Tag: Policy

NICE job. Cost-effectiveness in the UK

Aug 5, 2008• 18

By Matthew Holt

Yesterday I went to a high powered lunch put on by HealthTech, with a high powered crowd attending (including the head of the California Dept of Managed Health Care, lots of Kaiser Permanente people, Arnie Milstein from Mercer, et al).

The speaker was Andrew Dillon, the head of the National Institute for Clinical Excellence (NICE), the UK’s technology assessment agency. But unlike the late and somewhat lamented Congressional OTA that the Republicans killed in 1995, NICE has teeth. NICE is only well known in the US as being the agency that stops new wonderful treatments getting to blighted Brits who are instead left to die in the streets.

The way this works, as Dillon explained to the somewhat incredulous head of the California Dept of Managed Healthcare (and I paraphrase) was that if NICE says something’s off limits (such as a new drug) a doctor won’t prescribe it. And if they did, the pharmacy wouldn’t fill it. And if they tried to, well they wouldn’t find it because the hospital wouldn’t have bought it. Such power! And I’m sure the envy of the many regulators and payers in the room.

However, Dillon explained that contrary to popular belief there isn’t a straight cut off point for approving new technologies.

Creating Currency to Care For the Elderly

Aug 1, 2008• 9

By MAGGIE MAHAR

Did you know that Japan has found an ingenious way to “create” money that can be used to care for the elderly?

Bernard Lietaer, author of Access to Human Wealth: Money beyond Greed and Scarcity (Access Books, 2003) describes the system in this interview with Ravi Dykema, publisher and editor of Nexus, a leading Holistic journal.

Lietaer begins with the basics, by explaining what money is: “I define money, or currency, as an agreement within a community to use something as a medium of exchange. It’s therefore not a thing, it’s only an agreement – like a marriage, like a business deal…And most of the time, it’s done unconsciously. Nobody’s polled about whether you want to use dollars. We’re living in this money world like fish in water, taking it completely for granted.”

Lietaer, who co-designed and implemented the convergence mechanism to the single European currency system (the Euro), and served as president of the Electronic Payment System in his native Belgium, doesn’t take currencies for granted. He knows that a dollar is simply a piece of paper (which is no longer backed by gold). It has value because we have agreed that it has value.

The result of the primary care crisis

Jul 29, 2008• 11

By Matthew Holt

Over at Spot-on I’m writing about the primary care crisis in partial response to the great stuff from Bob Wachter last week on THCB and also from Maggie Mahar and Brian Klepper. Hopefully, it’s a primer for the politico types over there about the primary care crisis and also what the likely results of it are. Hint, no pay equality, but more retail clinics and online visits.

Meanwhile, my piece at Spot-on two weeks back about the Two Ted Kennedy’s appears rather smarter than it probably was given the long piece in the NY Times today about exactly how risky his surgery was and exactly the level of agreement (i.e. not much) that existed among the wide medical team he convened. Evidence based medicine? Well let’s just say that the oft heard rumors of Medicare’s impending bankruptcy may be truer than I tend to believe if every patient wants that level of service.

At any rate, please take a look at the new piece and the older piece and as ever come back here to comment.

Ask any health care wonk and they’ll tell you that within the larger
health care crisis is a primary care crisis. There is more and more
demand for primary care physicians – the person you probably call your
"family doctor" – but America’s medical schools are producing fewer of
them.

Why? Well in a word, money.

It’s not actually medical school that’s the problem. It’s what happens next. A newly graduated physician, looking a big chunk of debt used to pay for medical school tuition gets to chose their residency and, as such, decides what type of doctor to become.In the U.S. we let medical students choose what to do. Not being dummies, most of them notice that diagnostic radiologists and orthopedic surgeons make three times what primary care doctors make, and choose their career path accordingly. Why the vast difference in compensation? Doing something to a patient – fixing a broken hip, reading an x-ray – has always been better rewarded more than talking to them about their high blood pressure or their son’s excema.

Read the rest.

Friday frolicks in Nawlins

Jul 25, 2008• 4

By Matthew Holt

I’m in New Orleans taking the day off (shhh…wife is sleeping, don’t wake her yet!). Yesterday I gave a talk about Health 2.0 to a very confused looking group of state legislators at the National Conference of State Legislators.

But what was really confusing was the exhibit hall. There was a complete dogs breakfast of interest groups there. The NRA across from the Brady campaign to ban handguns; There were 4 or 5 variations of the humane society, and PETA had 2 booths, one explicitly about cruelty to elephants in circuses, and Barnum & Bailey/Ringling Bros also had a booth (presumably to try to stop legislators caring about cruelty to elephants). The oil & gas industry was next to a big booth of plug-in electric cars. All the right-wing think tanks (Cato, Heartland et al) were spread around, while the lefties (ACLU, Planned Parenthood, People for the American Way) were all sequestered in a ghetto. There were the correctional guys, the taser sellers, and about 4 booths selling ways to put alcohol breath locks on cars. Plus a bunch of companies selling micro-targeting marketing software—all used for targeting voters….not to forget the nudists—their trade association (who knew? or should that be, who nude?) was there and gave me a “naked-nation” pin. Not sure where I was supposed to pin it!

And of course the health care people were all there. Who knew that there are two different masseuse associations (with booths dead opposite each other), and of course the lab guys, the NPs, etc, etc were all there too. There was a mobile optometrists truck put on by an vision care insurer (VPS) which goes to under-served areas giving free eye exams and glasses.

Medicare Could Pave the Way for National Reform

Jul 25, 2008• 8

By MAGGIE MAHAR

Thanks the unbridled rise in health care prices, Medicare is going broke. As I mentioned in a recent post, four years ago the Medicare trust fund that pays for hospital stays started to run out of money. In 2004 the fund began paying out more than it takes in through payroll taxes.

Since then, the balance in the fund, combined with interest income on that balance, has kept the fund solvent. But in just 11 years, it will be exhausted,” the Medicare Payment Commission reported in its March. “Revenues from payroll taxes collected in that year will cover only 79 percent of projected benefit expenditures.” And each year after 2019, the shortfall will grow larger.

Make no mistake: this is not an example of an inefficient government program spending hand-over-fist without caring whether it is getting a bang for the taxpayer’s buck. As I discussed in that earlier post, health care prices have been climbing—without a concomitant improvement in patient outcomes or patient satisfaction—in the private sector as well.

Medicare Reform Could Pave the Way for National Reform

Before trying to roll out national health insurance, the next administration needs to address the structural problems that undermine the laissez-faire chaos that we euphemistically refer to as our health care “system.” Otherwise, we run the risk of winding up with a larger version of the dysfunctional, unsustainable system that we have today. Ideally, the administration should make Medicare reform a demonstration project for high quality, affordable universal coverage.

California kids may face triple whammy, leading to more uninsured

Jul 24, 2008• 4

By Sarah Arnquist

After years of seeing decreasing numbers of uninsured children, California is poised to go the other direction.

For years, child enrollment in private health insurance plans decreased as companies scaled back on health care costs by increasing employees’ share of the premiums or by stopping dependent coverage altogether.

But those declines were offset by increased enrollment in public programs. Recognizing that half the uninsured children already qualified for Medi-Cal (California’s version of Medicaid), and Healthy families (the
state’s SCHIP program), school districts and advocates focused efforts on finding and enrolling those children.

But now, things aren’t looking so rosy. State and county budgets constraints threaten to erode the children’s enrollment gains in
Medi-Cal, Healthy Families and Healthy
Kids programs, county-organized health plans.

"Come next spring, you could have a double or triple whammy of kids
losing health coverage," said Joel Diringer, a consultant who helped
many California counties create the local programs.

Obama health plan, silliness

Jul 23, 2008• 16

By Matthew Holt

Enter David Cutler. Result is more silly meaningless numbers

<sigh>

It is truly worrying when the single most sensible quote in the whole damn article comes from AEI’s Joe Antos.

How is this worth the NY Times’ attention? And what happens when the Obama bill comes up in Congress and somehow there isn’t a $2,500 check to be mailed to each household?

I thought this guy was going to treat us like grown-ups. After 8 years of insanity that would be nice.

If Cutler, who doesn’t exactly strike me as a major league populist, thinks that Obama has to “find a way to talk to people in a way they understand” how about he steers him to talk more about some insurance reforms that are both possible and very understandable. Like stopping this.

Cost containment is the missing link in Obama’s health plan

Jul 23, 2008• 2

By Robert Laszewski

Barack Obama’s health care plan follows the Democratic template—an emphasis on dramatically and quickly increasing the number of people who have health insurance by spending significant money upfront.

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The Obama campaign estimates his health care reform plan will cost between $50 and $65 billion a year when fully phased in. He assumes that it will be paid from savings in the system and from discontinuing the Bush tax cuts for those making more than $250,000 per year.

That the Obama health care reform plan would cost between $50 and $65 billion a year is highly doubtful. Obama claimed his plan was nearly identical to Hillary Clinton’s and her plan was projected by her to cost more than $100 billion a year.

Determination of need rule only goes partway

Jul 21, 2008• 1

By Charlie Baker

Charlie Baker is the president and CEO of Harvard Pilgrim Health
Care, Inc., a nonprofit health plan that covers more than 1 million New
Englanders. Baker blogs regularly at Let’s Talk Health Care.

I usually spend some time throughout the year visiting with accounts, physicians, hospitals, and brokers (among others), just to hear what’s up and what’s going on. Earlier this week, I was out visiting the leadership at a community hospital in Massachusetts, and asked them if they appreciated the MA Department of Public Health’s (DPH) decision to require academic medical centers to prove they weren’t duplicating existing clinical services in the community when they opened new operations in the suburbs around Boston.

For the uninitiated, this issue has been percolating in Massachusetts for the past couple of years, as a number of well known teaching hospitals have broken ground on some pretty big outpatient facilities in the suburbs around Boston. The service suite in these places varies, but it’s basically day surgery, cancer treatment, cardiac care, high-end radiology, and assorted other high-margin outpatient services that many community hospitals in Massachusetts argue they were already doing, and may now lose to these new facilities.

Governors saddled with health costs

Jul 18, 2008• 7

By Jane Sarasohn-Kahn

The National Governors Association (NGA) met in Philadelphia this week, where my City of Brotherly and Sisterly Love is witnessing some sobering discussions about health care.

On the one hand, Bill Clinton called in his opening keynote speech for the states to be laboratories of democracy.

But how much health-democracy can each governor afford when balancing their budget in the face of declining revenues? According to the NGA’s 2008 Fiscal Survey of the States, not a whole lot.