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
Ann Intern Med. 2014;160(9):585-593. doi:10.7326/M13-2275
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.
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.
Before the health insurances era Doctors were often payed in nature with eggs, chicken or other farm products. Needless to say that they were often poorly paid, furthermore people called them so lately that the care was unable to keep them alive and the doctors lost their patients in the same time. Once the Doctors and the people they cared got the health insurances to be created Doctors received currencies for their services and could see more than once their patients. The issue of payment was transferred to the insurer. In the beginning insurers reimbursed with a fee for service model like the patients did previously. But the increasing amount of money needed made them think of an alternative payment model. And here came the Pay for Performance model.
France has already put in place such a payment model here:
USA will implement this mode of payment in 2019 here:
Developing countries have already experienced these kind of payment here:
Below are other links related to the way Doctors will be payed in the future:
The Affordable Care Act (aka Obamacare) is practically a laboratory experiment at the scale of a continent that allows health economists to observe the effects of expending the health coverage to a whole population (a thing that Europeans have done and that they call modestly Universal Disease Coverage, in French couverture maladie universelle or CMU). Starting from his reading of a
Congressional Budget Office (CBO) report the health economist Austin Frakt lists the incentives and disincentives to work that a mandatory health coverage creates. But in my view the point is: does the labor market need workers anymore, with or without health coverage? If it really needs workers then it would be better that they could afford care and rehabilitation, it is the interest of both the employer and the employee. If it doesn’t, the labor market will always consider that the costs are to high.
The blog the incidental economist is about health economics, below is the post with a link to the CBO report:
Here below is a link toward a blogger who listed 21 arguments attempting demonstrate why and how people could afford themselves to avoid to subscribe to a mandatory health care insurance.
In my point of view, this kind of discourse do not consider two corner stones of the issue of health care insurance: solidarity (or in other word compassion toward our less wealthy fellow citizens) and the disproportional cost of the modern cares compared with the financing capacity of a single person.
Nonetheless the blogger’s propositions related to the chronic diseases prevention should be implemented. But the are not sufficient in case of an accidental damage.
Recently I found a definition of the field I am interested in: ie the health services research. Wikipedia defines it as ” to examine how people get access to health care practitioners and health care services, how much care costs, and what happens to patients as a result of this care.” quoting Academyhealth in the references.
Putted more simply, and according to Academyhealth, HSR tries to give responses to 4 questions in the field of health care in a community:
At what cost?
Under what circumstances?
Read more here
Nurse Anesthetists Do Not Need Doctor Supervision according to Schwartzy
nurse anesthetist students at UH (Photo credit: UMDNJ School of Nursing)
Governor Arnold Schwarzenegger. (Photo credit: Wikipedia)
Arnold Schwarzenegger, LA, USA (Photo credit: Wikipedia)
Thanks to Arnold Schwarzenegger, the Austria origin actor, the state of California is now in quasi bankruptcy while the richest of its citizens are more and more rich and the others are very poor, even homeless. This is a good example of what might become Europe if the ongoing right-wing policy is to be continued.
A solution that the CEOs and health care policy makers have found to cut spendings in hospital cares is to let nurses make the job of medical doctors. It is particularly frightening when it happens that those doctors in question who have been replaced by nurses are the anaesthetists.
Will the next step be to replace pilots by hostesses in Californian airplanes?
Well spending cuts is now directly threatening the patient health in the aim to protect the tax payer wealth!