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Revisiting Mortality Versus Survival In International Comparisons Of Cancer Care

April 1st, 2015

No one doubts that the US spends more than any other country on health care.  Whether this higher spending produces commensurate health benefits, however, is far from certain.

In the April 2012 issue of Health Affairs, Philipson et. al. make an intuitively persuasive observation, one which they summarize in their recent Health Affairs Blog post (authored by Goldman, Lakdawalla, and Philipson): “We find that survival after diagnosis rose more quickly in the U.S. than the E.U.”

Given this observation, they go on to make an inference, namely that the US gets value from it additional expenditures on cancer care.  It would be nice were the world so simple.  But it’s not.

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Mortality Versus Survival In International Comparisons Of Cancer Care

March 20th, 2015

In a recent paper, Soneji and Yang revisit a topic we first explored in the April 2012 issue of Health Affairs — namely, whether the U.S. gets value for its cancer care. We found that life expectancy after cancer diagnosis rose more quickly for patients in the U.S. than for patients in Europe. Moreover, while spending per patient also rose more quickly in the U.S., Americans still received good value from the health care system. Compared to the gains seen in Europe, for example, each additional life-year gained in the U.S. cost roughly $20,000 in additional U.S. spending.

Soneji and Yang re-examine trends in cancer deaths in the U.S. and Europe and draw different conclusions. While we welcome the attention paid to this important issue, Soneji and Yang’s conclusions rest on fundamental flaws in their own approach and a misunderstanding of the methods we use in our study.

To understand the value of U.S. cancer care, one must ask whether the health care system performs better for U.S. cancer patients than those of other countries and at what cost. In attempting to answer this question, Soneji and Yang ask whether more people die from cancer in the U.S. or in Europe. This isn’t the right question. The total number of people dying from cancer is a misleading indicator of health system performance. Factors like poverty, pollution, smoking, diet, and exercise all contribute to the number of people acquiring cancer and dying from it, and confound the effects of cancer treatments. The bottom line is that mortality reflects treatment, but it also reflects the number of people who get cancer.

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Health Affairs’ March Issue: The Benefits And Limitations Of Information

March 2nd, 2015

The March issue of Health Affairs contains papers focusing on the benefits—and the limitations—of information-gathering processes as a way to solve health system problems. Studies in this variety issue examine US hospital rating systems, disclaimers on dietary supplements, state prescription drug monitoring programs, the value of US versus Western European cancer care and other topics.

National hospital rating systems show little agreement — what’s a consumer to do?

Matt Austin of Johns Hopkins Medicine and coauthors compared four well-known national hospital rating systems designed for use by US consumers: U.S. News & World Report’s Best Hospitals; HealthGrades’ America’s 100 Best Hospitals; Leapfrog’s Hospital Safety Score; and Consumer Reports’ Health Safety Score. They analyzed ratings covering the time period from July 2012 to July 2013.

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The Innovation Conundrum In Health Care

December 12th, 2014

Editor’s note: This post is part of a series of several posts related to the 4th European Forum on Health Policy and Management: Innovation & Implementation, to be held in Berlin, Germany on January 29 and 30, 2015. For more information or to request your personal invitation contact the Center for Healthcare Management.

It is never too early for new technology in health care. In contrast to the innovator’s dilemma in other industries where the adoption can be sluggish because current customers may not be able to use the future’s toolbox, in medicine innovators always can be assured of an audience when announcing the “life-saving impact” of something new.

Coverage and widespread implementation usually are a different story, but creating hype and demand for unusual and unfamiliar medical technology has never been hard. But who then drives the invention, diffusion, application, and evaluation of such innovation?

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Yes, We Can Transcend Obamacare

November 6th, 2014

In a recent  Health Affairs Blog post, Washington and Lee University law professor Timothy Jost described a new health-reform plan designed by one of us (Roy) and fiscally modeled by the other (Parente) as a “serious proposal [that] deserves to be taken seriously.” Jost praises parts of the plan. Most notably, he writes that its suggested reform of Medicaid “makes a lot of sense and is similar to proposals made earlier by progressive commentators,” and describes its aim of enacting a uniform annual deductible for Medicare as a “common sense proposal.”

But much of Jost’s review is filled with ideological pique—there are various harrumphs about “nostrums” and “talking points” and “hobby horses.” His article contains some factual and analytical inaccuracies, but also a few good points worth discussing.

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Eleven-Country Survey Finds US Insurance Most Complex

November 18th, 2013

According to a November 13 Health Affairs Web First survey of eleven different countries’ health care, US adults are significantly more likely than their counterparts in other countries to forgo care because of cost, to have difficulty paying for care even when insured, and to encounter time-consuming insurance complexity. Cathy Schoen and colleagues at The […]

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Inequality Is At The Core Of High Health Care Spending: A View From The OECD

October 9th, 2013

It is commonly said that the US spends more than twice as much on health care as other developed countries, yet its outcomes are worse. The inference is that too much care is provided, to no good end.

Such international comparisons are drawn from the Organization of Economic Cooperation and Development (OECD), a group of 34 developed countries. Analyzing these data is a multi-step process, like peeling an onion, and the truth resides deep within its core.

The process starts by adjusting health care spending for “purchasing power parity” (PPP) and expressing it in US dollars. By that measure, per capita spending in the US is 160 percent more than the OECD mean (Panel A, left bracket), and this is the basis for the notion that the US spends more than twice as much. But it is only the first layer.

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The April Issue Of Health Affairs: The ‘Triple Aim’ Goes Global

April 8th, 2013

The April issue of Health Affairs, released today, examines how all high-income countries are struggling to achieve the “Triple Aim” — better health and better health care at lower cost. The articles in this issue find that the United States and other high-income countries have much to learn, with the “trade” in strategies and tactics likely to flow both ways.

Join us on Thursday, April 11, for a briefing on the April issue. Support for the new Health Affairs volume was provided by The Commonwealth Fund, Britain’s Nuffield Trust, and the Institute of Global Health Innovation at Imperial College London.

Drug Payment And Pricing — How Do US Practices Compare With Other Countries?

A featured study by Panos Kanavos of the London School of Economics and Political Science and coauthors compared prescription drug prices among selected countries that are members of the Organization for Economic Cooperation and Development in 2005, 2007, and 2010. Depending on how prices were adjusted for the volume of drugs consumed in the various countries, drug prices in the United States were between 5 percent and nearly 200 percent higher than in the other nations studied. A key contributing factor is that the United States takes up new and more expensive prescription drugs faster than other countries. The authors recommend that the United States require pharmaceutical manufacturers to provide more evidence about the value of new drugs in relation to cost before use of such drugs is reimbursed.

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Global Health and US Academia: Converging Interests

April 5th, 2013

As the debate over federal budget allocations and cuts continues, the National Institutes of Health (NIH), a leading funder for both domestic and global health research, could experience a whopping $1 billion budget cut. To date, modest investments in global health have helped create platforms for discovery science, such as large multiethnic studies of genetics and epigenetics; transformative programs, such as the President’s Emergency Plan for AIDS Relief; and life-altering interventions, such as oral rehydration salts, now widely used in the management of dehydration caused by diarrhea. Not only would large cuts to the NIH slow our progress in improving health worldwide, but they would also be out of step with the burgeoning interest in global health at universities across the United States.

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Health Affairs Briefing: The Triple Aim Goes Global

April 1st, 2013

You are invited to join us on Wednesday, April 11, when Health Affairs will hold a briefing to discuss its April 2013 issue, “Triple Aim Goes Global.”

The April issue examines how all high-income countries are struggling to pursue better health, better care, and lower cost – and to bring all of these goals into alignment. The issue received funding support from The Commonwealth Fund, the Nuffield Trust, and Imperial College London.

The briefing will take place at the Barbara Jordan Conference Center at the Kaiser Family Foundation, 1330 G Street, NW, in Washington, DC, on Thursday, April 11, 2013, 8:00 a.m. – 12:30 p.m.

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The Patient-Centered Medical Home In Europe

March 21st, 2013

A Health Affairs Web First study released yesterday finds that five European countries have adopted aspects of patient-centered medical homes, a US model for comprehensive care. However, additional efforts are needed to fully implement this concept outside the United States. The data was gathered through a survey, questioning 6,428 patients who had one of eight common chronic illnesses. Also, 152 primary care providers across five European countries (Belgium, Denmark, Germany, the Netherlands, and England) were queried.

Marjan Faber of Radboud University in the Netherlands and coauthors found that each country offered high quality of care for its patients — between 87 and 98 percent of patients in Germany, Belgium, the Netherlands, and Denmark had a single primary care physician. The rate was lower in England — 74 percent — where more primary care tasks are typically delegated to nurses. Although the survey demonstrated agreement in most areas between patients and physicians in evaluating their primary care experience, significant differences did emerge in the Belgian, Dutch, and English samples on frequency of illness self-management instructions

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The US Health Disadvantage And Clinicians: An Interview With Paula Braveman

February 22nd, 2013

The US spends far more per person on health care than any other nation. But a growing body of research demonstrates that Americans – rich or poor, minority or not – suffer from a widening “health disadvantage” when compared to citizens of other high-income countries. On January 9, the Institute of Medicine (IOM) and the National Research Council released “U.S. in International Context: Shorter Lives, Poorer Health.” Commissioned by the National Institutes of Health, a panel chaired by Professor Steven H. Woolf at Virginia Commonwealth University painstakingly investigated whether Americans of all ages were affected by a growing health gap previously observed between older Americans and their foreign counterparts.

The panel examined several decades of data from the US and 16 comparable high-income countries, most of which are European. What they found is, or should be, alarming, even for seasoned health advocates and policymakers. The report’s authors sound the alarm at the outset: “We uncovered a strikingly consistent and pervasive pattern of higher mortality and inferior health in the United States, beginning at birth.”

What does this report mean for clinicians and health systems, especially at a time when doctors, nurses and other health care professionals are adjusting to a shifting landscape of structural reforms? Is this a clarion call for clinicians, educators and policymakers to engage in realigning the way we deliver care? Or will this news drive clinicians to sound a retreat from the front lines of population health-oriented system change?

On January 11, two days after the release of the IOM report, I talked with one of the IOM panelists behind the report, Paula Braveman MD MPH, Professor of Family and Community Medicine and Director, Center on Social Disparities in Health at UCSF. I spoke with her on behalf of HealthBegins, a social enterprise and online community of clinicians and others committed to improving health care and the social determinants of health. We discussed the report and what it means for America’s clinicians.

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Lessons In Quality Improvement: Learning From Hospital Closures In Lancashire

February 1st, 2013

In health care quality improvement circles, the story of England’s East Lancashire has taken on almost mythical status: working with county and borough councils, local hospital organizations, and medical leaders in primary and secondary care, an executive of the National Health System (NHS) managed to close a substantial number of hospital beds — all the […]

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Advancing The Responsible Use Of Medicines: Quantifying Avoidable Health System Costs

December 6th, 2012

With global spending on medicines likely to reach one trillion dollars by 2014, and growing concern about the cost-effectiveness of all parts of healthcare spending, an examination of the ways in which medicines are used is both timely and relevant to understand their impact on patient outcomes and the costs of delivering healthcare.

A recent report by the IMS Institute for Healthcare Informatics tackles the issue of understanding the linkage between responsible medicine use and health system costs. By examining six levers for improving medicine use, and developing an economic model to estimate global avoidable costs, the Institute was able to illuminate the magnitude of the opportunity for improvement – avoiding costs for health systems while maintaining or improving health outcomes.

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Ten-Country Primary Care Survey: Progress In Health IT, Less Elsewhere

November 15th, 2012

Redesigning primary care is an integral part of health reforms in the United States and elsewhere. A new study, released today as a Web First by Health Affairs, reports the results of a survey of primary care doctors in the United States and nine other countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Switzerland, and the United Kingdom.

The survey, conducted between March and July 2012, found US and German physicians the most negative about their health care systems: only 15 percent of US and 22 percent of German practitioners thought their systems worked well. On the brighter side, the survey found that 69 percent of US doctors report the use of electronic health records, bringing use in the United States closer to the Netherlands, New Zealand, the United Kingdom, and Norway, all with near-universal capacity.

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World Diabetes Day: Health Affairs Resources

November 14th, 2012

To mark World Diabetes Day, I wanted to call readers’ attention to the thematic issue on diabetes published by Health Affairs in January 2012. Much of the issue dealt with the diabetes crisis in the United States, but several articles dealt with the global diabetes epidemic. For example, K.M. Venkat Narayan of Emory University and colleagues argued for four “policy paradigm shifts” in the global battle against diabetes:

conceptually integrating primary and secondary prevention along a clinical continuum; recognizing the central importance of early detection of prediabetes and undiagnosed diabetes in implementing cost-effective prevention and control; integrating community and clinical expertise, and resources, within organized and affordable service delivery systems; and sharing and adopting evidence-based policies at the global level.

The issue also included a look at a diabetes pay-for-performance program in Taiwan. Interested readers can visit the Health Affairs website to view our briefing on the January issue.

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More Avoidable Deaths In The US Than In Three European Countries

August 30th, 2012

Amenable mortality—deaths that could have been avoided with timely and appropriate health care—accounts for 21 percent of deaths among men and 30 percent among women under the age of 75 in several high-income countries. A Health Affairs Web First study released yesterday compares mortality rates in the Unites States, France, the United Kingdom, and Germany […]

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When Epidemiology Goes Astray: Valuing Cancer Care In The United States And Europe

May 14th, 2012

In a recent Health Affairs paper, we documented that the United States has a significant survival advantage over much of Europe when it comes to cancer: 1.8 years for those diagnosed during our study window.  Furthermore, we showed over a 17-year period that this gap had widened, not narrowed, and that this widening was more […]

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Higher Physician Spending In U.S. Driven By Fees, Not Practice Costs

September 8th, 2011

Research appearing in the newly released September issue of Health Affairs shows that physicians in the United States are paid more per service than doctors in other countries—in some cases double. There is also a far bigger gap between fees paid for primary care and fees paid for specialty care in the United States, compared […]

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We’re Only Human: Behavioral Economics And British Policy (Part 2)

July 20th, 2011

    Editor’s Note: This is the second part of a two-part post discussing behavioral economics and how it is being used by British policymakers. Part 1 focused mostly on the development and general principles of behavioral economics. Part 2 below discusses some of the ways British policymakers are seeking to use insights from behavioral economics. Behavioural […]

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