Category: Uncategorized

Stats Can’t Explain Everything; The Anecdote Remains Relevant

Jun 16, 2008• 3

By MAGGIE MAHAR

Lately, I’ve been thinking about the difference between stories and stats — those hard and fast numbers that give us “objective” information about everything from the body politic to the human body.

Social scientists like data, perhaps because it makes social science seem more “scientific.” They like to square things off and measure them. They like to count: How many? How much? What do the polls say? Percentages are impressive.

Try to tell a story, however, and a purist will remind you that “the plural of data is not anecdote.”

But what some social scientists (and some physicians) forget is that statistics measure only what can be counted. Many of the things that are most important, in medicine as in life, are immeasurable. Stories are valuable because they can capture some of the messiness of reality, including the ambiguities and contradictions that make both human experience and the human mind/body just beyond comprehension. (Since we have only the mind with which to understand the mind, ultimately investigation must end in a stand-off.)

What do Johnny Cash and employer-based health care have in common?

Jun 16, 2008• 2

By Robert Laszewski

OK, maybe it’s a stretch but bear with me.

I heard a senior exec from a big health plan say the other day that it’s hard to believe we will ever see the end of health insurance distributed primarily through the workplace in favor of an individual-based health insurance system. In fact, much of the health insurance industry is lining up behind staying with the system we know best and the one who has been our customer all these years–the employer.

That is understandable. As someone who came up through the ranks looking at the employer as the customer and individual health insurance as a minor product subset I have the same reaction.

But I will tell you that this idea of moving away from third-party employer pay and to a system of individual responsibility — or moving from defined benefit health insurance to defined contribution health insurance — has been coming on us for some time now.

Health costs are small businesses’ No. 1 problem

Jun 15, 2008• 3

By Jane Sarasohn-Kahn

The cost of health insurance is the No. 1 problem cited by small business owners. Health costs beat gas prices — the No. 2 most severe problem cited by small business, in a March 2008 survey.

This week, small business leaders convened at the annual National Small Business Summit conference of the National Federation of Independent Business (NFIB).

The report notes the downturn in the economy during the second half of 2007 when the NFIB Small Business Optimism Index dropped to 94.6 in December, the lowest since 2001.

Obama’s Rx for Change

Jun 13, 2008• 4

By Matthew Holt

Clinton has quit, Obama has three times McCain’s resources, and the country is fed up with the Republicans’ war, corruption and toadying to corporations. Democrats have won three "safe" Republican house seats
in recent months. It’s their election to lose, and assuming that the
fences between rivals really are mended, it might be a landslide.

I’ve written previously that I don’t think Obama is serious about pursuing health care reform. But this week he changed his tune and said categorically that by the end of his first term, there would be universal healthcare.

In an Obama administration, we’ll lower premiums
by up to $2,500 for a typical family per year. And we’ll do it by
….covering every single American and making sure that they can take
their health care with them if they lose their job…..We’ll do it by
the end of my first term as President of the United States……

Read the rest at Spot-On and return here to comment.

And the Voters Demand. . . Electronic Medical Records?

Jun 13, 2008• 3

By CRAIG STOLTZ

Over half of Americans think the next U.S. President should support. . .access to electronic medical records.

Compared to gas prices, the economy and the war in Iraq, this is, needless to say, a fairly minor issue. Even within the issue of healthcare reform, access to EMRs, as digital medical records are known, it’s small potatoes.

Yet a survey released by Kaiser-Permanente at the Information Therapy Conference in Washington shows that a majority of Americans agreed that providing people with online access to their own medical records should be a "top priority" for the next US President.

It’s tough to say what this data point really might mean. But my guess is it suggests people are frustrated by the mess of papers and records that make patienthood so difficult these days. Whether federal support for a nationwide program is the only or wisest solution to this problem is another question, of course.

It’s a Greene world at Ix!

Jun 13, 2008• 1

Here are three Greenes. Left to right Jeff (MedEncentive), Sarah (NY Times), Alan (DrGreene.com)

Kaiser, Blues of Mass….health plans & consumers online

Jun 13, 2008• 1

Kaiser Permanente put out a new survey updating one they did last year which says that more and more people are going online, and now a sizable minority had a preference for doctors using an EMR. (It’s not clear whether they’ll yet change a doctor based on that). It does seem that they’re more likely to expect it and want it from their health plan — 61% wanted EHR’s to come from their health plan. (Here’s the PDF of of the survey, which has lots of extra information for you nerds). But here’s probably the key results

Q. If two doctors had exactly the same qualifications, but one used an electronic record system and the other did not, which ONE would you choose? (ROTATE) The doctor using an electronic record system 47%The doctor NOT using an electronic record system 29%Don’t know/Unsure (Volunteered) 22% Q If two health insurance companies had exactly the same qualifications, but one provided their members with access to an electronic record system and the other did not, which ONE would you choose? (ROTATE)

The one using an electronic record system 60%The one NOT using an electronic record system 25% Don’t know/Unsure (Volunteered) 14%

So Kaiser Permanente has not only created its own health record via its big Epic project, but it’s decided to at least pilot with Microsoft HealthVault. (See a little more and some controversy about that here). And some other health plans are starting to notice.

Today, the big news is that BCBS Massachusetts has decided that it too needs to dive into this. They’ve decided to make their consumers records interoperable with Google Health by the end of the year.

So are Kaiser and BCBS Mass outliers, or are they first trickle of a torrent?

Denials, denials!

Jun 13, 2008

By Matthew Holt

Health minister “denies she is crazy”. OK she’s Australian, so take that with a grain of salt.

What’s the fuss about? Using more allied professionals to replace primary care docs. Apparently that’s not certifiable, even in Australia.

Managing obesity, Japanese style

Jun 13, 2008• 11

By Matthew Holt

So after making cracks about Strength through Joy last week, it appears that plans to change the health of the nation are happening. Not here of course, but the NY Times tells us about Japan:

Under a national law that came into effect two months ago, companies and local governments must now measure the waistlines of Japanese people between the ages of 40 and 74 as part of their annual checkups. That represents more than 56 million waistlines, or about 44 percent of the entire population.

Those exceeding government limits — 33.5 inches for men and 35.4 inches for women, which are identical to thresholds established in 2005 for Japan by the International Diabetes Federation as an easy guideline for identifying health risks — and having a weight-related ailment will be given dieting guidance if after three months they do not lose weight. If necessary, those people will be steered toward further re-education after six more months.

To reach its goals of shrinking the overweight population by 10 percent over the next four years and 25 percent over the next seven years, the government will impose financial penalties on companies and local governments that fail to meet specific targets. The country’s Ministry of Health argues that the campaign will keep the spread of diseases like diabetes and strokes in check.

SNIP

Companies like Matsushita must measure the waistlines of at least 80 percent of their employees. Furthermore, they must get 10 percent of those deemed metabolic to lose weight by 2012, and 25 percent of them to lose weight by 2015.

NEC, Japan’s largest maker of personal computers, said that if it failed to meet its targets, it could incur as much as $19 million in penalties. The company has decided to nip metabo in the bud by starting to measure the waistlines of all its employees over 30 years old and by sponsoring metabo education days for the employees’ families.

Sounds like fairly vicious pay for performance to me!

Do worker wellness programs violate employee privacy?

Jun 13, 2008• 6

By Jane Sarasohn-Kahn

Employees are split on whether employer wellness programs intrude on privacy, according to an Issue Brief from the Center for Studying Health System Change (CSHC).

The report details the results of interviews conducted in 2007 in 12 metropolitan American communities: Boston, Cleveland, Greenville, Indianapolis, Lansing, Little Rock, Miami, northern New Jersey, Orange County, Phoenix, Seattle, and Syracuse.

Employee wellness programs are growing in the marketplace as employers try to stem ever-increasing costs, both direct and indirect. This is real money: a report from the American Hospital Association estimated that three chronic diseases — asthma, diabetes and hypertension — accounted for 164 million days of absenteeism each year which cost cost employers $30 billion.