THCB

Categories

Above the Fold

HOSPITALS: The transparency debate

• 21

Here’s my editorial from today’s issue of Fiercehealthcare:

We’ve been hearing a great deal about price transparency in health care. California has a new law mandating that hospitals release their chargemaster billing data. The Administration’s advisors are demanding that hospitals and doctors reveal pricing, and one health plan (Aetna) has revealed its negotiated rates with physicians in one market (Cincinnati, OH). The theory is that pricing transparency will increase competition and make it easier for consumers to shop around. Proponents point to the reduction in the advertised price of LASIK surgery as an example of what might happen.

Speaking before Congress, Paul Ginsburg sounded several warnings about this trend. First, health care is in no way prepared to deliver pricing information. Several studies have shown that hospitals and physician groups do not know their costs or prices per service, and hence there is wide variation in what, if anything, they can tell consumers. Secondly, most health care is purchased not by consumers directly but by insurers. Ginsburg gave evidence that where contracted rates of insurers are exposed by regulation, prices tend to rise. Thirdly, there’s still little agreement on what we should be pricing. Each service? Each episode? Care per month? All care per year? Finally, apparently in the LASIK market, there’s less transparency than meets the eye, so to speak, and advertised low prices are in some respects come-ons like those cheap air-fares that aren’t really available. Transparency in health care is needed, but we need to think carefully what that really means in practice.

BLOGS: Health Wonk Review up at Kate’s

Damn. Health Wonk Review is up at Healthy Policy and I didn’t even notice till late PST. But young punkette Kate Steadman did a great job.

By the way, the punkette is still in Kansas City but is intending to move to DC to get a policy job. Having run many research projects with equally keen but, shall we say, less intuitive, young talent, I’d reccomend that any research shop looking for fresh meat snap her up PDQ.

PHYSICIANS: Docs believing in God, not as many as you’d think

• 4

I’m the ultimate American outcast in that I’m an atheist (or as we’re known now secular humanist), who thinks that (as one old friend put it) "all religions from the Bhagwan Rajneesh to the Unitarians are only interested in putting their hand in your pocket".

But I accept that makes me pretty unusual in America where roughly 90% of the population reliably polls as believing in God  (although I’d fit in OK in Sweden and most of Europe).

God

What I fund pretty interesting was a survey that came out last summer but was just featured in Forbes. The authors seem to be all excited that they found that American physicians were likely to believe in God and have it influence their daily lives. That’s because they were comparing physicians to scientists, who have very low rates of religious belief.

But what I found interesting was that only 76% of physicians said that they believed in God. If we take that to include a wide meaning of "God", that means that in their beliefs about religion, physicians look more like Europeans than Americans.

But I have no idea what conclusions to draw from that for the health system.

POLICY: Pat Salber says we should change policy on food availability

• 2

Pretty scary stuff from Pat Salber over at Peertrainer: The Doctor Weighs in on The epidemic of childhood obesity.

It is estimated that boys born in the US in the year 2000 have a 30% chance of developing Type 2 diabetes during their lifetime; girls have a 40 percent chance. Think of that: 1 in 3 boys and close to half of girls who are now in kindergarten will become diabetic at some point in their lives. 

Pat is right. If you’ve seen SuperSize Me or read Fast Food Nation you just know that we are with food where we were with smoking in the early 1960s. It’s going to be a 30–50 year battle, but in the end the forces that will have to pay the costs of obesity will gang up on the big food vendors and producers. It will remain a private choice, but one that is increasingly difficult to get to due to limits on access and social opprobrium. And the obvious place to start, as Arnie knows, is in the school cafeteria and with commercials. After all we know the commercials work, or they wouldn’t be on TV!

I did see this most amusing article a while back that showed that watching violence on TV didn’t make anyone violent, but watching food made 36% of the viewers want to eat.  I know it’s true! I personally am in the middle of one of my violent diets. I have taken a month off-booze, off-cards, off-sugar and off-meat three times since January 2005, and gone seriously onto working out at the gym. The good news is that I’m back snowboarding with no problems and have lost around 30 pounds. The bad news is that any restaurant or food commercial is making me ravenous! And boy do I miss my chocolate milk!

INTERNATIONAL: Exactly what care does a pregnant woman need? with UPDATE

• 1

Lynn Payer wrote a great book a while back called Medicine and Culture. I remember that Americans were put on medication if their blood pressure was too high, and Germans were put on medication if their blood pressure was too low. Here’s an amazing example of differences in medical treatment between the UK and Germany for the same “condition” — normal pregnancy. Be sure to read the comments!

NHS Blog Doctor: Vaginal examinations in pregnancy

 I asked a leading UK ObGyn with whom I’ve had a life long relationship what he thought. Here are my dad’s comments:

I agree entirely with Dr Crippen, vaginal examinations in pregnancy require a proper indication. apart from that there is no indication for performing vaginal ultrasound after about 13 weeks as abdominal u/s gives more information. About the only indications for v/e in pregnancy are to give an assessment of pelvic size in late pregnancy if the head does not engage in a primigravida (prior to xray pelvimetry if elective c/s for disproportion is contemplated) or to assess the state of the cervix if labour (in your language, labor!) is to be induced. In early pregnancy the only indication I would accept is in the investigation of vaginal infection (discharge). If there is any doubt as to the progress of early pregnancy, either diagnosis or possible missed abortion then vaginal u/s is indicated.

POLICY: I think Borowitz has got it

From the always good but sometimes brilliant The Borowitz Report. This one finally explains the point of Medicare Part D.

U.S. CONFUSES INSURGENTS WITH PRESCRIPTION DRUG PLANMilitary Launches ‘Operation Incomprehensible Program’ Across IraqIn an effort to confuse Iraqi insurgents, the Pentagon announced today that the U.S. had begun bombarding insurgent positions with copies of President Bush’s Medicare prescription drug plan.At a press briefing at the Pentagon, Secretary of Defense Donald Rumsfeld said that the idea of confusing the insurgents with the President’s Medicare plan was hatched last week, after Mr. Bush appeared at a series of town hall meetings at which seniors in his audience seemed thoroughly bewildered by the intricate new program.“We realized, if this prescription drug plan is that confusing in English, imagine how incoherent it would seem once it was translated into Arabic,” Secretary Rumsfeld said.As soon as Pentagon planners seized upon the idea of using the
President’s plan to confuse the insurgents, Operation Incomprehensible
Program was launched.

According to Secretary Rumsfeld, U.S. warplanes pounded insurgent
positions in the citiers of Tikrit and Najaf with copies of the
prescription drug plan in the early morning hours of Monday.
Mr. Rumsfeld said that satellite photos of those positions have
been encouraging thus far, showing dozens of Iraqi insurgents reading
the prescription drug plan and scratching their heads.
The Defense Secretary said he was hopeful that Operation
Incomprehensible Program would leave the Iraqi insurgents totally
baffled, but he hinted that the Pentagon had other tactics up its
sleeve: “We are fully prepared to bombard them with copies of my press
briefings.”

PHARMA: Still decent growth on a pretty big number

• 1

Pharma companies (or their investors) may be all depressed wishing that the good old days of fat pipelines and long patent protection windows were still here. But now and again it’s worth considering how big Big Pharma actually is. And, as  IMS health reports, it’s big. And it’s not just here in the US anymore (although this remains the biggest and most profitable market).

IMS Health (NYSE: RX), the world’s leading provider of market intelligence to the pharmaceutical and healthcare industries, today announced that 2005 total global pharmaceutical sales grew 7 percent at constant exchange rates, to $602 billion. In the ten major markets, audited growth was 5.7 percent in 2005, compared with 7.2 percent the previous year.

SNIP

In 2005, North America, which accounts for 47 percent of global pharmaceutical sales, grew 5.2 percent, to $265.7 billion, while Europe experienced somewhat higher growth of 7.1 percent, to $169.5 billion. Sales in Latin America grew an exceptional 18.5 percent to $24 billion, while Asia Pacific (outside of Japan) and Africa grew 11 percent to $46.4 billion. Japan, the world’s second largest market, which has historically posted slower growth rates, performed strongly in 2005, growing 6.8 percent to $60.3 billion, its highest year-over-year growth since 1991.

So consider that worldwide pharma spending now slightly exceeds the biggest chunk of US health spending (hospital care @ $588 billion).

PHARMA: Brandweek on Pfizer, Pharmacia, HGH and Rost

• 1

It’s all going down on Brandweek’s site — a much longer look at what THCB touched on a few weeks back. You’ll have to login to get the full story, though. (The link is now direct). Suffice it to say that Rost will be getting his hearing soon as he’s now filed suit in court. Meanwhile (having read Rost’s side of the story) if you want to follow The Veteran’s advice and get yourself a career as a whistleblower, better make sure that you get a remote email account and don’t use your work computer or work phone.

assetto corsa mods