May 2008

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Does living in the suburbs make you fat?

May 23, 2008 in Obesity | Permalink

Living in an urban, pedestrian friendly area may compel individuals to walk more, and thus reduce the likelihood one is obese. Living in a suburban, car-dependent area makes walking less attractive and thus could increase obesity. Some studies have shown that individuals who live in the suburbs weigh more than individuals living in urban areas. Does living in the suburbs cause obesity?

The Vox EU website cites a paper (“Fat City“) that claims that urban sprawl is not to blame for increasing waistlines. The authors examine six years worth of data on 6000 people, 79% of whom changed addresses. They find that people who are more likely to be obese are more likely to move to sprawling neighbourhoods. However, those who moved from urban to suburban areas showed no additional weight change compared to individuals who moved from suburban to urban areas. It looks like a case of correlation not being the same as causation.

To find out how “walkable” your neighborhood is, check out Walk Score.

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Cavalcade of Risk #52

May 21, 2008 in Carnivals | 8 comments

There was this statistics student who, when driving his car, would always accelerate hard before coming to any junction, whizz straight over it , then slow down again once he’d got over it. One day, he took a passenger, who was understandably unnerved by his driving style, and asked him why he went so fast over junctions. The statistics student replied, “Well, statistically speaking, you are far more likely to have an accident at a junction, so I just make sure that I spend less time there.”

Maybe this isn’t the best way to minimize your risk. Our experts bloggers offer more profound risk advice in the 52nd edition of the Cavalcade of Risk.

Introduction to Risk (Baseball player, Nobel prize winner explain risk)

  • For those interested in baseball, Rich Maltzman uses a baseball analogy to explain how people view risk in the A verse on risk article posted at Scope crêpe.
  • The Cognition and Language Lab summarizes Daniel Kahneman’s Nobel-prize-winning model showing that “loss aversion” can better characterize how individuals react to risk.

Hot Jobs (Chief Risk Officer, Scuba Diver, Astronaut/Exterminator)

Health and Medical (Over-medicated? Over-treated? Over-weight? etc.)

Housing Risk

  • Buying a house is one of the most significant risks an individual takes in their life. Ernesto TIG of InsuranceYak.com warns that a “buyer beware” mentality is likely warranted in his Costner vs Maronda Homes post.

Computer Risk

Personal Finance

  • Is the average investor over- or under-estimating real estate risk in the declining market? Super Saver weighs in with Properly Assessing Risk posted at My Wealth Builder.
  • Mag Herrera of ‘Life. Money. Development’ is a personal finance advisor who actually likes Credit Cards.
  • What is the difference between market risk, inflation risk and management risk? The Blueprint for Financial Prosperity blog explains in their post titled Understanding Investment Risk Types.
  • Investing Angel of Stock Tips explains that the “herd mentality” causes most investors to Buy High And Sell Low.
  • Almost any investment you will make is risk. But in The Top 25 Low Cost US Money Market Funds, Larry Russell of the Skilled Investor Blog extols the virtues of maximizing the return on the component of an investment you can control: the fees.

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Mobile Phone Microscope

May 21, 2008 in Health Care in Developing Nations, Supply of Medical Services | Permalink

The Economist (“Doctor on Call“) has an shows that mobile phones may have another use for doctors: a microscope.

“Mr Maamari is a member of a research team led by Dan Fletcher, a professor of bioengineering at the University of California, Berkeley, which has developed a cheap attachment to turn the digital camera on many of today’s mobile phones into a microscope. Called a CellScope, it can show individual white and red blood cells, which means that with the correct stain it can be used to identify the parasite that causes malaria. Moreover, by transmitting an image directly over the mobile network, the CellScope could greatly help with the remote diagnosis and monitoring of many illnesses.“

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Pharmaceutical price increases slowing

May 20, 2008 in Pharmaceuticals | Permalink

Joe Paduda finds the price inflation is slowing for drug purchased through Workers Comp programs.

“Drug trend continues to moderate, with inflation in 2007 coming in at 4.3%. That’s a big improvement over last year’s 6.5%, which was a big improvement over the previous year’s 9.5%…”

One reason for the price decline may be that more people are using generic drugs. The percentage of prescriptions filled with generic “looks to be in the high seventy percent range.”

Mr. Paduda is also compiling his Fifth Annual Survey of Prescription Drug Management in Workers Comp which I am sure will be an interesting read.

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Google Health is up and running

May 20, 2008 in Healthcare IT, Information | Permalink

Today, Google has made its Google Health program publicly available. You can get a tour of Google Health here and FAQs are available here.

TechCrunch has a great comparison (“…Hands-on Look“) of Google Health and Microsoft’s HealthVault.

“Whereas HealthVault’s strengths seem to lie in tying together different health information silos on the back end, Google Health is focusing more initially on the consumer side. It is trying to do an end-run around the health establishment by trying to get consumers to manually load their own medical information into their profiles. HealthVault allows this as well, but seems to have stronger partnerships with back-end health data providers.”

Google promises never to advertise on Google Health. So how will they make money? Likely, there will be a Google search bar in the Google Health portal and Google can collect ad revenue from related Google.com searches.

TechCrunch wisely points out that:

“…the key is importing your medical record in there. That is going to be a huge hurdle in terms of people feeling comfortable giving that sort of data to Google in the first place, and then simply getting the data in an electronic form from their doctors.”

El periódico el País relata su opinión en el artículo “El Dr. Google te recuerda que tomes la pastilla” (en español).

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Medical Onshoring?

May 19, 2008 in Supply of Medical Services | Permalink

As the cost for health care has continued to rise, many Americans have looked for less expensive treatments in foreign countries. Living in San Diego, I can attest that many Southern Californians head to Tijuana to have their prescriptions filled. A Minot Daily News article (“Medical onshoring…“) claims that “more than 150,000 Americans traveled abroad for health care in 2006.” The article continues to state that Blue Cross and Blue Shield of South Carolina has formed affiliations with health care facilities in Thailand, Turkey, Ireland, Costa Rica and Singapore. Can anyone get affordable health care in the U.S?

The answer may be yes…on American Indian sovereign lands. C.A. Chien is proposing a Medical Onshoring project (see his Medical Onshoring blog). Health workers from foreign countries can be hired for lower wages and will not be subject to U.S. medical restrictions while they are on American Indian sovereign lands.

One wonders if the quality of care will suffer? Chien states that all his facilities “…will be accredited at JCI levels, equal to those in Japan, Singapore, Thailand, India, Europe, or the U.K.” In the Minot Daily article, Chien continues argues that “…his system and its proprietary technology could reduce U.S. health-care costs by at least 15 percent.”

Although the impact of this model may be limited to those who are living in areas near American Indian lands, I am in favor of any innovation which could lower costs while maintaining quality.

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Pharmaceuticals in Developing Countries

May 18, 2008 in Pharmaceuticals | Permalink

The Economist has an interesting article on how pharmaceutical companies are trying to hawk their wares in developing countries (“Quagmire or goldmine?“) Generally, Pharma has stayed away from selling in developing countries due to uncertainties in their level of patent protection. For instance, Brazil has “threatened to invoke compulsory licensing (a legal mechanism that, in effect, legitimises such trampling [of patent rights]) to browbeat a foreign drugs firm into offering huge discounts.”

However, emerging economies are a growing market. Companies such as Moksha8, have started to market branded drugs to affluent customers in developing countries. Further, research into emerging economy-specific diseases is growing.

Hopefully, all this money rushing into emerging market pharmaceuticals will better the health of those living in poorer regions around the world.

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BREAKING NEWS: Health Wonk Review offers new insights

May 15, 2008 in Current Events | 10 comments

This past weekend, I went to Washington, D.C. for a conference. I was able to slip away for a few hours to spend some time at the Newseum, a very interesting museum about News. Thus, this week I will present the Health Wonk Review in newspaper format.


COVER STORY

Health Affairs Blog: Health Reform In The 2008 Election. A conversation with a Harvard health policy professor, the president of Health Policy and Strategy Associates Inc, and a health policy correspondent for NPR.

POLITICS & MEDICARE

Colorado Health Insurance Insider: Two former HHS secretaries discuss ways to cut the cost of Medicare. Donna Shalala advocates eliminating waste and streamline the process in an effort to provide universal health care while Tommy Thompson who advocates increasing Medicare premiums, increasing the age for Medicare eligibility, and cutting benefits.

Health Care Renewal: “Punching primary care in the face.” How the RBRVS Update Committee’s advice rebarding Medicare’s physician reimbursement system will affect compensation for primary and preventive care.

Healthcare Economist: Medicare Part D decreases average overall pharmaceutical price by 12%. Drug formularies and negotiation with pharmaceutical companies are the cause.

Toxic World Blog: Why is the Bush administration trying to loosen the regulations to reduce pollution recently? EPA figures state that “we would go from a cost of $20 billion to a savings of $23 billion if we tightened smog rules…”

Home of the Brave: “Over 50% of all inpatient psychiatric care is delivered in prisons in the US.”

BUSINESS & TECHNOLOGY

Code Blue Now: French doctors make twice the average French wage, but American doctors earn five times the average American wage. Why is this? It can partially be explained by looking at differences in malpractice laws and the fact that medical school is nearly free for most French physicians.

Disease Management Care Blog: Coordinated Delivery Systems vs. Integrated Delivery Systems. Can an “outsourced and modular approach to health care” improve quality?

InsureBlog: What the hell is a “Doctor Nurse?”

Workers Comp Insider: Why aren’t more insurers focusing on wellness in workers comp programs?

The Health Care Blog: The pro and cons of one Health 2.0 website. And why iMedix creeps out Craig Stoltz.

REGIONAL (Revealing my West Coast Bias)

Health Access California: John McCain’s health care reform plans including creating high-risk pools. California, already has a high risk pool: MRMIP. How is it working? While MRMIP is a lifeline for individuals with pre-existing conditions, it is expensive, has an annual benefit cap of $75,000, and has a waiting list of 500 people.

Health Business Blog: Interview with Richard Noffsinger, CEO of SafeMed. SafeMed is based in San Diego.

OPINION & MISCELLANEOUS

Freedom and Individual Right in Medicine: FAQ on Free Market Health Insurance. In a free market, insurers should be able to exclude individuals based on a pre-existing condition and one should realize that it is not one’s social obligation to subsidize the health care of those who can’t afford it.

Systems Thinker reminds us that May is Borderline Personality Disorder Awareness Month.

Tort Reform and Birth Outcomes

May 14, 2008 in Economics - General, Public Policy, Supply of Medical Services | Permalink

Many doctors claim that the medical malpractice system is broken and needs to be fixed. Doctors have high malpractice insurance premiums and often practice defensive medicine to protect themselves against lawsuits. To help alleviate this problem, many politicians have asked for some sort of tort reform. Tort reform can be generally categorized into 4 types of legal changes:

  1. Caps on noneconomic damages. Noneconomic damages cover items other than monetary losses, such as pain and suffering.
  2. Caps on punitive damages. Punitive damages are awarded in addition to compensatory (economic and noneconomic) damages in order to punish defendants for willful and wanton conduct.
  3. Modifications of collateral-source rule. Under the common-law collateral source rule (CSR), amounts that a plaintiff receives from sources other than the defendant (e.g., from his or her own insurance) may not be admitted as evidence in a trial.
  4. Modifications of the joint-and-several liability (JSL) rule. In a trial with more than one defendant, the first step is to apportion blame for the harm. Under JSL, the plaintiff can then ask the “deep pockets” defendant to pay all of the damages, even if that defendant was responsible for only a small fraction of the harm. Modifications to the JSL rule often hold that the “Deep pockets” defendant must be at least 50% liable for the harm in order to be held 100% responsible for the damages.

Which of these reforms are helpful? A paper by Currie and MacLeod (QJE 2008) aims to answer this question. The authors look at variation in tort laws across states between 1989 and 2001. They claim that malpractice laws put doctors more at risk for a lawsuit is a good thing because it will cause them to behave more carefully. When doctors fear expensive lawsuits or a blow to their reputation, they may behave with more caution. Thus, capping punitive and non-economic damages should decrease caution. On the other hand the JSL rule puts doctors more at risk. They will not be protected from a suit simply be associating with a deep pockets hospital.

Empirical Results

To test this, the authors look at the number of Caesarean sections performed and the rate of induction or stimulation of labor. C-sections are popular with doctors because they receive additional compensation compared to a “regular” birth. However, performing a C-section on a mother who does not need it exposes them to additional risks. The authors find that “JSL reform reduces C-sections and complications of labor and delivery…In contrast, caps on damages are found to increase procedure use, and hence costs. They also increase complications of labor and delivery in some specifications.”

For a robustness check, the authors look at C-section rates for high- and low-risk babies separately. The authors assume that doctors have less treatment discretion for high risk cases, and the results demonstrate that tort reform had less of an effect on procedure rates or outcomes for high risk cases.

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Hospital: Man, Woman, Birth, Death, Infinity, Plus Red Tape, Bad Behavior, Money, God and Diversity on Steroids

May 13, 2008 in Books | Permalink

What is life really like working in a hospital? The Economist reviews a recent book by Julie Salmon titled Hospital: Man, Woman, Birth, Death, Infinity, Plus Red Tape, Bad Behavior, Money, God and Diversity on Steroids.  Here is an excerpt from The Economist:

“…the fine grain of Ms Salamon’s observations allows her to paint a compelling—and damning—portrait of a dysfunctional health-care system. She describes the chaotic emergency room, with patients waiting in holding patterns like aircraft at a busy airport, and the “frequent flyers”, as the staff call those they send away with prescriptions for medicines these patients cannot afford, knowing they will soon be back in a bad way once more.

She meets uninsured patients with seven-figure bills, destined never to be paid, who know that only if they stay do they retain the right to be treated. (The hospital can force them to leave only if they can do so on their own two feet.) And she meets some whose stay will be tragically brief, because lack of insurance has kept them away from doctors until it is too late. One such is a young mother from the Dominican Republic without papers but with cancer that is already terminal before she seeks medical help. She dies so quickly that there is little the hospital’s staff can do other than help her relatives arrange care for her three small children.”

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