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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:,11299.html

and here:


And from now on, where do we go?

12 Aug

European politics are at a cross road, they have to make a choice: social welfare or repression.
In the present context public budgets do not allow them to afford both.

If they make the repression choice they have to remember that if you can’t secure all then you can secure nothing. Police and even army shall be everywhere, citizens will demand the right to carry guns for self protection and militias will be created.

If they make the people’s welfare choice they will have to lowering cost of studies and re-open classrooms, give more staff to schools and associations for the youth, create employment in public services.

Actually the easier road is not always the better road. And their milestoning is quite radically different.

Now listen to a local witness speaking:

Vodpod videos no longer available.

Cancer: screening or not screening?

29 Jul

Must all big smokers have a Chest Tomography?

Must all women before 50 have a mammogram every year?

Must all men after 80 be screened for prostate cancer?

Health care journalists push for it as you can see for example in the following videos (beware these following videos are not recommendations but examples of biased reporting, by media, of scientific research results):

Chest tomography for lung cancer

mammogram 1
mammogram 2

Scientists worry about adverse iatrogenic events and high false positive rates that will certainly worry patients creating a new category of patients: the “worried wells”. (in the order there are five categories of patients the sick , the early sick (early detection), the well, the worried well and the worried sick.)

Governmental agencies hesitate before the high number of people needed to screen for saving a single life and try to product guidelines that satisfy everybody.

And people are questioning themselves searching information on the internet and social media.

But I make a proposition for a new preventive action: if tomorrow everybody drive is car at a speed below 40 km per hour it will save a lot of lives (by lowering lethal road crash and air pollution). Are you ready to do that? 🙂

P4P for French primary care physicians for the first time of their history

26 Jul

For the first time of their history, French primary care practitioners will be paid for performance. Until now their remuneration was only of “fee for service” type. But the new contract with social security scheme of July 2011 introduces a dose of “pay for performance”. Goals that will have to be reached in order to receive bonuses will be fixed by the contract negotiated with the French national social security scheme.

Old time when practitioners only had an obligation of mean is from now on a past history. Bonuses are now also paid for the obtaining of results.

The risk of such a new remuneration is that it only add on to the previous one “fee for service” remuneration without address the problem of repetitive un-necessary medical cares.

Pay for performance should potentially show better results in a salaried context like in England than in a fee for service context like it is in France.

Furthermore patients with multiple chronic diseases often do not correspond to any guidelines available.  But… wait and see.

All the more, results depend on how generous will be the financial incentive and how high will be set the performance thresholds. From now on bonuses costs are estimated between 360 and 380 million Euros.

UK charges a French big pharma

27 Jun

The United Kingdom charges a lawsuit against our national laboratory Servier for having abused of a dominant position to protect it’s perindopril blud pressure drug. The State attorney claims for 2 hundred Million. This affair seems to be a follow up of an antitrust inquiry conducted by European commission. The pharmalot website published a post about this lawsuit.

How the most powerful nation in the world intends to deal with the health gap between it’s poorest and richest citizens

25 Jun

USA is moving forward improving its social security with a National Prevention Strategy, and an affordable care act (ACA). The midyear congress of health services professionals is debating the issues with a typically american enthusiasm. A big deal indeed: 32 million american people have no health care access by lacking of insurance coverage. One important aspect of the ACA is to track and having no tolerance to social security fraud.

Twelve health care systems comparison (including France)

23 Jun

A survey compared twelve health care systems (including France, United States, Germany, Brasil, China…). The methodology questionned 15,735 health care consumers on their experience with health system, satisfaction,  appreciation on wasteful and performance, quality of preventive services. Percentage of public investment, percapita expenditure and spending compared to  GDP are presented too. The french system is defined as: “a statutory national health insurance system with compulsory, universal coverage for all French residents. Coverage is provided through health insurance funds, and participants are determined primarily by their occupation. Thirty chronic conditions, including diabetes, are fully covered.”  All other systems of the remaining eleven Countries are described alike.
On the item of preventive services efficacy, Canada ranked at the first place and France is eleventh just before the last one which is Switzerland.

Quotation by courtesy of the authors:
Paul H. Keckley, PhD
Executive Director
Deloitte Center for Health Solutions
Sheryl Coughlin, PhD, MHA
Head of Research
Deloitte Center for Health Solutions
Deloitte LLP
Deloitte Center for Health Solutions
555 12th Street N.W.
Washington, DC 20004
Phone 202-220-2177
Fax 202-220-2178
Toll free 888-233-6169

health insurance exchange

4 Jun

Its not the New York Stock Exchange (NYSE) but more simply the Health Insurance Exchange that the federal health reform law is actually designing in North America.

This exchange will offer individuals, small employers and small businesses the capacity to enroll in health insurance program with the highest quality/cost rate.

Hence, such an insurance choice should enhance the access to affordable cares for self employed workers.

The NASI (National Academy of Social Insurance) assists the states to implement this federal law ensued from the Patient Protection and Affordable Care Act (ACA)

diabetes 2 drugs faces adverse events

1 Jun

In the USA there is also a type 2 diabetes drug banned from the market and charged by state public attorneys like benfluorex in France.

God bless america

30 May

In the United States it is usual that in addition to the traditional basic safety screening questions asked by a family practitioner to he’s patient: (do you smoke, do you take alcohol, do you take drugs…) a relevant supplementary question (here is the difference with a French practitioner) is “do you keep a gun at home?“.

Fortunately states laws will take corrective measures against this insane investigation in Florida, Alabama, North Carolina and West Virginia.

A Medical practitioner must heel bullets injuries not ask question…

The National Physician Alliance published the top 5list of actions in primary care to enhance cost effectiveness in the archives of internal medicine (see our post entitled no is beautiful)

They recommends an unbranded doctor attitude with a lot of funny pins for sell

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