INDICATORS FOR MONITORING THE HEALTH OF THE POPULATION – FINAL REPORT

11 May

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:

http://www.drees.sante.gouv.fr/indicateurs-de-suivi-de-l-etat-de-sante-de-la-population,11299.html

and here:
INDICATEURS DE SUIVI DE L’ÉTAT DE SANTE DE LA POPULATION RÉVISION 2013 – RAPPORT FINAL

Health insurance: a matter of life and death

7 May

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 ReformA Quasi-experimental Study

Benjamin D. Sommers, MD, PhD; Sharon K. Long, PhD; and Katherine Baicker, PhD
Ann Intern Med. 2014;160(9):585-593. doi:10.7326/M13-2275
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Le monde n’attend pas

28 Apr

Two beautifully touching songs that the blog called .Le monde n’attend pas shared with us and allowed us to discover.

inequality, Scarcity of oil, scarcity of water maps the cartography of conflicts

10 Apr

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.

Geography is destiny in medicine

6 Apr

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 :

http://earthsky.org/human-world/bill-davenhall-your-doctor-needs-to-know-your-place-history

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.”

Quoted from:

http://proceedings.esri.com/library/userconf/health09/docs/plenary/goodman.pdf

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.

Quoted from:

https://depts.washington.edu/geog/2011/03/in-health-care-geography-is-destiny/

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.

Pitfalls of retrospective database studies

30 Mar

As you know a part of my work consists to participate in studies based on the extraction from retrospective databases and the analysis of the informations thus retrieved. The eligibility of the beneficiaries to the provision that represents the study’s outcome is always a major concern. There is two explanations for a beneficiary not having access to a care according to the data retrieved from the reimbursement base: either a real lack of access or a non eligibility of the care for a record in the reimbursement data base (for example if the insured is covered by another insurance or has lost his coverage and has exited from the health plan)*. I have always to keep in mind that I work on secondary data which are only a reflection of the primary data the reality of which I try to apprehend.
The dilemma is pretty well addressed in this article:

http://onlinelibrary.wiley.com/doi/10.1046/j.1524-4733.2003.00242.x/full

*as always there is a third possibility: the data concerning the care has been erased from or not yet recorded in the base. The timeline of the refreshment of the base (ie the loading and the purifying of the data) must be precisely described in the methodology of the study.

Article cited:
1)- Motheral, B., Brooks, J., Clark, M. A., Crown, W. H., Davey, P., Hutchins, D., Martin, B. C. and Stang, P. (2003),

A Checklist for Retrospective Database Studies—Report of the ISPOR Task Force on Retrospective Databases.

Value in Health, 6: 90–97. doi: 10.1046/j.1524-4733.2003.00242.x

Two other articles address the pitfalls of inferring from secondary data extracted from a retrospective data base:

2)- Berger M, Mamdani M, Atkins D, Johnson M.

Good Research Practices for Comparative Effectiveness Research: Defining, Reporting and Interpreting Nonrandomized Studies of Treatment Effects Using Secondary Data Sources: The ISPOR Good Research Practices for Retrospective Database Analysis Task Force Report—Part I.

Value in Health 2009 ; 12(8) :1044-52
3)-

The use of claims databases for outcomes research : Rationale, challenges, and strategies. Annual international meeting of the Association for Pharmacoeconomics and Outcome Research.

Philadelphia, Pennsylvania (USA), 1996/05/12. CLINICAL THERAPEUTICS, vol. 19, n° 2, 1997, pages 346-366, 74 réf., ISSN 0149-2918, USA. MOTHERAL (B.R.) *, FAIRMAN (K.A.). Outcomes Research. Express Scripts. Inc. Maryland Heights. USA

Full text of the article here:

http://ehealthecon.hsinetwork.com/Motheral_ClinTher_1997.pdf

 

The Decrease of life expectancy.

18 Mar

For the first time in history life expectancy decreases in a industrialized country as shown in the study below:

content.healthaffairs.org/content/31/8/1803.abstract

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:

http://www.nytimes.com/2012/09/21/us/life-expectancy-for-less-educated-whites-in-us-is-shrinking.html?pagewanted=all&_moc.semityn.www&_r=0

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:

http://www.healthypolicies.com/2012/09/paul-krugman-america’s-greatest-public-health-champion/

Lessons from Medicare

17 Mar

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:

http://www.cbo.gov/sites/default/files/cbofiles/attachments/01-18-12-MedicareDemoBrief.pdf

and the blog that discusses the report:

http://theincidentaleconomist.com/wordpress/can-the-better-care-lower-cost-act-live-up-to-its-name/

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:

http://www.ameli-sophia.fr/le-service-sophia

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.

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The French national medical Board incites physicians to produce content on the internet

16 Mar

The French national Medical Board declares in its last Newsletters that Physicians, as a reliable source of information, should be encouraged to produce contents on the Internet. The ethic is the same as in a patient-physician relationship but the advantage is that the patient can takes his time to apprehend and deepen the information given to him by the physician by consulting his website. The National Board incites physicians to be present on the Web as professionals. But Doctors can also have their blogs like every citizen, provided that they do not discredit the profession and its digital reputation. And provided also that they do not use their blog for advertising and for falsely flattering their skill! The Board recommends also the Doctors to stay sober in their presentation and not to request fees in their websites, but I think that that went without saying.

http://www.conseil-national.medecin.fr/sites/default/files/livre_blancdeontoweb2012.pdf

http://www.conseil-national.medecin.fr/sites/default/files/charte_internet_cnom2014.pdf

http://www.conseil-national.medecin.fr/newsletter/2014/3

Drunksouls

14 Mar

An epic band from Marseille, the lyrics will make you shiver, especially the song “revolution”. If it is true that artists reflects the moods of peoples, stakeholders of our developed societies are allowed to be worried. How long the youth will support what the democracies are offering for their futur.

http://brooklynrocks.blogspot.fr/2012/04/drunksouls-revolution-cd-review.html

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