist: Waste, Economists and American Healthcare
PS. In memoriam: Gary S. Becker, 1930-2014. The Becker-Posner blog is terminated.
Predicción del riesgo individual de alto coste sanitario para la identificación de pacientes crónicos complejos
Two articles appear on the same topic, published at the same time, in Canada and Catalonia (I am coauthor of the latter). The results of both studies are similar. Their goal is to identify those patients that will belong to the highest spenders next year.
Canada results:
If the top 5% patients at risk of becoming HCUs are followed, the achieved sensitivity and specificity is 42.2% and 97%, respectively. These values suggest very reasonable predictive power, indicating that the model picks up 42.2% of all high-cost healthcare users and correctly identifies 97% of those who are not high users.Catalonia results:
En el modelo, todas las variables fueron estadísticamente significativas excepto el sexo. Se obtuvo una sensibilidad del 48,4% (intervalo de confianza [IC]: 46,9%-49,8%), una especificidad del 97,2% (IC: 97,0%-97,3%), un VPP del 46,5% (IC: 45,0%-47,9%) y un AUC de 0,897 (IC: 0,892-0,902).The models are slightly different, while the results are close.
I suggest you have a look at them, predictive modeling is one of the main current topics of health services research. Some people consider that it is under the umbrella of Big Data, although it was born before such a term was created.
PS. A must read. Bob Evans, and The Undisciplined Economist: Waste, Economists and American Healthcare
PS. In memoriam: Gary S. Becker, 1930-2014. The Becker-Posner blog is terminated.
09 de maig 2014
The forthcoming systemic drug industry?
While reading WSJ this week I found that big changes are happening in the pharmaceutical industry. We all know that the former message was: if the industry business model is broken, the best is to manage its decline (John Kay FT dixit). I also explained such trend in this post. Consultants predicted 5 alternative strategies, now the 6th is in place.
The trend is focused towards a new industry structure after the failure of the two parts model: innovative and generic. WSJ says:
Such a level of market concentration should lead to competition policy concerns, since the rivalry is not at industry level, it is at therapeutic group level. Unfortunately regulators are on vacation again. Maybe one day we will complain about a systemic industry that some of its parts may collapse and creates larger risks than returns, but it will be too late.
PS .Def: Systemic risk can be defined as the likelihood and degree of negative consequences to the larger body. With respect to federal financial regulation, the systemic risk of a financial institution is the likelihood and the degree that the institution's activities will negatively affect the larger economy such that unusual and extreme federal intervention would be required to ameliorate the effects
PS. Pharma megamergers, do they work?
PS. Reinhardt, as clear as ever in his blog: Congress and the Belief That Human Life Is Priceless
The trend is focused towards a new industry structure after the failure of the two parts model: innovative and generic. WSJ says:
A wave of mergers and acquisitions is reshaping the global pharmaceutical industry. Many drug companies are narrowing their focus, dropping out of noncore businesses and bulking up where they have the size and expertise to generate significant sales growth.
The deals would leave fewer competitors with larger revenue streams in each segment of the drug business, from prescription medicines and vaccines to drugs for livestock and pets.After the failure of the standard innovative model throught patents, the alternative is to concentrate on rare diseases, and on highly profitable market segments -low volume and high profit-. Concentration is taking place also in commoditizated markets (generics).
Such a level of market concentration should lead to competition policy concerns, since the rivalry is not at industry level, it is at therapeutic group level. Unfortunately regulators are on vacation again. Maybe one day we will complain about a systemic industry that some of its parts may collapse and creates larger risks than returns, but it will be too late.
PS .Def: Systemic risk can be defined as the likelihood and degree of negative consequences to the larger body. With respect to federal financial regulation, the systemic risk of a financial institution is the likelihood and the degree that the institution's activities will negatively affect the larger economy such that unusual and extreme federal intervention would be required to ameliorate the effects
PS. Pharma megamergers, do they work?
PS. Reinhardt, as clear as ever in his blog: Congress and the Belief That Human Life Is Priceless
08 de maig 2014
Facts and data
Balanç de l’atenció mèdica i sanitària públiques del 2013
- The impact of the decree that changes the health system towards a Social Security-based (April 2012) is: 3,4% citizens are not covered (216.900). However, the government has decided to introduce an exception and all continues as it was in the former National Health System. (That's rule of law! an example of articulated institutions)
- Primary care visits have decreased again in 2013: 5,17% (!) (7 million visits less than in 2008)
- Emergency visits, a decrease of 1%
- Specialty visits, an increase of 2,9%
- Inpatient care, no change -0,2%
- Ambulatory surgery, an increase of 3%
- Electronic drug prescriptions, 91% of coverage
- Satisfaction level: 8,06, better than 2008 (7,43)
- Health expenditure over GDP 8,3% (2011). A 0,3 pp increase on public and private expenditure over GDP since 2008. Public expenditure 5,6%, Private expenditure 2,7% over GDP (2011).
More details in the report.
- The impact of the decree that changes the health system towards a Social Security-based (April 2012) is: 3,4% citizens are not covered (216.900). However, the government has decided to introduce an exception and all continues as it was in the former National Health System. (That's rule of law! an example of articulated institutions)
- Primary care visits have decreased again in 2013: 5,17% (!) (7 million visits less than in 2008)
- Emergency visits, a decrease of 1%
- Specialty visits, an increase of 2,9%
- Inpatient care, no change -0,2%
- Ambulatory surgery, an increase of 3%
- Electronic drug prescriptions, 91% of coverage
- Satisfaction level: 8,06, better than 2008 (7,43)
- Health expenditure over GDP 8,3% (2011). A 0,3 pp increase on public and private expenditure over GDP since 2008. Public expenditure 5,6%, Private expenditure 2,7% over GDP (2011).
More details in the report.
Subscriure's a:
Missatges (Atom)