This article points to a significant opportunity to leverage tele-health technologies to help manage patients with chronic diseases.

Along those lines, the Chronic Care Model (“CCM”) is a robust, proven mechanism to improve outcomes for patients with chronic care illnesses.

I’ve developed a proposal for a technology-rich platform to enhance and extend the CCM through the use of patient-controlled mobile phones. We call this “mCCM”. mCCM is envisioned as a platform to facilitate patient self-management when dealing with chronic conditions.

Tele-health systems are sometimes designed from a technological perspective. OpenPHI proposes to use an existing care model (CCM) as the core and then to wrap the most effective mobile technology elements around the patient’s point of view.

See http://www.openphi.com/files/OpenPHI_Mobile_Chronic_Care_Model.pdf for the full proposal.

Comments welcome.

[/]

= = = = =

http://content.healthaffairs.org/cgi/content/abstract/hlthaff.2009.0474

Health Affairs, doi: 10.1377/hlthaff.2009.0474
(Published online February 18, 2010)
(c) 2010 by Project HOPE

Chronic Conditions Account For Rise In Medicare Spending From 1987 To 2006

Kenneth E. Thorpe1,*, Lydia L. Ogden2 and Katya Galactionova3

1 Kenneth E. Thorpe (kthorpe{at}sph.emory.edu) is the Robert W. Woodruff Professor and Chair of the Department of Health Policy and Management, Rollins School of Public Health, Emory University, in Atlanta, Georgia.
2 Lydia L. Ogden is on assignment from the Centers for Disease Control and Prevention and is currently chief of staff for the Center for Entitlement Reform and a doctoral candidate in health services research and health policy at the Rollins School of Public Health.
3 Katya Galactionova is a research analyst at the Department of Health Policy and Management, Rollins School of Public Health.

*Corresponding author

Medicare beneficiaries’ medical needs, and where beneficiaries undergo treatment, have changed dramatically over the past two decades. Twenty years ago, most spending growth was linked to intensive inpatient (hospital) services, chiefly for heart disease. Recently, much of the growth has been attributable to chronic conditions such as diabetes, arthritis, hypertension, and kidney disease. These conditions are chiefly treated not in hospitals but in outpatient settings and by patients at home with prescription drugs. Health reform must address changed health needs through evidence-based community prevention, care coordination, and support for patient self-management.

Key Words: Medicare – Health Spending – Chronic Care – Health Reform

Full text freely available at http://content.healthaffairs.org/cgi/content/full/hlthaff.2009.0474v1

Slowing the rise in health spending is among the nation’s top health policy priorities. Absent policy change, the Congressional Budget Office (CBO) estimates that Medicare spending will grow at an average of 7 percent each year from 2010 to 2018, rising to $879 billion annually and 4 percent of gross domestic product (GDP). The rate of growth of Medicare spending over the long term is predicted to exceed the rate of growth in federal revenues and the overall economy. As a result, much academic and political attention has focused on reforming Medicare as imperative for restraining spending increases.

Many Medicare reform proposals designed to slow the growth in spending would redirect costs from the government to others, such as enrollees and participating providers. The slowdown would be accomplished by reducing provider payments, increasing the age of Medicare eligibility, implementing means testing for Medicare, restricting coverage as with the Part D “doughnut hole,” and increasing copayments and deductibles. These approaches are unlikely to produce long-term reductions because they fail to address the key factors driving the rise in health care spending overall and in Medicare spending, particularly for chronic diseases. Understanding these facts is essential to reaching the right policy solutions.

Common approaches to tracking trends in health spending analyze changes in use (who is seeking care and for what), payment source (who pays), and provider (who gets paid). Analyses also examine trends in the inputs used to treat patients, such as rising rates of diagnostic imaging and treatment duration and intensity, as well as changes in the definition of treatable disease and targeted patient populations for medication therapy.

But cost-trend analysis by itself provides little insight into the ultimate causes of spending increases or the clinical characteristics of patients driving the rise in spending. And factors underlying the rise in treatment duration and intensity are not well understood across disease states.

We examined the changing clinical characteristics of Medicare patients that account for the rise in spending over the past twenty years, analyzing changes in the prevalence of treated disease, condition-specific spending, and sources of treatment in 1987, 1997, and 2006.

Much of the recent growth in spending among Medicare beneficiaries is attributable to rising spending on chronic conditions -specifically, diabetes and hypertension, both of which rose considerably in treated prevalence over the past two decades. Channels of spending for the most prevalent conditions have changed, too, with more spending for care provided in outpatient settings and for prescription drug therapy and less for inpatient care.

Our analysis did not disaggregate the component increases in spending that result from factors such as expanded treatment guidelines or innovative medical technology and therapies. Instead, we focused on changes in disease prevalence, changes in spending by disease, and changes in treatment locations as three important aspects of overall health outlays. Understanding these disease and care trends is critical to ensuring that health reform policy levers address the real drivers of current and anticipated health spending.

The use of Health IT systems, by the very nature of their intended use, has life-and-death implications. And healthcare-related information has a lifespan of dozens of years: you may not need to open that business-related spreadsheet again in the next 40 days, but as a 40-plus adult I still need access to my childhood vaccination records.

We should all be concerned if massive amounts of our tax dollars are wasted in proprietary software packages that are unsupported a few years from now (due to mergers, acquisitions, bankruptcy, etc.). It’s also worrisome if large numbers of patients’ medical information is locked in proprietary formats that become unreadable in 10 years.

It’s bad enough when the vendors of proprietary business software change their file format solely to force you to upgrade because they need a new revenue stream. But do we rally want these obnoxious business practices to control our future access to our family’s health information?

Therefore, buyers of health IT should demand that vendors:
* provide the source code of their software packages
* disclose their proprietary data formats
* provide tools to export data from the vendors’ system to industry-standard formats

[/]

http://huffpostfund.org/stories/2010/01/shopping-health-software-some-doctors-get-buyer%E2%80%99s-remorse

Shopping for Health Software, Some Doctors Get Buyer’s Remorse
By Emma Schwartz

Huffington Post Investigative Fund
Created 2010-01-29 16:55

Volatile Industry Prompts Calls for Oversight of Firms’ Financial Strength

Robert Cameron wasn’t much of a technology buff, but the orthopedic surgeon knew he wanted to get rid of all the paper in his nine-physician practice in Pensacola, Fla. So he bought an electronic medical records system from a California-based company called Acermed.

Cameron’s group spent more than $400,000 on the software, but the system still never fully worked and even confused patients’ scheduled visits, according to a lawsuit the doctors filed against the technology company in 2006. Acermed filed for bankruptcy in September 2007, complicating the doctors’ attempts to recover their expenses.

The effort to go digital “was a disaster,” Cameron says now.

Computerizing American medical records within five years is a key goal of federal health policymakers, who have committed to dispense billions of dollars in stimulus money to doctors and hospitals that make the transition in the coming years. Although the dispute between the Florida doctors and Acermed is an extreme example of what can go wrong during a move to digital systems, it highlights some of the challenges for individual medical practices making the conversion.

“This is a very volatile industry,” said Steven Lazarus, president of consulting company Boundary Information Group. “Any product doctors buy could be bought or changed within two years.”

Federal officials hope that electronic medical records will help lower costs and improve health care quality. And while they acknowledge that the effort will be difficult, they say that any hurdles along the way will pay off through savings to the health care system and improved quality of care.

But there’s also concern that the government may not be doing enough to ensure that taxpayer money isn’t wasted on faulty systems.

What’s more, doctors often have little expertise in buying electronic health records, commonly called EHRs, and do not always know what questions to ask or what protections they should push for in their contracts, several industry consultants said in interviews.

“I’ve seen physicians buy EHRs where they’ve spent less time buying them than their house and car,” said Margret Amatayakul, a prominent health care information technology consultant, who has studied the market for more than 10 years.

In a marketplace full of eager sellers of technology -and some with limited track records- “there’s a lot of risk,” she said.

Hundreds of companies -big and small, new and old- sell health information technology but industry analysts expect a wave of consolidation in the market, creating uncertainty that certain products will stay in the marketplace or even if some vendors will survive. Amatayakul said she found that up to 70 percent of vendors moved in and out of the market in some years, through mergers, acquisitions or on occasion, bankruptcy.

Congress did not address the possibility that federal incentives could be spent on products from companies with shaky finances when it wrote the stimulus law setting aside billions of dollars for electronic health records.

But as government officials write the rules for distributing the stimulus money, there have been renewed calls for oversight. During testimony before a congressionally mandated advisory committee last summer, Sheldon Razin, chairman of Quality Systems, a large electronic medical record vendor, urged officials to “consider a review of company financials to include long-term viability,” according to his presentation document.

“We just think it’s an important issue that the government needs to consider,” said Steven Plochocki, who works with Razin as chief executive of Quality Systems. “Government can’t guarantee people will stay in business, but we think it’s an important element.”

The federal committee did not suggest any consideration of financial viability in their recommendations to David Blumenthal, national coordinator for health information technology. Paul Egerman, who chaired the group that heard Razin’s comments, acknowledged that financial viability was a concern, but said that the group was swayed by the recent experience of the financial industry.

“We had a fear that there’s a greater risk to hospitals and doctors from organizations that are too big than ones that are too small,” Egerman said. “We wanted to make it possible for innovation.” He said the committee believed that the centers the government plans to set up around the country to aid doctors in their purchases would include help on how to better evaluate companies’ financials.

Officials from another advisory group, the National Committee on Vital and Health Statistics, disagreed in a May report to Blumenthal.

“We’re starting a very exciting process that could change the landscape of health care, but the thing that will stop it quickly is if the doctors feel that they don’t have some good direction,” said Harry Reynolds, chair of the committee and a vice president with Blue Shield Blue Cross of North Carolina. “You’ve got to make sure that there’s a clear definition of viability.”

Although Blumenthal’s unit has no plans to review company financials at this time, it “will continue to examine the issue”, said Nicholas Papas, a spokesman for the Department of Health and Human Services.  “This is a complex matter,” he said.

Bankrupt Vendors

The Bush administration first set the goal of putting most Americans’ medical records online by 2015. By 2006, the industry had begun to receive some oversight through the Certification Commission for Healthcare Information Technology (CCHIT), a nonprofit organization contracted by the government to certify electronic health records.

The commission reviews whether companies’ products meet the operating standards they promise. It does not evaluate the firms’ financial viability, although since 2008 it has asked companies to voluntarily disclose their number of customers and how long they have been in business.

Mark Leavitt, chair of the certification commission, said evaluating the financial stability of a company poses many challenges. For example, he noted, even a big, financially successful company could decide to discontinue a software system that didn’t pan out. And merely certifying the firm’s financial strength could give doctors “a very misleading sense of security” about the future of the product they bought, he said.

Still, some doctors have complained that their practices have been hurt after purchasing certified software from a vendor that later went bankrupt.

Canada-based MedcomSoft, which received certification in 2006, declared bankruptcy two and a half years later. The year before, MedcomSoft began installing its software for some members of the 1,200-doctor Independent Physicians Network in Wisconsin. The company also agreed to build a database of the network’s patients and provide maintenance, but failed to do so, according to a 2008 lawsuit filed by the physicians’ group. That forced the doctors to pay outsiders to keep their system going, they alleged in court documents.

Four months after the doctors filed suit in November 2008, MedcomSoft’s attorney filed a motion to withdraw representation, stating that it appeared “neither Medcomsoft nor its parent corporation has any employees, officers, or directors.”

Not every client fared as the Wisconsin group did. Megan Peterson, a manager with medical billing company PBF Online, the Johnstown, Pa., company that bought Medcomsoft out of bankruptcy, said the successor firm had retained 85 percent of the original customers. “We’re a strong stable company and will continue to be that for our clients,” she said.

Nevertheless, the executive director of the Wisconsin physician network, Michael Repka, said: “It’s going to be considerable time and labor for [medical] practices that are going to switch to a new system.”

In another case, a Florida-based company, Dr. Notes, went bankrupt in 2007 after 57 liens were filed against the company, according to a tally by the South Florida Business Journal. Some doctors alleged they were locked out of their medical records or left saddled with hundreds of thousands of dollars in loan payments on hardware despite being promised by the company they would recoup the costs.

South Carolina-based First Choice Healthcare was one such company, which in 2005, won a $1.5-million judgment against Dr. Notes in state court. Since then, the health care provider has only collected $100,000, the company’s lawyer Andrew Schwartz.

“The doctors are left holding the bag,” Schwartz said.

A Fight Over Source Code

Cameron’s Florida doctors group, Gulf Coast Orthopaedic Specialists, looked at half a dozen companies before signing with Acermed in April 2005. After installing the first part of the system, they alleged in their lawsuit, the scheduling software “malfunctioned causing patient appointment[s] to disappear.” Also, the billing system was not feeding claims back to insurers, which over the next six months nearly ran the practice into bankruptcy itself, the complaint alleged.

Gulf Coast doctors continued to alert Acermed to the problems, but the company was unable to fix them, the lawsuit stated. They weren’t the only ones having trouble. Two other doctor groups-one in Florida, another in Tennessee-had also filed suit against Acermed, alleging similar problems. Gulf Coast filed its suit in October 2006.  Acermed stated in court documents that the doctors had no basis for their claim.

As it turned out, Acermed had been dealing with problems of its own. In July 2006, a federal judge ordered Acermed to pay more than $750,000 for using some of the source code from another vendor it had once worked with to develop its own electronic medical record software in 2004.

Gulf Coast’s lawsuit was still pending when, in September 2007, Acermed filed for bankruptcy. Company officials at the time said that the reason for their bankruptcy was the financial impact of legal bills, not problems with their software.

In January 2008, Ophthalmic Imaging Systems of Sacramento, Calif., bought Acermed and renamed it Abraxas Medical Solutions with Acermed’s former chief executive Michael Bina as president.

In an email, Bina said he does not “represent AcerMed any more and would not like to comment on its behalf.” He said that one of his conditions for joining Abraxas had been that it continued to service Acermed customers, and that “many clients” of AcerMed have stayed with the new company. One of those clients, Tony Cattone, general manager of a 70-doctor medical practice in New Jersey, said in an interview, “they have lived up to their commitments and it’s working fine.”

Several other doctors said they were left with loan payments for a system they never received.

And today, the Gulf Coast group still hasn’t entirely gotten rid of paper. In December 2008, the doctors settled their lawsuit with Acermed for an undisclosed amount. They invested in a different electronic system, but the doctors aren’t entirely happy with the new one either, said Alan Trest, the group’s technology manager. With the current system, doctors have to type rather than dictate notes. Some aren’t willing to make that transition because they say it takes them more time. So the group still pays for transcriptions.

“They haven’t really completely bought into the idea,” Trest said.

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The idea of providing care at home has a lot of merit.

“The current system, focused on reactive and emergency treatment, mainly in hospitals, has changed little since the NHS was established in 1948, he said…” The same could be said for the US system.

[/]

http://www.guardian.co.uk/society/2010/feb/03/nhs-home-treatment-care

NHS ‘could save BP$15bn’ treating more patients at home.

CBI report fuels debate about what role hospitals would have if community services were significantly expanded

* Denis Campbell, health correspondent
* guardian.co.uk, Wednesday 3 February 2010 13.10 GMT

Is it time for the NHS to offer more treatment at home? Photograph: Ian Waldie/Getty Images

The NHS could save BP$15bn by treating far more patients at home and in new high street walk-in centres, according to a new report {http://www.cbi.org.uk/ndbs/Press.nsf/38e2a44440c22db6802567300067301b/f2aa76202344d1a880257650005a50e7/$FILE/CBI-Doing%20More%20With%20Less.pdf} from the CBI [Confederation of British Industry (CBI)].

Too much medical care is delivered in hospitals because there are not enough alternatives in the community, says the business group, which is urging a rapid expansion of “smarter care”.

Controversially, the report recommends that private companies should be allowed to provide the new services and that the NHS should not necessarily have a monopoly on delivering care in such ways.

It will also add to the growing pressure for the NHS to deliver much more care in patients’ homes – a demand backed by two other reports today – and will fuel the debate about what role hospitals would have if community services were significantly expanded.

“At present resources are skewed in favour of hospital care, but there is considerable scope for treating more people at home, near their workplace or the high street,” said John Cridland, the CBI’s deputy director-general.

“By re-engineering health services to give people more choice about how and where they are treated, we could diagnose problems earlier and reduce the number of costly hospital admissions.”

The NHS will have to rethink how it operates in order to cope with major problems – such as the ageing population, increasing medical problems associated with obesity and alcohol abuse, and the growing number of people with long-term conditions such as diabetes – at a time when its budget is being squeezed, added Cridland.

The current system, focused on reactive and emergency treatment, mainly in hospitals, has changed little since the NHS was established in 1948, he said. But its future will see it building on existing partnerships between the NHS and independent sectors in areas such as hip operations and the running of walk-in centres.

“If the examples of good practice contained in this report were applied more widely, we estimate that around BP$15bn could be saved by 2015,” said Cridland.

“But for that to happen the government must allow the best provider to deliver health services, irrespective of whether they are from the NHS, private or voluntary sectors.”

A separate report out today, by healthcare information analysts Dr Foster Intelligence and Healthcare at Home {http://www.drfosterintelligence.co.uk/index.asp}, estimates that the NHS could save up to BP$1.2bn a year by delivering in patients’ homes more chemotherapy, end-of-life care and treatment for long-term conditions.

In addition, a third paper, from the Expert Patient Programme Community Interest Company {http://www.expertpatients.co.uk/}, says that greater use of self-management techniques by the 15.4 million people with long-term conditions could save BP$1,800 on each patient each year in care costs.

The Department of Health said that NHS services were already being delivered in these ways. A spokeswoman said: “[There is] an impressive track record in the NHS for putting more services into communities, tailoring care to people’s individual needs and giving patients more choice.

“We have more early-intervention mental health teams operating in communities, there is increasing use of telecare for older people and we have invested in new GP services to improve access to primary care.”

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* Report errors or inaccuracies: userhelp@guardian.co.uk
* Letters for publication should be sent to: letters@guardian.co.uk

I’m constantly amazed that anybody would be surprised that consumers are very concerned about the privacy of their health data.

Consumers already keep different accounts in different banks to spread both their risk and to try to hide the extent of their financial holdings from (ex)spouses / creditors / tax agencies. Why would consumers then want a single entity (government or for-profit) to hold all their health information in a single account?

If in the financial sector the working model is already consumer-centric, maybe this is model worth considering for health records as well.

[/]

http://ehr.healthcareitnews.com/blog/public-wary-about-data-privacy

Public worried about health data privacy
By Jeff Rowe, Editor

A recent poll suggests that as federal officials move forward on expanding the role of IT in the healthcare sector, they need to make sure that public is on board when it comes to who gets access to patient data.

The poll, conducted by the Michigan-based Ponemon Institute [http://www.ponemon.org/research-studies-white-papers], clearly indicates that, while the public is largely inclined to allow physicians to share patient data, they are much more wary when it comes to allowing federal officials or non-healthcare private companies the same access.

According to a recent article on the poll in Forbes magazine [http://www.forbes.com/2010/01/25/digital-privacy-ponemon-technology-cio-network-healthcare.html?boxes=financechannelforbes], “of the 868 Americans surveyed about their views on digitizing and storing health records, only 27% said they would trust a federal agency to store or access the data –the same percentage as those who would trust a technology firm like” Google, Microsoft, or General Electric.

The article rightly points out that federal data storage is not part of the Obama administration’s recent push for electronic health records, but the public’s wariness could certainly impact federal and state policy when it comes to the possibility of having companies such as Google managing web-based healthcare portals.

The survey also found that when “asked to rate the sensitivity of various types of personal information, users rated health records as far more sensitive than other information they typically share with Web companies. On a scale from one to seven, medical data received an average rating of 6.64, while credit card information received only a 4.27 and online search records just a 1.86.”

According to Larry Ponemon, the Institute’s director, “The takeaway message is that people still care about privacy.”

That fact, when combined with the recent rise in attempts by hackers [http://www.healthcareitnews.com/news/attempted-hacker-attacks-healthcare-rise] to access healthcare data, suggests that policymakers need to put security issues front and center in order to reassure the public about the safety of their personal information.

You may find this older (2003) paper of interest.

New innovation and development models may be needed as the pharma industry faces a “patent cliff” {http://www.economist.com/theworldin/PrinterFriendly.cfm?story_id=14742621}.

The role of Open Source-like development and business models are not limited to software development any more. Cheers.

[/]

- – - – -

Download full paper from:
http://lacal.net/files/NIMAN-KENCH.doc

OPEN SOURCE IN THE PHARMACEUTICAL INDUSTRY

Neil B. Niman, University of New Hampshire
Brian T. Kench, University of Tampa

ABSTRACT

Recent evidence suggests that pharmaceutical companies focus more on managing their intellectual property rights than in developing drugs that cure medical problems. The open source movement offers alternate rules for the process of developing new drugs and managing intellectual property rights. The essence of open source is to radically change the development process before there exists something worthy of being assigned a set of rights.  Open source in the pharmaceutical industry also offers the potential to reduce the time it takes to develop breakthroughs, test their viability and safety, and bring them to market.

The paper below makes the argument that the health status of a population has a measurable economic impact.

It would seem beyond dispute and self-evident that a healthy population leads to strong, productive workers that can then earn good salaries with which to become robust consumers of products and services.

From a purely capitalistic point of view, you’d expect industry to strongly support activities and programs that deliver a strong consumer base for their wares.

What we know for a fact is that the current illness-focused care system is both very expensive and fails to improve the health of our population.

Maybe we should ask new questions (i.e. “how do we improve e/a family’s health?”) instead of throwing more money at new answers to the failed old questions (i.e. “let’s automate the treatment of poor health”)?

[/]

Economic arguments for addressing the social determinants of health inequalities.

Working Document No.4 – 2009
DETERMINE – EU Consortium for Action on the Socioeconomic Determinants of Health (SDH).

http://www.health-inequalities.eu/pdf.php?id=25d4fa63460c83d64115e80cd65980d3

http://www.health-inequalities.eu/

…

2. Making the case: Establishing economic arguments

Introduction

This chapter presents the findings of a literature review conducted in June 2008 together with further research in April 2009. The review was undertaken to help inform and shape further data collection by establishing the main economic arguments for addressing social determinants of health inequalities.

Health can be considered in economic terms as both a capital and a consumption good. In the case of health as a capital good, people in good health attract a higher value than those in poor health due to their greater ability to be economically productive. Health as a consumption good is concerned with the contribution that good health makes to an individual’s wellbeing, happiness or satisfaction.

Targeted investment to address health inequalities by action on social determinants of health is more cost effective than paying later for the consequences of these inequalities. It follows then that addressing health inequalities is not only a matter of social justice but also contributes to economic growth.

The economic benefits of better health

There are strong economic arguments for investing in health at population level. In 2001, the WHO Commission on Macroeconomics and Health demonstrated that a healthier population can bring substantial economic benefits to countries with developing economies. The authors estimated that 50% of the growth differential  between rich and poor countries was due to ill health and shorter life expectancy. Increasing life expectancy at birth by 10% through targeted investment to tackle the major causes of premature deaths could increase the economic growth rate by 0.35% per year. (1)

Benefits to the economy may not be limited to developing countries. In 2005, a review of evidence in high income countries concluded that “there is considerable and convincing evidence that significant economic benefits can be achieved by improving health not only in developing but also in developed countries.” The report outlines four channels through which this may occur: higher productivity, higher labour supply, improved skills as a result of greater education and training and increased savings available for investment in physical and intellectual capital. (2) However more recent work suggests that the evidence is less conclusive about the links between health and the economy particularly at the macro level. (3)

These issues have been considered in the development of a health strategy for the EU which commenced with a reflection process in 2004. (4) The second of four principles in the strategy Together for Health “Health is the greatest wealth” states that health is a prerequisite for economic productivity and prosperity.

It also emphasises that healthy life expectancy not merely life expectancy is the key factor for economic growth and points to the inclusion of Healthy Life Years as a Lisbon Structural Indicator to underline this distinction. (5) The role of healthcare systems in supporting growth and employment has been recognised in a report commissioned as part of the mid-term review of the Lisbon strategy. Facing the challenge: The Lisbon strategy for growth and employment notes the importance of healthcare systems “… in generating social cohesion, a productive workforce, employment and hence economic growth.” (6)

The economic costs of ill health

Clear understanding of the cost of ill health is a prerequisite for assessing the economic returns of investing in health. While healthcare costs are substantial and increasing, these represent only one part of the overall picture.

Failure to include the welfare costs of ill health risks understating the true economic benefits derived from health interventions. Three perspectives have been identified to gain a more complete picture of the costs of ill health. The broad perspective encompasses social welfare costs; the limited perspective considers micro- and macroeconomic costs; while the very limited perspective focuses on healthcare costs. (7)

Cost of illness studies separate costs into three components: direct costs, i.e. those associated with treating illness; indirect costs, i.e. costs associated with loss of productivity due to morbidity or premature death and; intangible costs which include the psychological dimensions of illness. However in many cases only the first two are measured. A review of cost of illness studies found that the cost of chronic diseases ranged from 0.02% to 6.77% of a country’s GDP. Cardiovascular disease in particular was found to account for between 1-3% of GDP in most developed countries. (8)

The cost of health inequalities

Health inequalities are understood to be the difference in health outcomes between different population groups, including socioeconomic groups. Such inequalities are estimated to reduce average life expectancy across the EU252 by 1.84 years which equates to approximately 11.4 million life years lost. At the same time, healthy life expectancy is reduced due to the existence of inequalities by an average of 5.14 years or approximately 33 million healthy life years lost. (9) While these figures represent the EU25 as a whole, the large variation in the magnitude of health inequalities within member states is well recognised, with some southern European countries having smaller inequalities and most countries in the East and Baltic regions having larger inequalities than the European average. (10)

These inequalities have significant economic implications for the EU and for member states. When health is valued as a capital good, inequalities related losses have been estimated to cost around Euro$141 billion in 2004 or 1.4% of GDP. This rises sharply to Euro$1,000 billion or 9.5% of GDP when health is valued as a consumption good. (9)

Richard Wilkinson, Professor Emeritus at the University of Nottingham Medical School and Honorary Professor at University College London.
{http://en.wikipedia.org/wiki/Richard_Wilkinson_%28public_health%29}

Kate Pickett, Professor of Epidemiology at the University of York and a National Institute for Health Research Career Scientist.
{https://hsciweb.york.ac.uk/research/public/Staff.aspx?ID=1197}

When:
Tuesday, 19th January 2010, at 3:00- 5:00 pm Washington DC time

Please check the local time in your own town: http://www.timeanddate.com/worldclock/meeting.html

Where: in front of your personal or work computer anywhere in the world or at:
PAHO HQ Room 1017
525 23Rd  St. NW Washington DC 20037

Link to participants – Via Internet

https://sas.elluminate.com/m.jnlp?sid=1110&password=M.A4FA308B5F1FA6CD60DB62C0137303

We will broadcast this session in English via the Elluminate Live!® software using integrated VoIP for the audio component

Please connect a few minutes before 3 pm Washington DC time. You must have a headset or speaker and microphone

The event is free and open to interested people. You may attend virtually from your personal or work computer anywhere in the world. In addition to watching live presentations, you will have the option to ask questions and provide comments.

This conference will enable the sharing of good practices and lessons learned.

Welcome

3:00 – 3:20pm
* Juan Manuel Sotelo, Manager, External Relations, Resource Mobilization, and Partnerships PAHO/WHO
* Jarbas Barbosa, Manager, Health Surveillance and Disease Prevention and Control (HSD) PAHO/WHO
* Theresa Bernardo, Manager, Knowledge Management and Communications (KMC) PAHO/WHO

Presenters

3:20 – 4:00pm
Why more equal societies almost always do better
Where in the developed world do people live the longest? Where do people born at the bottom of the economic ladder have the best shot at climbing up?
In which nations do children do best in school? Which countries send the most people to prison?  Have the teenage pregnancies?  Suffer the most homicides?
The answers matter and are indicative of a society’s overall health and the quality of life for its citizens.
That is the contention of eminent British epidemiologists Richard Wilkinson and Kate Pickett, authors of The Spirit Level: Why Greater Equality Makes Societies Stronger.

Presenters

Richard Wilkinson has played a formative role in international research and his work has been published in 10 languages. He studied economic history at the London School of Economics before training in epidemiology and is Professor Emeritus at the University of Nottingham Medical School and Honorary Professor at University College London.

Kate Pickett, Professor of Epidemiology at the University of York and a National Institute for Health Research Career Scientist. She studied physical anthropology at Cambridge, nutritional sciences at Cornell and epidemiology at Berkeley before spending four years as an Assistant Professor at the University of Chicago.

4:00 – 5:00pm
Q&A from Participants

Contact Information:

E-mail: Ruglucia@paho.org
Pan American Health Organization PAHO/WHO – Washington D.C.

- – - – Further reading – - -

http://www.guardian.co.uk/society/2009/mar/12/equality-british-society

The theory of everything

These two British academics argue that almost every social problem, from crime to obesity, stems from one root cause: inequality. John Crace meets the authors of what might be the most important book of the year

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http://en.wikipedia.org/wiki/Black_Report

Black Report

The Black report was a 1980 document published [1] by the Department of Health and Social Security (now the Department of Health) in the United Kingdom, which was the report of the expert committee into health inequality chaired by Sir Douglas Black. It was demonstrated that although overall health had improved since the introduction of the welfare state, there were widespread health inequalities. It also found that the main cause of these inequalities was economic inequality. The report showed that the death rate for men in social class V was twice that for men in social class I and that gap between the two was increasing not reducing as was expected.

The Black report was commissioned in March 1977 by David Ennals, Labour Secretary of State, following publication of a two-page article by Richard Wilkinson in New Society, on 16 December 1976, entitled ‘Dear David Ennals’. The report was nearly ready for publication in early 1979.

However, in the General Election on 3 May 1979, the Conservatives were elected. The Black Report was not issued until 1980 by the Conservative Government. The Black report was published on August Bank Holiday with only 260 copies made available on the day for the media. However, the report had a huge impact on political thought in the United Kingdom and overseas. It led to an assessment by the Office for Economic Co-Operation and Development and the World Health Organization of health inequalities in 13 countries -though not on UK government policy [2].

Penguin Books published a shortened version of the Report in 1982, making it widely available [3]

The Whitehead Report published in 1987 came to the same conclusions as the Black report, as did the Acheson Report later in 1998.

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http://www.sochealth.co.uk/Black/black.htm

The Black Report 1980

The publication of the Black Report over the Bank Holiday Weekend of 1980 by the Thatcher Government signalled the end of the hopes of improvement in public health for twenty years. It was clear that the Government would have preferred to suppress the whole thing, and it is greatly to the authors’ credit that this did not happen. However you do not need to read very much to see why the Conservatives wanted to suppress it. Redistribution, increased public expenditure and taxation and unashamed socialism are flaunted on almost every page.

FTC reminds us that storing data in the cloud has drawbacks

[Editor's Note]

This point raised by the article below re: risks to consumer’s private data being “in the cloud” is very applicable to the entire Health IT / EMR / Personal Health Record discussion.

It’s not clear to me if in the rush to “digitize healthcare” enough attention (and priority) has been paid to protecting consumers’ privacy.

If somebody hacks into your bank account and steals US$1,000 from you that is clearly a bad outcome. But you can recover from that. Money is replaceable via a bank refund or a credit card protection plan.
But if your electronic medical record (“EMR”) is hacked whereby all future employers (and significant others) can find out about your {mental health issues} / {abortion while in college} / {paternity test results} that is not a recoverable incident.

Using paper-based records it would take a bit of work to illegally copy the records of 100 patients. Using an EMR, you can copy the records of thousands of patients in minutes onto a USB drive.

http://www.lasvegassun.com/news/2009/nov/20/umc-has-patient-privacy-leak/

“Private information about accident victims treated at University Medical Center has apparently been leaking for months, the Sun has learned, allegedly so ambulance-chasing attorneys could mine for clients.
Sources say someone at UMC is selling a compilation of the hospital’s daily registration forms for accident patients. This is confidential information – including names, birth dates, Social Security numbers and injuries – that could also be used for identity theft.
Hospital officials knew of rumors of the leaks since the summer, but doubted them until provided evidence Thursday by the Sun. Now they’re scrambling to catch up to a crisis that may affect hundreds, if not thousands, of patients….”

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The Federal Trade Commission worries that consumers don’t really understand the privacy implications to storing some of their most crucial data in the cloud, and it wants the FCC to think about such issues when finalizing its national broadband plan.

By Nate Anderson | Last updated January 6, 2010 11:47 AM

Take Google’s new Nexus One phone as a case study of the pros and cons of storing life details on remote servers. Nexus One phones can back up their complete settings to Google’s servers, including data such as “Wi-Fi passwords, bookmarks, a list of the applications you’ve installed, the words you’ve added to the dictionary used by the onscreen keyboard, and most of the settings that you configure with the Settings application.” Get a new phone and the data transfers easily.

But that data is now sitting on servers outside of your control, where it can be accessed far more easily by Google itself, hackers, and law enforcement than it ever could if kept within the device. Once data passes over the network, it gets much easier to access in realtime; once it is stored on a remote server, it gets much easier to access at any time.

And those are just the phone settings. Google also has access to search history data, anything stored in Google Docs or Spreadsheets, complete schedules stored in Google Calendar, and recent Maps searches. Combine them all, and companies like Google become one-stop shops for authorities looking for personal information.

Such issues have raised concerns at the Federal Trade Commission (FTC), especially since many consumers aren’t really aware of the data security issues raised by storing information on remote servers. “For example, the ability of cloud computing services to collect and centrally store increasing amounts of consumer data, combined with the ease with which such centrally stored data may be shared with others, create a risk that larger amounts of data may be used by entities in ways not originally intended or understood by consumers,” said the FTC in a letter (PDF) this week. {http://fjallfoss.fcc.gov/ecfs/document/view?id=7020352132}

That letter was directed at the Federal Communications Commission (FCC), which is currently drawing up a national broadband plan that will be submitted to Congress next month. In advance of the plan’s release, the FTC wants to make sure that the FCC “considers technologies such as cloud computing and identity management in implementing a national broadband plan.”

That means publicly recognizing the FTC’s growing expertise on issues on online privacy and data security. “Accordingly, we recommend that the Broadband Plan recognize the FTC’s law enforcement, consumer education, and ongoing policy development efforts in light of its years of experience in online, and offline, consumer protection,” concludes the letter.

The FTC is in the middle of a set of hearings on these issues; the next one takes place on January 28.

This article provides additional evidence that just spending more money on healthcare’s potions, lotions, and treatments does not necessarily lead to better population health.

As per the article: Norway is better able to control drug-resistant infections because they stopped taking so many drugs. The World Health Organization says antibiotic resistance is one of the leading public health threats on the planet.

There are way too many antibiotics used in the US already, plus those we all ingest through the food supply. {http://www.ucsusa.org/food_and_agriculture/solutions/wise_antibiotics/pamta-testimony.html}

Sometimes less (healthcare) is definitively more (health). Read the classic book by Ivan Illich: http://en.wikipedia.org/wiki/Ivan_Illich#Medical_Nemesis

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http://news.yahoo.com/s/ap/20091231/ap_on_re_us/when_drugs_stop_working_norway_s_answer

Solution to killer superbug found in Norway
AP

By MARTHA MENDOZA and MARGIE MASON,

Associated Press Writers Martha Mendoza And Margie Mason, Associated Press Writers – Thu Dec 31, 12:01 am ET

OSLO, Norway – Aker University Hospital is a dingy place to heal. The floors are streaked and scratched. A light layer of dust coats the blood pressure monitors. A faint stench of urine and bleach wafts from a pile of soiled bedsheets dropped in a corner.

Look closer, however, at a microscopic level, and this place is pristine. There is no sign of a dangerous and contagious staph infection that killed tens of thousands of patients in the most sophisticated hospitals of Europe, North America and Asia this year, soaring virtually unchecked.

The reason: Norwegians stopped taking so many drugs.

Twenty-five years ago, Norwegians were also losing their lives to this bacteria. But Norway’s public health system fought back with an aggressive program that made it the most infection-free country in the world. A key part of that program was cutting back severely on the use of antibiotics.

Now a spate of new studies from around the world prove that Norway’s model can be replicated with extraordinary success, and public health experts are saying these deaths – 19,000 in the U.S. each year alone, more than from AIDS – are unnecessary.

“It’s a very sad situation that in some places so many are dying from this, because we have shown here in Norway that Methicillin-resistant Staphylococcus aureus (MRSA) can be controlled, and with not too much effort,” said Jan Hendrik-Binder, Oslo’s MRSA medical adviser. “But you have to take it seriously, you have to give it attention, and you must not give up.”

The World Health Organization says antibiotic resistance is one of the leading public health threats on the planet. A six-month investigation by The Associated Press found overuse and misuse of medicines has led to mutations in once curable diseases like tuberculosis and malaria, making them harder and in some cases impossible to treat.

Now, in Norway’s simple solution, there’s a glimmer of hope.

—

Dr. John Birger Haug shuffles down Aker’s scuffed corridors, patting the pocket of his baggy white scrubs. “My bible,” the infectious disease specialist says, pulling out a little red Antibiotic Guide that details this country’s impressive MRSA solution.

It’s what’s missing from this book – an array of antibiotics – that makes it so remarkable.

“There are times I must show these golden rules to our doctors and tell them they cannot prescribe something, but our patients do not suffer more and our nation, as a result, is mostly infection free,” he says.

Norway’s model is surprisingly straightforward.

* Norwegian doctors prescribe fewer antibiotics than any other country, so people do not have a chance to develop resistance to them.

* Patients with MRSA are isolated and medical staff who test positive stay at home.

* Doctors track each case of MRSA by its individual strain, interviewing patients about where they’ve been and who they’ve been with, testing anyone who has been in contact with them.

Haug unlocks the dispensary, a small room lined with boxes of pills, bottles of syrups and tubes of ointment. What’s here? Medicines considered obsolete in many developed countries. What’s not? Some of the newest, most expensive antibiotics, which aren’t even registered for use in Norway, “because if we have them here, doctors will use them,” he says.

He points to an antibiotic. “If I treated someone with an infection in Spain with this penicillin I would probably be thrown in jail,” he says, “and rightly so because it’s useless there.”

Norwegians are sanguine about their coughs and colds, toughing it out through low-grade infections.

“We don’t throw antibiotics at every person with a fever. We tell them to hang on, wait and see, and we give them a Tylenol to feel better,” says Haug.

Convenience stores in downtown Oslo are stocked with an amazing and colorful array – 42 different brands at one downtown 7-Eleven – of soothing, but non-medicated, lozenges, sprays and tablets. All workers are paid on days they, or their children, stay home sick. And drug makers aren’t allowed to advertise, reducing patient demands for prescription drugs.

In fact, most marketing here sends the opposite message: “Penicillin is not a cough medicine,” says the tissue packet on the desk of Norway’s MRSA control director, Dr. Petter Elstrom.

He recognizes his country is “unique in the world and best in the world” when it comes to MRSA. Less than 1 percent of health care providers are positive carriers of MRSA staph.

But Elstrom worries about the bacteria slipping in through other countries. Last year almost every diagnosed case in Norway came from someone who had been abroad.

“So far we’ve managed to contain it, but if we lose this, it will be a huge problem,” he said. “To be very depressing about it, we might in some years be in a situation where MRSA is so endemic that we have to stop doing advanced surgeries, things like organ transplants, if we can’t prevent infections. In the worst case scenario we are back to 1913, before we had antibiotics.”

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Forty years ago, a new spectrum of antibiotics enchanted public health officials, quickly quelling one infection after another. In wealthier countries that could afford them, patients and providers came to depend on antibiotics. Trouble was, the more antibiotics are consumed, the more resistant bacteria develop.

Norway responded swiftly to initial MRSA outbreaks in the 1980s by cutting antibiotic use. Thus while they got ahead of the infection, the rest of the world fell behind.

In Norway, MRSA has accounted for less than 1 percent of staph infections for years. That compares to 80 percent in Japan, the world leader in MRSA; 44 percent in Israel; and 38 percent in Greece.

In the U.S., cases have soared and MRSA cost $6 billion last year. Rates have gone up from 2 percent in 1974 to 63 percent in 2004. And in the United Kingdom, they rose from about 2 percent in the early 1990s to about 45 percent, although an aggressive control program is now starting to work.

About 1 percent of people in developed countries carry MRSA on their skin. Usually harmless, the bacteria can be deadly when they enter a body, often through a scratch. MRSA spreads rapidly in hospitals where sick people are more vulnerable, but there have been outbreaks in prisons, gyms, even on beaches. When dormant, the bacteria are easily detected by a quick nasal swab and destroyed by antibiotics.

Dr. John Jernigan at the U.S. Centers for Disease Control and Prevention said they incorporate some of Norway’s solutions in varying degrees, and his agency “requires hospitals to move the needle, to show improvement, and if they don’t show improvement they need to do more.”

And if they don’t?

“Nobody is accountable to our recommendations,” he said, “but I assume hospitals and institutions are interested in doing the right thing.”

Dr. Barry Farr, a retired epidemiologist who watched a successful MRSA control program launched 30 years ago at the University of Virginia’s hospitals, blamed the CDC for clinging to past beliefs that hand washing is the best way to stop the spread of infections like MRSA. He says it’s time to add screening and isolation methods to their controls.

The CDC needs to “eat a little crow and say, ‘Yeah, it does work,’” he said. “There’s example after example. We don’t need another study. We need somebody to just do the right thing.”

—

But can Norway’s program really work elsewhere?

The answer lies in the busy laboratory of an aging little public hospital about 100 miles outside of London. It’s here that microbiologist Dr. Lynne Liebowitz got tired of seeing the stunningly low Nordic MRSA rates while facing her own burgeoning cases.

So she turned Queen Elizabeth Hospital in Kings Lynn into a petri dish, asking doctors to almost completely stop using two antibiotics known for provoking MRSA infections.

One month later, the results were in: MRSA rates were tumbling. And they’ve continued to plummet. Five years ago, the hospital had 47 MRSA bloodstream infections. This year they’ve had one.

“I was shocked, shocked,” says Liebowitz, bouncing onto her toes and grinning as colleagues nearby drip blood onto slides and peer through microscopes in the hospital laboratory.

When word spread of her success, Liebowitz’s phone began to ring. So far she has replicated her experiment at four other hospitals, all with the same dramatic results.

“It’s really very upsetting that some patients are dying from infections which could be prevented,” she says. “It’s wrong.”

Around the world, various medical providers have also successfully adapted Norway’s program with encouraging results. A medical center in Billings, Mont., cut MRSA infections by 89 percent by increasing screening, isolating patients and making all staff – not just doctors – responsible for increasing hygiene.

In Japan, with its cutting-edge technology and modern hospitals, about 17,000 people die from MRSA every year.

Dr. Satoshi Hori, chief infection control doctor at Juntendo University Hospital in Tokyo, says doctors overprescribe antibiotics because they are given financial incentives to push drugs on patients.

Hori now limits antibiotics only to patients who really need them and screens and isolates high-risk patients. So far his hospital has cut the number of MRSA cases by two-thirds.

In 2001, the CDC approached a Veterans Affairs hospital in Pittsburgh about conducting a small test program. It started in one unit, and within four years, the entire hospital was screening everyone who came through the door for MRSA. The result: an 80 percent decrease in MRSA infections. The program has now been expanded to all 153 VA hospitals, resulting in a 50 percent drop in MRSA bloodstream infections, said Dr. Robert Muder, chief of infectious diseases at the VA Pittsburgh Healthcare System.

“It’s kind of a no-brainer,” he said. “You save people pain, you save people the work of taking care of them, you save money, you save lives and you can export what you learn to other hospital-acquired infections.”

Pittsburgh’s program has prompted all other major hospital-acquired infections to plummet as well, saving roughly $1 million a year.

“So, how do you pay for it?” Muder asked. “Well, we just don’t pay for MRSA infections, that’s all.”

—

Beth Reimer of Batavia, Ill., became an advocate for MRSA precautions after her 5-week-old daughter Madeline caught a cold that took a fatal turn. One day her beautiful baby had the sniffles. The next?

“She wasn’t breathing. She was limp,” the mother recalled. “Something was terribly wrong.”

MRSA had invaded her little lungs. The antibiotics were useless. Maddie struggled to breathe, swallow, survive, for two weeks.

“For me to sit and watch Madeline pass away from such an aggressive form of something, to watch her fight for her little life – it was too much,” Reimer said.

Since Madeline’s death, Reimer has become outspoken about the need for better precautions, pushing for methods successfully used in Norway. She’s stunned, she said, that anyone disputes the need for change.

“Why are they fighting for this not to take place?” she said.

____

Martha Mendoza is an AP national writer who reported from Norway and England. Margie Mason is an AP medical writer based in Vietnam, who reported while on a fellowship from The Nieman Foundation at Harvard University.

Unhealthy habits are what’s killing us

By David Frum, CNN Contributor

STORY HIGHLIGHTS
* Americans’ poor health, relative to other countries, is cited as a reason for health reform
* David Frum says there’s little evidence health bill will improve U.S. life expectancy
* He says research shows unhealthy habits explain why Americans get sick more often
* Individual choices to adopt healthy lifestyles would have more impact, he says

Editor’s note: David Frum writes a weekly column for CNN.com. A resident fellow at the American Enterprise Institute, he was special assistant to President George W. Bush in 2001-2. He is the author of six books, including “Comeback: Conservatism That Can Win Again” and the editor of FrumForum.

(CNN) — Health care reform is proceeding toward the president’s desk, likely to become law in the new year.

Supporters promise the bill will cut costs and extend coverage.

But here’s the real test: What will the trillion-dollar expense of this bill actually buy? Will it improve America’s health? My guess: No.

For all the money Americans spend on health care (60 percent more per person than any other advanced country), Americans are not an especially healthy people.

Life expectancy at 50 in the U.S. ranks 29th in the world, three years behind world leader Japan, one and a half years behind Canada. Other indicators — infant mortality, life expectancy at birth — look even worse.

This poor performance is often blamed on the fact that millions of Americans lack health insurance. But as a recent paper for the National Bureau of Economic Research found, the U.S. — despite its kludgy health insurance system — does a remarkably good job of extending disease-fighting treatment to all.

Authors Samuel Preston and Jessica Ho observe:

* The U.S. screens a higher percentage of women for cervical cancer than any other country in a sample of 15 advanced countries.

* Americans have the highest survival rates for breast, lung, colon or rectal cancer in a sample of 20 advanced countries.

* Compared with Australia, Canada, Denmark, Finland, Sweden and Great Britain, the U.S. had the third-lowest fatality rate for male heart attack victims ages 40-64, the second-lowest for men ages 85-89 and the best for women aged 85-89.

* Americans 50 and older with heart disease are more likely to receive medication than similarly aged Europeans. Ditto stroke. Ditto high cholesterol.

Cancer and heart disease are not any old ailments. These are the leading causes of death for people 50 and older.

So if the U.S. health system does such a good job saving its middle-aged and elderly sick, why do Americans die comparatively young?

Answer: because Americans are much more likely to get sick in the first place.

And that likelihood owes very little to the health care system and a great deal to the bad choices American individuals make.

If you eat too much, exercise too little, drink too much, smoke, take drugs, fail to wear a seat belt or ignore gun safety, there is only so much a doctor or hospital can do for you.

And Americans do all those things, more than other people.

One-third of Americans are overweight. That one single fact accounts for almost 10 percent of all health care spending. At any given moment, one out of six motorists is unbelted. American children are nine times more likely to be injured in a gun accident than children in other developed countries.

If all Americans quit smoking, if everybody wore a seat belt, if gun owners consistently secured their weapons, if we all drank in moderation and abjured illegal drugs and if the one-third of the country that is overweight would drop the extra pounds, those individual actions would do more to improve health and extend lives than any contemplated by Congress or the president.

Acting on this information won’t be easy: It violates too many taboos. Americans understandably treasure their right to make their own choices, including the choice to super-size it. And many are uncomfortably aware that self-destructive behavior is most often found among the poor and among minorities: Black women are more than three times as likely as white women to be severely obese.

In the near term, public policy can achieve only a limited impact against these problems. There is evidence that youth obesity can be reduced by zoning rules that forbid fast-food restaurants to be sited within 200 yards of a school. More and better gym classes, better cafeteria menus and a ban on soda in schools would all help too.

Over the longer term, we will have to rethink the deeper structure of American food policy: subsidies to corn and soybean growers, the paving over of exurban land that might provide nearby cities with less expensive fruits and vegetables.

Ultimately, though, these are decisions that individuals must make for themselves. In this respect, the present concept of medicalized health care sends some unwelcome messages. By “outsourcing” the concept of health as something that doctors, hospitals and now government do for you — rather than something that depends considerably on your own choices and efforts — we ask the medical system to do more than any medical system can do.

As you consider your new year’s resolutions, remember: better habits will benefit not only your family and yourself — but all your neighbors and countrymen as well.

The opinions expressed in this commentary are solely those of David Frum.