New Thinking: Medical Hot Spots (Lowering Medical Costs by Giving Neediest Patients Better Care)

From the 2 August 2011 blog posting at Medical-Lee Speaking

Atul Gawande, associate professor of surgery and public health at Harvard and one of our most prolific contemporary physician-writers, adapts his New Yorker piece [full text of the article The Hotspotters] surveying innovative attempts to lower healthcare costs by better serving those patients with greatest need to a 13 minute PBS FRONTLINE report focused on one such program, the Camden Coalition of Healthcare Providers in Camden, New Jersey, led by Dr. Jeffrey Brenner, that is having unprecedented success.

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Evidence Links Increases In Public Health Spending To Declines In Preventable Deaths

Full Text Online Article from the 11 July 2011 issue of Health Affairs – At the Intersection of Health, Healthcare, and Policy

[Abstract]Public health encompasses a broad array of programs designed to prevent the occurrence of disease and injury within communities. But policy makers have little evidence to draw on when determining the value of investments in these program activities, which currently account for less than 5 percent of US health spending. We examine whether changes in spending by local public health agencies over a thirteen-year period contributed to changes in rates of community mortality from preventable causes of death, including infant mortality and deaths due to cardiovascular disease, diabetes, and cancer.

We found that mortality rates fell between 1.1 percent and 6.9 percent for each 10 percent increase in local public health spending. These results suggest that increased public health investments can produce measurable improvements in health, especially in low-resource communities. [Flahiff’s emphasis].However, more money by itself is unlikely to generate significant and sustainable health gains; improvements in public health practices are needed as well.

Click here to read the rest of the article

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What’s The Use Of Health Economic Evaluations?

From the 10 May 2011 Medical News Today article

The production of health economic evaluations of pharmaceuticals is a multibillion dollar industry globally. Nevertheless, little is known about uptake by medical decision makers.

Dr. Sandra Erntoft has investigated whether there are differences in use across decision makers and to what extent these patterns can be explained by contextual factors?

The review – “Pharmaceutical priority setting and the use of health economic evaluations – A systematic literature review”, published in Value In Health identifies differences in the use between decision makers and contexts. Health Economic evaluations are not only used in order to inform decisions, but also serves the purpose of rationalize decisions, structuring the priority setting process or requesting additional budgets. Factors that seem to support an increased use of health economic evaluations are a general awareness and acceptance of limited health care resources, demands for an explicit priority setting process, the lack of budgetary responsibilities and the presence of health economic skills.

Dr. Sandra Erntoft, Research Director of the Swedish Institute for Health Economics says “When these preconditions are not in place, it is difficult for a decision maker to use health economic evaluations directly in medical decision making. In order to increase the use these cultural and institutional barriers need to be removed.”

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