If you want to know what's going on in OECD countries on pharmaceuticals, just read this paper. The challenges are huge, and policy answers are delayed. My impression is that beyond the standard approach (the one in the paper), somebody should start talking about priorities for research and innovation according to health needs and potential benefit from recent advances in basic science. There is a need for a dialogue between firms and governments about it. Just a signaling game, saying how much are willing to pay for new innovations if they fit with health needs and potential benefit.
The estimates of impact of income on longevity are now available for US. And the results are clear. The summary of the article in 4 statements:
First, higher income was associated with greater longevity throughout the income distribution.The gap in life expectancy between the richest 1% and poorest 1% of individuals was 14.6years (95% CI, 14.4to 14.8years) for men and 10.1 years (95% CI,9.9 to 10.3 years) for women.
Second, inequality in life expectancy increased over time. Between 2001 and 2014, life expectancy increased by 2.34 years for men and 2.91 years for women in the top 5%of the income distribution, but by only 0.32 years for men and 0.04 years for women in the bottom 5%(P < .001 for the differences for both sexes).
Third, life expectancy for low-income individuals varied substantially across local areas. In the bottom income quartile, life expectancy differed by approximately 4.5 years between areas with the highest and lowest longevity.Changes in life expectancy between 2001 and 2014 ranged from gains of more than 4 years to losses of more than 2 years across areas.
Fourth, geographic differences in life expectancy for individuals in the lowest income quartile were significantly correlated with health behaviors such as smoking(r = −0.69,P < .001),but were not significantly correlated with access to medical care, physical environmental factors, income inequality, or labor market conditions. Life expectancy for low-income individuals was positively correlated with the local area fraction of immigrants (r = 0.72, P < .001), fraction of college graduates (r = 0.42, P < .001), and government expenditures (r = 0.57, P < .001).
Differences are huge. Confronting the issue from a policy perspective is not that easy. Individual health behaviors are the key to understand what's going on.
Last week, Theranos clinical lab has received more bad news. Though the final resolution is still pending, all available informations raise concerns about the acuracy of such lab.Could this happen in Europe? My feeling is that the outdated and obsolete regulation could replicate the story.
In Europe, in vitro diagnostics regulation was decided 18 years ago!. The last proposal debated two years ago in the Parliament got no final agreement. I have explained the inefficiency of european parliament formerly. Health care safety and quality deserves better regulation and specially in lab tests.
Beyond safety issues, the value of lab tests require deeper assessment. Current proposals are not taking into account properly this issue. Now is the moment to introduce it in the final proposal, otherwise it will forgotten for the next two decades.
Platform Scale(n): Business scale powered by the ability to leverage and orchestrate a global connected ecosystem of producers and consumers toward efficient value creation and exchange.
The new hype on business models is around platforms. Well, this is not new, a decade ago David Evans wrote Catalyst Code but its impact was limited. Now "Platform scale" and "Platform revolution" are the two required business books. If you want to understand the economic foundations go to "Platform Economics".
The topic requires more elaboration than a post in a blog. How this trend affects health care in practice remains to be seen.
The Platform Manifesto
1. The ecosystem is the new warehouse
2. The ecosystem is also the new supply chain
3. The network effect is the new driver for scale
4. Data is the new dollar
5. Community management is the new human resources management
6. Liquidity management is the new inventory control
7. Curation and reputation are the new quality control
8. User journeys are the new sales funnels
9. Distribution is the new destination
10. Behavior design is the new loyalty program
11. Data science is the new business process optimization
12. Social feedback is the new sales commission
13. Algorithms are the new decision makers
14. Real-time customization is the new market research
15. Plug-and-play is the new business development
16. The invisible hand is the new iron fist
Some economists, while watching the film Inside job, were astonished by Martin Feldstein statements and justifications of banks with toxic assets. I was one of them. Too many conflicts of interest sorrounded his words. When I saw him, I thought, this is the "health economist" that wrote: Economic Analysis for Health Service Efficiency: Econometric Studies of the British National Health Service. n 1967 (!). This was one of my first readings in health economics many-many years ago.
While I was reading the following paragraph in a new book, I thought that the topic deserved a deeper approach to economists' ethics:
The question of whether there is a profound tension between our professional norms and our self interest deserves careful attention. Conflict of interest in economics gained much (unwanted) attention after the documentary Inside Job accused some finance economists of doing analysis favorable to financial industry interests while receiving undisclosed pay from those same interests. Even if you believe, as I do, that Inside Job was unfair to some of its targets, it did fuel a crisis of confidence in economists that we all have a strong interest in correcting. The response has been to strengthen the norms that we disclose possible conflict of interests in our research and policy recommendations; this is surely a good thing. An example from my own field of development is that researchers on foreign aid should disclose whether they are employees of or consultants to agencies dispensing foreign aid (or conversely, recipients of funding from antiaid interests).
Yet the issue of conflict of interest is too complex to be so quickly dismissed by a simple disclosure requirement.
The case for economic ethics is simple and, we think, undeniable. Economists enjoy tremendous influence today over the life chances of others—innumerable others. That is the heart of the matter. The influence of economists arises from their expertise in a field vital to social wellbeing,
freedom, and other valued goals. As economists know better than anyone, when you monopolize a resource that others need, you exert power over them. Moreover, in recent years, economists’ influence has been amplified by institutional developments. Independent central banks, the multilateral development banks, and other international financial institutions are often in a position to set economic policy and even engage in social engineering without much oversight by elected officials or the public. Economists are at the helm of such institutions and occupy staff positions in the departments where the actual work gets done. Combined with its intellectual monopoly, institutional power enhances the ability of the economics profession to alter the course of human affairs—for the better, of course, but also, sometimes, for the worse.
...
Influence over the lives of others, which can be immense, coupled with the risk of doing even substantial foreseeable and unforeseeable harm, implies that economic practice is ethically fraught. And yet the profession largely manages to ignore the attending burdens. Perhaps because economists understand that harm is universal in economics, the Hippocratic tradition appears to offer no insight into how economists should comport themselves. What does “do no harm” mean in a world where there are no free lunches and where all actions (including doing nothing) entail tradeoffs? And perhaps because economists often paint on big canvases, where they affect the lives of thousands or even millions of people all at once rather than individual clients one by one, clinical ethics seems largely irrelevant. The scale of economic interventions generates among economists a fear that serious and open engagement with professional ethical issues would paralyze them with doubt in those moments of human need when what is called for instead is focused audacity.
This is a real call for action into an improvement of practices and behaviors of economists.
What goes first? An equitable health system or an efficient one?. You'll see in some textbooks this biased trade-off formulation.
A more appropriate question would be, “what is more important for a population, a health system that delivers equitable (fairly distributed) health outcomes or a health system that maximises health gains?” The difference between the meaningless first question (which does not contrast outcomes) and the potentially meaningful second question (which does contrast outcomes) is critical.
On a continuum of health gains and equity, possible goals of a health system include:
✯ Achieving the greatest health gains for a given input without regard to whether this means concentrating the gains in one (social) group: a traditional health outcomes focus,
✯ Achieving the fairest distribution of health for a given input without regard to the actual level of health achieved: a non-traditional outcome focus on (one form of) health equity, and
✯ Achieving an appropriate balance between the greatest health gains for a given input subject to the constraint of fairly distributing the health gains across social groups: an outcome balancing health equity and health gains
If finally there is a prioritisation on waiting lists, we would focus on the third option. Unfortunately I wrote a post 5 years ago on the same topic...and still waiting for its application.
PS. The trade off started with A. Okun 40 years ago, from a macroeconomics perspective. Have a look at the anniversary at Brookings.
PS. "Public health refers to all organized measures (whether public or
private) to prevent disease, promote health, and prolong life among the
population as a whole. Its activities aim to provide conditions in which
people can be healthy and focus on entire populations, not on
individual patients or diseases. Thus, public health is concerned with
the total system and not only the eradication of a particular disease." WHO dixit. Can you imagine asking citizens about a Public Health Survey?. The term doesn't make any sense. All over the world the common term is Health Survey if you want to ask people about their health perception, except in Catalonia. So weird, somebody should check it, maybe it's a mistake.
Two ideas from the philosopher Harry Frankfurt: (1) from a moral point of view, economic equality does not really matter very much, and (2) there is a misunderstanding of the relationship between treating people equally and treating them with respect.
Both ideas are covered in an new book. Some selected statements:
Economic equality is not, as such, of any particular moral importance; and by the same token, economic inequality is not in itself morally objectionable. From the point of view of morality, it is not important that everyone should have the same. What is morally important is that each should have enough. If everyone had enough money, it would be of no special or deliberate concern whether some people had more money than others. I shall call this alternative to egalitarianism the “doctrine of sufficiency”—that is, the doctrine that what is morally important with regard to money is that everyone should have enough.
Some philosophers believe that an equal distribution of certain valuable resources, just by virtue of being egalitarian, is a significant moral good. Others maintain that what actually is of moral importance is not that the resources be distributed equally but that everyone enjoy the same level of welfare. All of these philosophers agree that there is some type of equality that is morally valuable in itself, quite apart from whatever utility it may possess in supporting efforts to achieve other morally desirable goals.
It is easy to confuse being treated with the sort of respect in question with being treated equally. However, the two are not the same. I believe that the widespread tendency to exaggerate the moral importance of egalitarianism is due, at least in part, to a misunderstanding of the relationship between treating people equally and treating them with respect. The most fundamental difference between equality and respect has to do with focus and intent. With regard to any interesting parameter—whether it pertains to resources, welfare, opportunity, rights, consideration, concern, or whatever—equality is merely a matterof each person’s having the same as others. Respect is more personal. Treating a person with respect means, in the sense that is germane here, dealing with him exclusively on the basis of those aspects of his particular character or circumstances that are actually relevant to the issue at hand.
Demands for equality have a very different meaning in our lives than do demands for respect. Someone who insists that he be treated equally is calculating his demands on the basis of what other people have rather than on the basis of what will accord with the realities of his own condition and will most suitably provide for his own interests and needs. In his desire for equality, there is no affirmation by a person of himself. On the contrary, a concern for simply being equal to others leads people to define their goals in terms that are set by considerations other than the specific requirements of their own distinctive nature and of their own circumstances. It tends to distract them from recognizing their most authentic ambitions, which are those that derive from the character of their own lives, and not those that are imposed on them by the conditions in which others happen to live.
I found the reference while reading The New Rambler. You'll find there the critical view. Strongly recommended for those interested in this topic and specially those that reject demagogy on using this term.
