Month: February 2004

The Global Fund for AIDS, TB and Malaria has suspended its funding to Ukraine.

The Global Fund for AIDS, TB and Malaria has suspended its funding to Ukraine.

Wish us luck as we re-register.

I’ve been doing some election research. Not exactly on-topic in terms on Central Asia, but maybe useful anyway:

What’s wrong with John Kerry’s Health Plan?

This is a solid plan to improve access to health care in America. Expanding access to the federal employee health plan will improve risk-polling and serve effectively to improve access to insurance. Covering all children is a valuable and important goal.

However, this plan will not do much to lower health care costs or improve quality of care. It’s a band-aid that will attempt to lower health care costs without addressing the true structural problems of the American health care system. You can’t fix the US health care system without making difficult decisions, decisions that this plan is trying to avoid.

His plan for controlling health care costs, and my comments, are as follows:

Creating a new approach to control spiraling health care costs – and passing the savings on to workers

This premium rebate pool isn’t a bad idea, but I don’t know how much effect it will actually have on reducing costs. I like the idea of encouraging employers to do disease management.

Making prescription drugs more affordable

This is very weak. Picking on pharmacy benefit managers seems petty, and unlikely to lead to real savings. Loopholes on generic drugs are part of the problem of high priced prescription drugs, but if brand-name drugs weren’t so exorbitant, then we wouldn’t need generics so badly. The same is true with negotiating discounts on prescription drugs.

The real reason that drugs are so expensive in the US is because drug companies spent vast sums of money on advertising. Advertising dwarfs R&D as a drug company expense. If we placed limits on drug company advertising, that would be a big step in the right direction. We could also do what the Europeans do, and place a legal limit on how much profit pharmaceutical companies are permitted to make off a single drug. Limiting advertising and the profit which can be made of individual drugs would encourage pharmaceutical companies to do more research on more different kinds of drugs, instead of the current system which has every company chasing for the best new allergy and acne medications. It would also substantially bring down drug costs.

Making malpractice insurance more affordable

His suggested ideas, while sound, are unlikely to have any major effect on malpractice insurance costs at all.

Improving care and reducing costs with a new quality bonus

The “Quality Bonus” concept is intended to provide financial incentive for providers to improve the systems involved in quality of care. This systemic approach is a good one; medical errors in the United States stem from a flawed system, not from incompetent providers. Supporting modern information systems, computerized prescribing systems, and making errors transparent is valuable, but it is never explained how the quality bonus would be implemented to achieve this.

Cutting administrative costs in half with a new “technology bonus”

These ideas are sound. Improving record-keeping through computerization would improve the efficient of health care, and cut costs by reducing the time spent on paperwork.

Reducing uncompensated care costs and investing in the safety net

Investing in health care for underserved populations is always a public good. The question is whether Kerry’s plan will really save the $10 billion annually he wants to use to invest in community, migrant, homeless, and school-based health centers. If these saving do not occur, does the investment still take place?

Supporting disease prevention and health promotion programs

The US government is already actively involved in disseminating best practices in diseases prevention. It’s hard to see what else could be done. In addition, the federal government’s efforts at health promotion have been pretty weak – nowhere near best practices in the field. Scaling up existing programs will not work – it would require an entire new approach.

Things John Kerry fails to address:

Nursing care A shortage of nurses is one of the greatest threats facing the US health care system. As baby boomers age, more hospital care, and more nurses, will be required. Yet there are not enough nursing students to meet this increase in demand, and trained nurses are leaving the profession in droves. It’s a vicious circle – fewer nurses means more patients per nurse and worsening hospital care. Nurses then leave the profession because of the stress of trying to do a job without adequate support, leaving even fewer nurses to do an even more difficult job.

What we need are strong incentives to keep existing nurses in the profession, and to encourage the training of additional nurses. This could include regulations mandating a proper patient to nurse ratio and tuition incentives for students training to become nurses. Reaching out to non-traditional student populations would also be useful – recruiting more men and more students from populations less likely to go to college.

Specialty Care Reducing the American dependence on specialists could significantly reduce the cost of health care in the United States. You don’t need to see a dermatologist about acne, and you don’t need to see a gastroenterologist about a stomachache. Encouraging people to see their family physicians first both improves care and decreases cost. In Britain, they have found that a well trained general practitioner can also provide gynecological care, and oversee a health pregnancy. In fact, births attended by general practitioners had better outcomes that those overseen by ob-gyns.

I’ve been doing some election research. Not exactly on-topic in terms on Central Asia, but maybe useful anyway:

What’s wrong with John Kerry’s Health Plan?

This is a solid plan to improve access to health care in America. Expanding access to the federal employee health plan will improve risk-polling and serve effectively to improve access to insurance. Covering all children is a valuable and important goal.

However, this plan will not do much to lower health care costs or improve quality of care. It’s a band-aid that will attempt to lower health care costs without addressing the true structural problems of the American health care system. You can’t fix the US health care system without making difficult decisions, decisions that this plan is trying to avoid.

His plan for controlling health care costs, and my comments, are as follows:

Creating a new approach to control spiraling health care costs – and passing the savings on to workers

This premium rebate pool isn’t a bad idea, but I don’t know how much effect it will actually have on reducing costs. I like the idea of encouraging employers to do disease management.

Making prescription drugs more affordable

This is very weak. Picking on pharmacy benefit managers seems petty, and unlikely to lead to real savings. Loopholes on generic drugs are part of the problem of high priced prescription drugs, but if brand-name drugs weren’t so exorbitant, then we wouldn’t need generics so badly. The same is true with negotiating discounts on prescription drugs.

The real reason that drugs are so expensive in the US is because drug companies spent vast sums of money on advertising. Advertising dwarfs R&D as a drug company expense. If we placed limits on drug company advertising, that would be a big step in the right direction. We could also do what the Europeans do, and place a legal limit on how much profit pharmaceutical companies are permitted to make off a single drug. Limiting advertising and the profit which can be made of individual drugs would encourage pharmaceutical companies to do more research on more different kinds of drugs, instead of the current system which has every company chasing for the best new allergy and acne medications. It would also substantially bring down drug costs.

Making malpractice insurance more affordable

His suggested ideas, while sound, are unlikely to have any major effect on malpractice insurance costs at all.

Improving care and reducing costs with a new quality bonus

The “Quality Bonus” concept is intended to provide financial incentive for providers to improve the systems involved in quality of care. This systemic approach is a good one; medical errors in the United States stem from a flawed system, not from incompetent providers. Supporting modern information systems, computerized prescribing systems, and making errors transparent is valuable, but it is never explained how the quality bonus would be implemented to achieve this.

Cutting administrative costs in half with a new “technology bonus”

These ideas are sound. Improving record-keeping through computerization would improve the efficient of health care, and cut costs by reducing the time spent on paperwork.

Reducing uncompensated care costs and investing in the safety net

Investing in health care for underserved populations is always a public good. The question is whether Kerry’s plan will really save the $10 billion annually he wants to use to invest in community, migrant, homeless, and school-based health centers. If these saving do not occur, does the investment still take place?

Supporting disease prevention and health promotion programs

The US government is already actively involved in disseminating best practices in diseases prevention. It’s hard to see what else could be done. In addition, the federal government’s efforts at health promotion have been pretty weak – nowhere near best practices in the field. Scaling up existing programs will not work – it would require an entire new approach.

Things John Kerry fails to address:

Nursing care A shortage of nurses is one of the greatest threats facing the US health care system. As baby boomers age, more hospital care, and more nurses, will be required. Yet there are not enough nursing students to meet this increase in demand, and trained nurses are leaving the profession in droves. It’s a vicious circle – fewer nurses means more patients per nurse and worsening hospital care. Nurses then leave the profession because of the stress of trying to do a job without adequate support, leaving even fewer nurses to do an even more difficult job.

What we need are strong incentives to keep existing nurses in the profession, and to encourage the training of additional nurses. This could include regulations mandating a proper patient to nurse ratio and tuition incentives for students training to become nurses. Reaching out to non-traditional student populations would also be useful – recruiting more men and more students from populations less likely to go to college.

Specialty Care Reducing the American dependence on specialists could significantly reduce the cost of health care in the United States. You don’t need to see a dermatologist about acne, and you don’t need to see a gastroenterologist about a stomachache. Encouraging people to see their family physicians first both improves care and decreases cost. In Britain, they have found that a well trained general practitioner can also provide gynecological care, and oversee a health pregnancy. In fact, births attended by general practitioners had better outcomes that those overseen by ob-gyns.

I’ve been doing some election research. Not exactly on-topic in terms on Central Asia, but maybe useful anyway:

What’s wrong with John Kerry’s Health Plan?

This is a solid plan to improve access to health care in America. Expanding access to the federal employee health plan will improve risk-polling and serve effectively to improve access to insurance. Covering all children is a valuable and important goal.

However, this plan will not do much to lower health care costs or improve quality of care. It’s a band-aid that will attempt to lower health care costs without addressing the true structural problems of the American health care system. You can’t fix the US health care system without making difficult decisions, decisions that this plan is trying to avoid.

His plan for controlling health care costs, and my comments, are as follows:

Creating a new approach to control spiraling health care costs – and passing the savings on to workers

This premium rebate pool isn’t a bad idea, but I don’t know how much effect it will actually have on reducing costs. I like the idea of encouraging employers to do disease management.

Making prescription drugs more affordable

This is very weak. Picking on pharmacy benefit managers seems petty, and unlikely to lead to real savings. Loopholes on generic drugs are part of the problem of high priced prescription drugs, but if brand-name drugs weren’t so exorbitant, then we wouldn’t need generics so badly. The same is true with negotiating discounts on prescription drugs.

The real reason that drugs are so expensive in the US is because drug companies spent vast sums of money on advertising. Advertising dwarfs R&D as a drug company expense. If we placed limits on drug company advertising, that would be a big step in the right direction. We could also do what the Europeans do, and place a legal limit on how much profit pharmaceutical companies are permitted to make off a single drug. Limiting advertising and the profit which can be made of individual drugs would encourage pharmaceutical companies to do more research on more different kinds of drugs, instead of the current system which has every company chasing for the best new allergy and acne medications. It would also substantially bring down drug costs.

Making malpractice insurance more affordable

His suggested ideas, while sound, are unlikely to have any major effect on malpractice insurance costs at all.

Improving care and reducing costs with a new quality bonus

The “Quality Bonus” concept is intended to provide financial incentive for providers to improve the systems involved in quality of care. This systemic approach is a good one; medical errors in the United States stem from a flawed system, not from incompetent providers. Supporting modern information systems, computerized prescribing systems, and making errors transparent is valuable, but it is never explained how the quality bonus would be implemented to achieve this.

Cutting administrative costs in half with a new “technology bonus”

These ideas are sound. Improving record-keeping through computerization would improve the efficient of health care, and cut costs by reducing the time spent on paperwork.

Reducing uncompensated care costs and investing in the safety net

Investing in health care for underserved populations is always a public good. The question is whether Kerry’s plan will really save the $10 billion annually he wants to use to invest in community, migrant, homeless, and school-based health centers. If these saving do not occur, does the investment still take place?

Supporting disease prevention and health promotion programs

The US government is already actively involved in disseminating best practices in diseases prevention. It’s hard to see what else could be done. In addition, the federal government’s efforts at health promotion have been pretty weak – nowhere near best practices in the field. Scaling up existing programs will not work – it would require an entire new approach.

Things John Kerry fails to address:

Nursing care A shortage of nurses is one of the greatest threats facing the US health care system. As baby boomers age, more hospital care, and more nurses, will be required. Yet there are not enough nursing students to meet this increase in demand, and trained nurses are leaving the profession in droves. It’s a vicious circle – fewer nurses means more patients per nurse and worsening hospital care. Nurses then leave the profession because of the stress of trying to do a job without adequate support, leaving even fewer nurses to do an even more difficult job.

What we need are strong incentives to keep existing nurses in the profession, and to encourage the training of additional nurses. This could include regulations mandating a proper patient to nurse ratio and tuition incentives for students training to become nurses. Reaching out to non-traditional student populations would also be useful – recruiting more men and more students from populations less likely to go to college.

Specialty Care Reducing the American dependence on specialists could significantly reduce the cost of health care in the United States. You don’t need to see a dermatologist about acne, and you don’t need to see a gastroenterologist about a stomachache. Encouraging people to see their family physicians first both improves care and decreases cost. In Britain, they have found that a well trained general practitioner can also provide gynecological care, and oversee a health pregnancy. In fact, births attended by general practitioners had better outcomes that those overseen by ob-gyns.