Morbidity adjusted life-expectancy

OBTENCIÓN DE LA ESPERANZA DE VIDA Y DESCOMPOSICIÓN EN ESTADOS DE SALUD A PARTIR DE INFORMACIÓN CLÍNICA

I have always considered that any estimate of healthy life expectancy that is build upon many assumptions and coefficients in the end it is difficult to understand. The global burden of disease and its use of DALYs is an extraordinary effort, though if you dig into the results you'll find methological difficulties.
An alternative to such estimates is just to show how the burden of mordibity is distributed across lifetimes. That is precisely what we have presented at the last Health Economics Conference. I believe that such estimation is a promising way to present population life expectancy and health. As far as this is the first attempt, there is still room for improvement.

Healthy and satisfied

Enquesta de salut de Catalunya

Latest data from the 2013 Health Survey shows that 81,1% of the population consider themselves as healthy, slightly better that in 2010 that was 79,3%. Regarding satisfaction, 86,9% of population is satisfied with public health services, again better than 2010 that was 84,7%. Though in 2012 results were a little bit better.
In the details of the results you'll find that obesity and overweight is the biggest issue to address in my opinion. There is still a lot to do on tobacco and alcohol, but data shows some improvement.
This health survey should be broadcast in the media and efforts to promote healthy behaviours should raise. Unfortunately nowadays media is focused on negative messages and this issue lies far from journalists' interests.

Positive and negative risk cultures

Risk Savvy

While reading The Guardian I find out that Nudge theories could fall from the mainstream.:

Though nudge-economics remains seductive, what once seemed like a panacea has come to look a bit more like a series of sticking plasters. Earlier this year the nudge unit was removed from direct government control, partly sold to the Nesta innovation charity run by New Labour guru Geoff Mulgan, a move which seemed to suggest the prime minister no longer viewed it as quite so central to his philosophy. That move has coincided with a backlash, or at least a critical analysis, of some of the tenets on which its brand of behavioural economics is based.

You already know from this blog I have devoted many posts to it. And I've said many times that its application is still in its beginings. However, if you look at the new book by Gerd Gigerenzer "Risk Savvy", maybe the perspective could be otherwise. He examines Kahneman works and gives a different view. The issue of two systems of the brain, A and B, when taking decisions is under criticism. He defends heuristics that in some sense use both when taking some difficult decisions.
His work goes beyond such criticism and it is an additional perspective on how we take decisions and the role of risk and uncertainty.
He considers that health sector is dominated by a negative risk culture, a way of doing that tries to hide errors and in such situations learning is much more difficult. On the other end of the spectrum are "positive error cultures that make error transparent, encorage good errors and learn from bad errors to create a safer environment". This is the case of commercial aviation. From his view, the use of check lists and safety measures should be boosted in many settings to improve efficiency.
Gigerenzer work is a good recommendation for summer reading. Wether he is able to convince you more than Kahneman, it's uncertain right now.

Big data, big opportunity

Learning from Big Health Care Data

Big Data is more than a buzzword, it raises high expectations about how the massive treatment of data may deliver new results. At NEJM you'll find an article that explains general implications for health care:

Two key “learning” applications of big health care data that hold the promise of improving patient care are the generation of new knowledge about the effectiveness of treatments and the prediction of outcomes. Both these functions exceed the bounds of most computer applications currently used in health care, which tend to offer physicians such tools as context-sensitive warning messages, reminders, suggestions for economical prescribing, and results of mandated quality-improvement activities

At JEP, you'll find an article by Hal Varian that shows the new challenges for econometrics:

Conventional statistical and econometric techniques such as regression often work well, but there are issues unique to big datasets that may require different tools. First, the sheer size of the data involved may require more powerful data manipulation tools. Second, we may have more potential predictors than appropriate for estimation, so we need to do some kind of variable selection. Third, large datasets may allow for more flexible relationships than simple linear models.

All in all, you'll be convinced that it is more than a buzzword.

PS. You may find an example of application of big data in our recent article in Gaceta Sanitaria.

Who sets the health policy agenda?

Making Health Policy

From this book:

In relation to policy making, the term agenda means: the list of subjects or problems to which government officials and people outside of government closely associated with those officials, are paying some serious attention at any given time . Out of the set of all conceivable subjects or problems to which officials could be paying attention, they do in fact seriously attend to some rather than others.

The crucial issue is who sets the policy agenda, how and why. Two main sources appear as agenda-setting: government and mass media-social networks. There are of course, additional groups and lobbyists that can influence such a process.
Nowadays we could consider that the recession and cutbacks has created a window of opportunity for some to discuss many foundations of our health system. In such a situation, the worst position is the delay on setting the list of topics to be addressed by the government, otherwise non-elected bodies try to mobilise efforts and decisions towards their interests that add to those of the opposition. Therefore, if you are interested on the basics of agenda-setting, have a look at chapter 4 and ask yourself who is in control of it. Are you comfortable with the answer?. If not, something should be done.

Sooner than later

Snake Oil: How Fracking’s False Promise of Plenty Imperils Our Future

Health Impact Assessment of Shale Gas Extraction - Workshop Summary

Applying a Health Lens to Decision Making in Non-Health Sectors - Workshop Summary

Some months ago I suggested a look at PINSAP, the governmental plan to relate health with policy decisions beyond health care and public health. I considered it a real challenge and we have to follow closely what it may deliver. Right now a new pressure on politicians is arising regarding shale gas extraction. Hydrofracturing has wide environmental impacts. Health impact is less known, and this is the reason why IOM released a study last year on that. It says:

The governmental public health system lacks critical information about environmental health impacts of these technologies and is limited in its ability to address concerns raised by federal, state, and local regulators, as well as employees in the shale gas extraction industry and the general public.

If this is so, why hhas the US allowed such extractions?. I suggest you have a look at the book: Snake Oil: How Fracking’s False Promise of Plenty Imperils Our Future,  though it is focused on environmental impact, it provides a clear understanding of the technology and its enormous implications.
If we have to apply health lens to decision making in non-health sectors, this is a clear example for rejecting a technology of tremendous consequences. There are sound reasons to stop such developments sooner than later.

Current expenditure patterns

While looking at the changing economic landscape, you may achieve the conclusion that current trends have never been considered as an option in any forecast. Take for example the total anual expenditure per person. In 2008 it was 13.152€, in 2013 it was 11.710€ (current values, without taking into account CPI). A reduction of 10,9% since the begining of the recession. However, the change in one year (2012-2013) is really high in some categories, people are spending more on pharmaceutical products (9,2%) and less in medical services (-9,8%) (p.4).
If you want to look at individual voluntary health insurance, before the recession the per capita expenditure was 132€ (1.218m€/7,364 m population, 2008) while in 2012 was 137€ (1.445m€/7,571m population), an increase of 5€ . These are the official statistical data.