Tag: "health care quality"

5 Myths about Cancer Care

PIC2In this month’s Health Affairs, leading health economists Dana P. Goldman and Tomas Philipson challenge five myths about cancer care. To the right we have an infographic that explains them very clearly.

The most economically interesting one is the fourth. This appears to challenge the notion that we should be skeptical about paying high prices for therapies that might buy only a short time of good life. (In health-economics, we use terms like Quality-Adjusted Life Year [QALY] and Disability-Adjusted Life Expectancy [DALE].)

The classic approach to these calculations was illustrated by Professor Christopher Conover in a recent article:

…[M]ost of the gains were concentrated in the 35-64 age group, which narrows the plausible range of what the average gain in life expectancy might be. Someone who is 60-64 is 7.3 times as likely to die in a given year as someone age 35-39. The reason this matters is that there are reasonably well-accepted rules of thumb about the value of what’s called a quality-adjusted life year (QALY).

Half of Doctors Give Obamacare D or F

Confident DoctorsThe Physicians Foundation and Merritt Hawkins (a physician recruiting firm) have just published their biennial physicians’ survey. The survey interviews over twenty thousand physicians in all fifty states and multiple specialties:

  • Only 19 percent say they have time to see more patients.
  • 44 percent plan to take steps to reduce services or find non-clinical employment.
  • Only 35 percent describe themselves as “independent practice owners,” down from 62 percent in 2008.
  • 53 percent describe themselves as hospital or medical-group employees, up from 38 percent in 2008.

Paying Doctors for Performance Does Not Work

Aaron Caroll, in the New York Times:

doctor-xray-2“Pay for performance” is one of those slogans that seem to upset no one. To most people it’s a no-brainer that we should pay for quality and not quantity.

In Britain, a program was begun over a decade ago that would pay general practitioners up to 25 percent of their income in bonuses if they met certain benchmarks in the management of chronic diseases. The program made no difference at all in physician practice or patient outcomes, and this was with a much larger financial incentive than most programs in the United States offer.

States Spent $7.7 Billion on Prisoners’ Heath Care in 2011

GOV065A new report from the Pew Charitable Trusts reports that 41 states experienced growth in their correctional health care spending from fiscal 2007-2011, with a median increase of 13%. Further:

…state spending on prisoner health care increased from fiscal 2007 to 2011, but began trending downward from its peak in 2009. Nationwide, prison health care spending totaled $7.7 billion in fiscal 2011, down from a peak of $8.2 billion in fiscal 2009. In a majority of states, correctional health care spending and per-inmate health care spending peaked before fiscal 2011. But a steadily aging prison population is a primary challenge that threatens to drive costs back up. The share of older inmates rose in all but two of the 42 states that submitted prisoner age data. States where older inmates represented a relatively large share of the total prisoner population tended to incur higher per-inmate health care spending.

Hits and Misses

yogaPractice does not make perfect; meditation does.

Two-thirds of uninsured young adults find health coverage unaffordable; nearly half do not see the value of health insurance.

New study: Cat people are smarter than dog people.

“Walking school buses” being used to combat obesity.

Random thoughts don’t necessarily provide valuable insights.

Health Wonk Review: Certain aspects of ObamaCare might be leading to unintended outcomes that improve medical care.

Hits and Misses

utyutruyMaryland hospital employees reduced infection errors by washing hands 90 percent of the time.

It will cost $240 million to fix five states’ failing ObamaCare exchanges.

One in five Americans is now dependent on Medicaid.

Big fat surprise: Government crusade against fat might have increased obesity.

Diagnostic breakthrough: Doctors identify disease-causing bacterium by sequencing DNA strands in patient’s spinal fluid.

After having burnt through $30 billion subsidizing providers’ electronic health records, the Office of the National Coordinator of Health IT wants to become a regulator.

Hits and Misses

Scale with tape measure bowThe post-2008 recession is associated with increasing obesity in rich nations.

The actual waiting time for an appointment at Phoenix VA hospital was 115 days – 91 days longer than falsely reported.

Samsung’s new watch has medical sensors that scan below the skin and read data deep inside veins.

Stanford University doctors are using iPhones to photograph the inside of the eye.

Federal grants to states for health care increased 34 percent, 2008-2014. Grants for everything else dropped.

No kidding! States that accepted ObamaCare’s Medicaid expansion face unanticipated health expenses.

Is ObamaCare Junk Insurance, Especially For Low-Income Americans?

Many of ObamaCare’s advocates believe that the proportion of a household’s income spent on health care is an appropriate measure of how effective health insurance is at doing its job. If a household spends ten percent or more of income on health care, it is said to be “underinsured” by the Commonwealth Fund or the Kaiser Family Foundation. Five percent is the cut-off for low-income households.

According to that standard, ObamaCare fails miserably at insuring low-income households:

In Washington, one in four individuals in households earning less than 250% of the poverty level signed up for a bronze plan with a deductible of $5,000-$6,350 per person and $10,000-$12,700 per family. Even after premiums, these households could face medical costs ranging from 17% to 40% of income before ObamaCare’s non-preventative-care benefits kick in.

Beyond the premium subsidies that the law provides, households earning up to 250% of the poverty level qualify for cost-sharing assistance. It can greatly reduce the deductible that must be exhausted before benefits kick in and, after that, the co-payments required for medical services and prescription drugs. But those cost-sharing subsidies are available only for those who buy silver-level coverage…

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Source:Investor’s Business Daily.

Patient Power Works: Significant Savings for Employers and Beneficiaries

We previously discussed the executive summary of CIGNA’s 8th annual Choice Fund experience study, which reports outcomes from 2.6 million beneficiaries of CIGNA’s consumer-driven employer-based health plans (that is, plans which are paired with a Health Savings Account or Health Reimbursement Arrangement). CIGNA has just released a much more detailed presentation of the results.

The presentation clarifies that the improved outcomes control for health status. That is, they compare “apples to apples”, and the results are not due to healthier people choosing consumer-driven plans and sicker people staying in traditional plans. Newly shared outcomes include:

  • Choice Fund customers increase their compliance with recommended care in the second year, even more than in the first year;
  • They improve their health-risk status by six percent;
  • Medical cost trend goes down 12 percent versus traditional plans;
  • The improvement persists over time, up to $7.900 savings by fifth year;
  • The improvement occurs in low-risk, medium-risk, and high-risk patients; and
  • Because employers contribute to HSAs and HRAs, employees spend less money out of pocket than peers in traditional plans!

Some New Medicines are Approved More Quickly than Others

Joe DiMasi of the Tufts Center for the Study of Drug Development, and colleagues, have reviewed the time it takes for the FDA to review different types of new drugs.

seniors-and-prescriptionsFDA’s Neurology division, which approves drugs for Alzheimer’s disease, multiple sclerosis, Parkinson’s disease, and stroke, takes three times as long to approve drugs as the Oncology division. These differences cannot be explained by differences workload, the type and complexity of the drugs reviewed, or the safety of the drugs approved.

If the FDA could cut the performance gap between the divisions in half, the authors estimate that the cost of developing a new drug would decrease by $46 million — a savings that adds up to approximately $874 million per year.

Full report available from the Manhattan Institute.