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China standard is living as funds from export industries eventually trickle down into the earnings of (some) ordinary Chinese. Where are the Chinese spending their newfound wealth?  In part, the answer is self-beautification procedures.  According to the Economist:

China performs more cosmetic surgery than any country except America and Brazil. Almost 1.3m licensed procedures were carried out in 2010, according to the International Society of Aesthetic Plastic Surgery (as well as many more unlicensed ones). The market, which barely existed 15 years ago, is now worth some $2.4 billion. China’s growing wealth, and its obsession with celebrity culture, is fuelling the increase. Beauty is also deemed an advantage in the competitive white-collar workplace. People in search of a job submit a photograph with their application…The three most common procedures are double eyelid surgery, liposuction and nose jobs.”

Not all is well, however.

…a leading plastic surgeon, called for higher standards after botched surgery complaints reached 20,000 a year. Her plea echoes that of Ma Xiaowei, a vice-minister of health, who said that during a random inspection of plastic surgery clinics in 2010, fewer than half met national standards.

…As many as 70% of China’s cosmetic procedures take place in unlicensed salons that offer simple procedures such as face-slimming injections.  Some doctors, badly paid in state-run hospitals, moonlight in illegal salons.

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Antibiotics such as penicillin have helped to fight numerous diseases such as syphilis, and infections caused by staphylococci and streptococci.  However, overuse of antibiotics is a problem.  Physicians sometimes prescribe antibiotics to fight viral infections even though antibiotics are only effective against bacterial infections.  Because of this overuse, more and more strains of drug-resistant bacteria are appearing.  The Economist estimates that drug-resistant bacteria cost Europe alone €1.5 billion per year in health care cost and lost productivity.

Creating new antibiotics to fight drug-resistant bacteria is one of the most important challenges facing mankind.  Drug companies, however, are less enthusiastic about producing these types of drugs.  Patients take drugs for chronic diseases for a lifetime; drugs for antibiotics are usually only taken for a few week.  ”Between 1983 and 1992 American regulators approved 30 new antibiotics. Since 2003 they have approved just seven.”  Funding drug research for antibiotics, however, could change these priorities.

In the fight against drug-resistant bacteria, Europe is leading the way.  On May 8th the European Commission and Europe’s pharmaceutical association gave details of a plan to boost antibiotics research by up to €590m ($760m).

Will the U.S. match the European initiative with similar funding levels? Only time will tell.

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Governor Chris Christie vetoes a bill today that would form have created a health exchange in New Jersey.

“While I appreciate the Legislature’s attempt to find steady policy footing in these shifting legal sands, I am concerned that a hastily created exchange in New Jersey will impose unnecessary obligations upon the state’s citizens,” Christie said in his veto message. “I believe the better course of action … is to continue to monitor the ever-changing landscape surrounding the implementation of the Affordable Care Act, and to refrain from imposing its mandates upon our citizens until outstanding issues are settled.”

Will ObamaCare ever be implemented?  And if so, what provisions will be implemented in which states?  This is an open question that will not come close to being resolved until the Supreme Court makes its decision on the constitutionality of the Affordable Care Act.

For patients with osteoarthritis, the answer is not at all.

A paper in the New England Journal of Medicine examined 180 patients 75 years old or younger, that had osteoarthritis of the knee, and reported at least moderate knee pain on average despite medical treatment.  The researchers randomized this individuals into three groups:

  • Surgery Group #1 (Lavage): The joint was lavaged with at least 10 liters of fluid. Anything that could be flushed out through arthroscopic cannulas was removed. Normally, no instruments were used to mechanically débride or remove tissue.
  • Surgery Group #2 (Débridement): The joint was lavaged with at least 10 liters of fluid, rough articular cartilage was shaved (chondroplasty was performed), loose debris was removed, all torn or degenerated meniscal fragments were trimmed, and the remaining meniscus was smoothed to a firm and stable rim.through arthroscopic cannulas was removed. Normally, no instruments were used to mechanically débride or remove tissue.
  • Placebo Procedure: To preserve blinding in the event that patients in the placebo group did not have total amnesia, a standard arthroscopic débridement procedure was simulated. After the knee was prepped and draped, three 1-cm incisions were made in the skin. The surgeon asked for all instruments and manipulated the knee as if arthroscopy were being performed. Saline was splashed to simulate the sounds of lavage.

The authors compared patient pain levels in these three groups before the surgery and after the surgery at regular increments (2 weeks,  6 weeks, 3 months, 6 months, 1 year and 2 years.)    The authors found that “At no point did either arthroscopic-intervention group have greater pain relief than the placebo group.

Read the rest of this entry »

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The latest edition of the health work review is up at InsureBlog.

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Some medical procedures and tests are unnecessary.  Others can even be harmful to patients.  In an effort to reduce the frequency of these services, Consumer Reports is teaming with the ABIM Foundation and nine medical specialty societies to develop evidence-based lists of tests and procedures for patients and physicians to question as part of Choosing Wisely.  According to their website:

The goal of this campaign is to help physicians, patients and other health care stakeholders think and talk about overuse of health care resources in the United States. The campaign is part of the ABIM Foundation’s goal of promoting wise choices bWy clinicians in order to improve health care outcomes, provide patient-centered care that avoids unnecessary and even harmful interventions, and reduce the rapidly-expanding costs of the health care system.

Why would a medical society agree to identify care that is unnecessary?  Some potential reasons, some more cynical than others:

  • Physicians care about patients
  • Physicians want to maintain their reputation as nearly above reproach.  By identifying unnecessary services, doctors will be less susceptible to criticism that they are profit-driven,
  • By creating of list of procedures that should not be done, physicians may be implicitly indicating that the remaining procedures not on the list are on average beneficial to patients;
  • Physicians may place low-margin unnecessary tests on the list, but leave high-margin unnecessary tests off the list.

Most of the current recommendations are very obvious (e.g., don’t give a stress test to people without symptoms, don’t conduct imaging tests for patients with general headaches.   Nevertheless, preventing unnecessary tests can not only help reduce cost, but it can improve patient health.

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Surprisingly (or perhaps not) most Americans have limited liquid financial resources during their retirement years.  From the NBER Bulletin on Aging and Health:

…for many households “discussions of whether to purchase an annuity or draw down wealth in another fashion are largely moot; the amount of retirement support that their savings will provide is very limited. For example, nearly half (43 percent) of households would not be able to make the $25,000 minimum investment typically required to purchase an annuity even if they liquidated all of their financial assets.

Source:

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A number of studies have already examined this question.

  • Baker et al. (2003) examined the effectiveness of a public reporting effort in hospitals in Ohio, finding little relationship between a hospital’s report card ranking and changes in its market share.
  • Cutler et al. (2004) examined the effects of reporting quality information about cardiac surgery on hospital volume, finding that being identified as a high-mortality hospital was associated with a decline in the number of cardiac surgery patients at that hospital in the period following the designation.
  • Dafny and Dranove (2008) examine the influence of Medicare HMO report cards…showing that highly ranked plans were gaining market share prior to the report cards’ release but that the report cards led to further gains in market share for high-scoring plans.
  • Chernew et al. (2008) use a Bayesian learning model to estimate enrollees’ general assessment of plan quality prior to the release of report cards and the changes in these assessments over time. They find that the addition of publicly reported plan information has a small incremental effect.

A more recent study by Werner et al. (2012) examines whether Medicare’s Nursing Home Compare website affects consumer decisions. Nursing Home Compare evaluates nursing homes using a variety of factors including: 1) whether they passed inspections, 2) structural measures such as staffing ratios, 3) quality measures reported on MDS assessments.

The authors find “a very small (though statistically significant) demand response to public reporting.”  Skilled nursing facility (SNF) market share experienced a 0.1% increase in market share in cases where the facility increased its reported quality of treating patient pain from the 25th percentile SNF to the 75th percentile SNF.

Werner et al. note that this small economic response implies that SNFs are unlikely to invest in quality improvement since improving quality will not increase market share and improve profits.

One shortcoming of the study is that it only focuses on SNFs.  Since Medicare uses SNFs for shorter term post-acute care, the study cannot identify changing consumer responses for long-term nursing stays.  Because the time the patient spends in long-term nursing homes is typically much longer than SNFs and because patients typically have more time to review their long-term nursing home options than would be the case when they enter SNFs, it is more likely that a consumer response would be observed in the long-term nursing home setting.

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