The following originally appeared atÂ The UpshotÂ copyright 2014, The New York Times Company. One of the earliest pieces of the health-care law to go into e
The French government has issued a report enlisting the available surrogates of risk factors, health determinants and health status of the population at a nation’s wide level.
Some experts from the self employed workers social scheme (RSI) participated to the panel of experts.
In many cases, to construct the surrogates the authors of the report plans to use the reimbursement databases of the national mandatory health care insurance schemes. It is the case for example when the surrogate is a recourse rate to a category of treatment or medicine (anti hypertensive treatment; opioid addiction treatment …).
Feel free to consult the report (in French) here:
Health insurance would be a matter of life and death suggests the study referenced below:
Benjamin D. Sommers, Sharon K. Long, Katherine Baicker; Changes in Mortality After Massachusetts Health Care ReformA Quasi-experimental StudyChanges in Mortality After Massachusetts Health Care Reform. Annals of Internal Medicine. 2014 May;160(9):585-593.
The results are widely reported in the media and blogosphere.
Drs. Sommers and Baicker work in the Department of Health Policy and Management, Harvard School of Public Health, Kresge Building, Room 406, 677 Huntington Avenue, Boston, MA 02115 and Dr. Long works at the Health Policy Center, Urban Institute, 2100 M Street NW, Washington, DC 20037.
Since the design is purely observational, results must not serve to inference nor be generalized nevertheless they go in the same direction as common sense, and logic: health insurance therefore care accessibility therefore life prolongation. But until now that chain of events had still to be observed at a large-scale (state-scale) and this is the merit of this study.
Changes in Mortality After Massachusetts Health Care Reform: A Quasi-experimental Study
Two beautifully touching songs that the blog called .Le monde n’attend pas shared with us and allowed us to discover.
I want to share with my followers this incredibly sensitive talk of my cousin (the introduction is a little bit long but you can jump to Tho’s intervention at the 6.14th minute). Enjoy and above all meditate about what the true nature of mankind is.
Heraclitus of Ephesus (Ἡράκλειτος, Herakleitos; c. 535 BC – 475 BC), a Greek philosopher, is known for having said: character is destiny (otherwise said A man’s character is his fate.)
The two main reasons why the derived adage “geography is destiny” applies to medicine are first that exposure to diseases risk factors varies from one region to another in a same country with the same health services and health insurance coverage :
and second that the pattern of care chosen by practitioners to treat the population for a given condition also greatly varies depending of the place of abode (still at a same health services and health insurance coverage level):
“A study of the geographic distribution in elementary school children discloses no correlation between Tonsillectomy and any other factor, such as overcrowding, poverty, bad housing, or climate. In fact it defies any explanation, save that of variation of medical opinion on the indications for operation.”
There is tremendous unexplained variation in rates of surgical procedures from hospital catchment area to hospital catchment area, and region to region that cannot be explained by epidemiologic factors. For example, colleagues and I discovered in 1992 (see Spine, 1992) that the 15 fold difference in surgical procedures on the spine in Washington State was inexplicable by almost all population and diagnostic factors.
From the citations quoted above we could even go further in completing the adage by saying: in medicine geography is not only destiny it is also the caregiver.
For the first time in history life expectancy decreases in a industrialized country as shown in the study below:
The New York time reported one of the key result of the study in a article entitled “Life Spans Shrink for Least-Educated Whites in the U.S.”here:
These data must be integrated to the social policies that are based on the assumption that the upcoming generations will live longer.
Paul Krugman, the Nobel prize of economy, explains this reversing trend by the increase of income inequalities at a macroeconomic level here:
Are disease management, patient education or value based payment cost efficient?
In the medicare experience results were mitigated and barely paid the program’s fees. You can read the brief that has been issued by the Congressional Budget Office‘s health and Human Resources division:
and the blog that discusses the report:
In France a program of disease management and care coordination has been implemented. Its name is Sophia and it targets two chronic diseases, asthma and diabetes mellitus. More information here:
But I can’t find any evaluation of the kind of the CBO report that searches if the health care cost savings, inherent to the program, balance the program’s fees. If you have found such a report let me know.