The successful recent trends in healthy life expectancy (3)

The Cost of an Additional Disability-Free Life Year for Older Americans: 1992–2005

We already know that the trend of healthy life expectancy is on the right track. If we all agree that under a universal coverage system, the aim should focus on being efficient and equitable at purchasing population health,  then a crucial question would be: how much does it cost an additional healthy life year?.
We do have such estimates for USA. A quite recent article says that the average discounted cost per additional disability-free life year is $71,000, assuming that half of the gains in healthy life expectancy were attributable to increases in spending.
Is this more or less than you would be willing to pay for it?. Recall how much we are spending per month of survival with cancer treatments. You can check it on p.254 of this article. As a society, currently we are paying from €562 (Erlotinib+Chemotherapy) up to €66,164 (Ipilimumab) for one month of additional survival and nobody cares about it. That's life!. Glups!

Where is value created in hospital mergers?

Hospitals, Market Share, and Consolidation

In the current wake of private hospital mergers, somebody should ask the right question. Where is value created?. If the goal is to reduce competition and create an environment close to a monopoly, than we can understand that market rivalry will decrease, prices will be higher, consumers will lose. In my opinion, the current mergers process shows signs of value destruction or value redistribution rather than value creation. Antitrust authority has been condescendent with the recent events and its resolution has forgotten the basics. Once you approve the merger, there is no way out, no easy reversal of a "quasi-monopoly" as it is the case of Barcelona private hospitals from today, that 64% of beds will belong to one firm.
Cutler and Morton published a JAMA article stating that something should be done to prevent such situations.

Antitrust authorities are examining these consolidated systems as they form, but broad conclusions are difficult to draw because typically the creation of a system will generate both benefit and harm and each set of facts will be different. Moreover, the remedies traditionally used (eg, blocking the transaction or requiring that the parties divest assets) by antitrust authorities in cases of net harm are limited. For this reason, local governments may want to introduce new policies that help ensure consumers gain protection in the event of consolidation, such as insurance products that charge consumers more for high-priced clinicians and health care centers, bundling payments to clinicians and health care organizations to eliminate the incentives of big institutions to simply provide more care, and establishing area-specific price or spending target

And their point is: local governments. Antitrust authorities are unable to understand the unique conditions of local competition. Unfortunately, local governments have no authority over such matters here. Meanwhile, the harm (to competition) has already been made.

PS. As far as the poor quality regulation is the norm in our current state, the only way out is to escape from this disordered world. To disconnect asap, there is no other option.

PS. If you want to know the answer to my today's question, have a look at this article: The Impact of Hospital Mergers on Treatment Intensity and Health Outcomes. You'll find strong reasons to be concerned:

The primary specification results indicate that mergers increase the use of bypass surgery and angioplasty by 3.7 percent and inpatient mortality by 1.7 percent above averages in the year 2000 for the average zip code. Isolating the competition mechanism mutes the treatment intensity result slightly, but more than doubles the merger exposure effect on inpatient mortality to an increase of 3.9 percent.The competition mechanism is associated with a sizeable increase in number of procedures.

PS. If Antitrust economics helps to support these processes, then somebody should rethink the theory and its application from scratch.

Cartier-Bresson. Rome Exhibition. Must see.

The successful recent trends in healthy life expectancy (2)

Health at a Glance: Europe 2014

A new european health report by OECD has been released. It includes key data and information regarding how health systems are performing and citizen's health. Some days ago I was highlighting the successful achievement in healthy life expectancy in our country (as a temporal trend). Now we can compare these data with other countries and we can see that we are at the top 10 of EU-28.
Data can raise many comments. If you want to know the big change in health expenditure, look at p. 121. In 2000-2009 european expenditure growth rate was 4.7%, in 2009-2012 is -0.6%. In our specific case is still less. Now is the moment to remember those that some years ago said that health expenditure would never collapse because there were some factors (technology and ageing,...) beyond the control of decision makers.
In summary, we can confirm that healthy life expectancy has increased and resources have shrunk. That's all folks (up to now).

PS. On cross-fertilization between health economics and management.

 

Norman Rockwell. Rome exhibition. Must see.

How much does it cost (a drug)?

Once again you can check the cost of developing a new drug ($2.6 billion in years 1995-2007), a jump in real terms of 145% from its former 2003 estimate $802m. These figures were widely criticised. And now as you may imagine this is again a huge nonsense. The Economist and Forbes joke about this numbers and my view is even more sceptical.
I'm still waiting for an estimate of new drugs costs adjusted by value. Unless somebody is able to provide such a figure, I will avoid analysing in detail any cost accounting exercise.

Risky lifestyle regulation, what's new?

Regulating Lifestyle Risks The EU, Alcohol, Tobacco and Unhealthy Diets

Since we all agree that lifestyles affect health, then more evidence is needed on what to do and how to do it. Fortunately, a new book summarises the state of the art on regulating lifestyles. Selected sentences from two selected chapters 14 and 15:
Nudging healthier lifestyles: Informing the non-communicable diseases agenda with behavioural insights
by Alberto Alemanno

In sum, most behavioural insights consist of ‘mechanisms rather than law-like generalizations’.66 For purposes of policy, it would therefore be valuable to have a better understanding of how the major findings of behavioural research apply within heterogeneous groups. Unfortunately, due to methodological and empirical complexity, current variety of behavioural studies.71 A number of different types of studies are possible, such as (a) experiments, (b) randomized controlled trials (RCTs) and (c) surveys. 

Using outcome regulation to contend with lifestyle risks in Europe Tobacco, unhealthy diets, and alcohol
by Stephen d. Sugarman

In conclusion, outcome regulation offers a new way to deal with lifestyle risks – risks that people now take but at a deep level want reduced. That is, mature peoplemostly do not want to smoke or get drunk or eat unhealthily. They have been enticed into doing so in substantial part because of marketing efforts by sellers of these products who have created social norms in support of their consumption. People also drink, smoke, and eat the wrong things because they provide short-termpleasure, even if they also bring with them long-term serious harms.

There are some debatable conclusions, however this book is a required reading for any health regulator.

PS, NYT article on mediterranean diet, original in BMJ..

The opportunity cost of delay in applying HTA

Some weeks ago I attended the meeting of the Spanish Health Techonology Assessment Association. The presentations and communications highlighted the current status on economic evaluation, and to be honest, an uncertain application and usefulness for public policy in our country. The reason?. There is a fear, a deep fear, that economic evaluation could guide some coverage decisions. Since this represents a reduction of discretionary powers, politicians prefer the status quo. Any change that represents an introduction of health technology assessment will reduce the degrees of freedom in their decisions. Is this fair for society? I would like somebody to calculate the opportunity cost for such a delay.

PS. I suggest you have a look at Sculpher, Peiró and Culyer presentations. My presentation was about stratified medicine, and J. Pons about the state of the art in HTA.

PS. Tomorrow, Conference at Fundació Grifols: Personal and collective determinants of health ailments, Whose responsibility is it?. Determinantes personales y colectivos de los problemas de salud, ¿de quién es la responsabilidad? I'll give a speech in the first session.

The successful recent trends in healthy life expectancy

Esperança de vida, lliure de discapacitat i en bona salut a Catalunya

If there is one measure to monitor continously in welfare policy, this is the case for healthy life expectancy. If somebody wants to track wether citizens, clinicians, health managers, politicians, firms, etc... are contributing to better life in the health arena, then this is the aggregate measure. If somebody were able to establish the right incentives for achieving the best benchmark, this would be great. Kindig suggested long time ago that "purchasing population health" should be valued according to healthy life expectancy.
Fortunately, new data about recent trends has been published and we can confirm that has increased over a period of 7 years, between 2005 and 2012 from 63 to 65.7 years for men and from 60.6 years  to 66.1 for women . In women the proportion of years lived in good health has gone up by 5 percentage points, from 72 to 77 % in men and has increased only one point from 81 to 82 %. In any case, in marginal and in absolute terms there is a substantial improvement . Nobody would have been able to foresee changes of this magnitude.
Some months ago I showed in this blog an alternative measure, the morbidity-adjusted life expectancy.  An alternative construct that allows easier geographic and temporal comparisons.
We are on the right track, contrary to those that thought with the crisis and cutbacks things would worsen. As you know and I have explained many times, there are lot of areas for improvement and we have not to reduce our effort to mantain this successful trend.

PS. My congratulations to the authors of the report. Excellent and helpful work.