Public Reports Watch-Running Public Hospitals in Australia

National Health and Hospitals Network report

Related;
Canberra Babylon

Health debate

Public hospitals - reform overseas

Blog of the Day

Running a Hospital- President and CEO of Beth Israel Deaconess Medical Center in Boston

Should we encourage Swine Flu parties?

Infectious-disease specialists say they understand the logic: surviving the current, apparently mild strain of the virus may be protective if a more virulent strain emerges next fall. But they are generally against it.

Dr. Anne Moscona, a flu specialist at Weill Medical College of Cornell University, said she had been called by a reporter for a women’s magazine “asking if mothers should hold swine flu parties, like chickenpox parties.”

(Chickenpox parties, at which children gather so they can all be infected by a child who has the pox, are often held by parents who distrust chickenpox vaccine or want their children to have the stronger immunity that surviving a full-blown infection affords and are willing to take the risk that their child will not get serious complications.)

“I think it’s totally nuts,” Dr. Moscona said. “I can’t believe people are really thinking of doing it. I understand the thinking, but I just fear we don’t know enough about how this virus would react in every individual. This is like the Middle Ages, when people deliberately infected themselves with smallpox. It’s vigilante vaccination — you know, taking immunity into your own hands.”

The idea has arisen from the history of the 1918 Spanish flu. A mild spring outbreak was followed by two deadly waves in the early and late winter of 1918-1919. Some believe, although there is little evidence beyond anecdotal reports in old newspapers, that those who got sick in the first wave were less likely to get sick in the second and third.

Many cite as the source of their thinking the book “The Great Influenza,” a history of the 1918 pandemic by John M. Barry.

Mr. Barry, in a telephone interview, said he had never publicly suggested deliberate self-infection, “but I used to joke with my wife, and I may have jokingly said it in speeches, that if a virus emerged and looked mild, I’d be on an airplane to Indonesia.”

-Debating the Wisdom of ‘Swine Flu Parties’

Containment is no longer a feasible option

In the 1918 Spanish flu, American cities that reacted quickly had fewer deaths than those that acted slowly and used fewer precautions, according to a 2007 study of 43 cities by researchers from the University of Michigan and the Centers for Disease Control. The most common combination was school closings and bans on public gatherings, which in 34 cities lasted for a median of four weeks. All those cities except New York, Chicago, and New Haven closed their schools; the median time was six weeks.

Deaths per 100,000 population ranged from 210 for Grand Rapids, Mich., to 807 for Pittsburgh.

Although some scientists and historians have argued that those measures just delayed deaths that later happened anyway, Dr. Cetron, one of the authors of the 2007 study, denied it.

“There’s no evidence of that,” he said. “Cities that acted early and layered on different interventions did well.”

Many people do not realize how long measures take to work. A child can shed flu virus for 10 days, Dr. Imperato said, an adult for 5.

Some experts are cautiously optimistic. A computer simulation of this outbreak released Wednesday by a team from Northwestern University projected a worst-case scenario, meaning no measures have been taken to combat the spread. It predicted a mere 1,700 cases in the United States four weeks from now.

-Containing Flu Is Not Feasible, Specialists Say

Spend more on Public Health, Mexico!

Mexico’s public health budget is about 3 percent of gross domestic product — within the range of spending by other major Latin American economies, but well below the rate in developed countries, according to the World Bank; and Mexico has only about half as many hospital beds per capita than the United States.

To help Mexico meet the extra costs of the flu epidemic, the World Bank issued a loan of $205 million.

“The two key things that they need to work on now,” said Keith Hansen, a World Bank health official for Latin America and the Caribbean, “is surveillance, to pick up patterns of infection, and to make sure that everybody who needs care has access to it.”

In an acknowledgment that Mexicans frequently act as their own doctors, the government’s announcements, played repeatedly on the radio, advise people not to self-medicate and instead to seek out medical attention.

-First Flu Death Provides Clues to Mexico Toll

Peter Orszag on The Daily Show

The Daily Show With Jon Stewart	M - Th 11p / 10c
Peter Orszag Pt. 1
comedycentral.com
Daily Show Full Episodes Economic Crisis Political Humor

The Daily Show With Jon Stewart	M - Th 11p / 10c
Peter Orszag Pt. 2
comedycentral.com
Daily Show Full Episodes Economic Crisis Political Humor

Political institutions and human development

Political institutions and human development - does democracy fulfil its 'constructive' and 'instrumental' role ?

Summary: Institutions are a major field of interest in the study of development processes. The authors contribute to this discussion concentrating our research on political institutions and their effect on the non-income dimensions of human development. First, they elaborate a theoretical argument why and under what conditions democracies compared to autocratic political systems might perform better with regards to the provision of public goods. Due to higher redistributive concerns matched to the needs of the population democracies should show a higher level of human development. In the following they analyze whether our theoretical expectations are supported by empirical facts. The authors perform a static panel analysis over the period of 1970 to 2003. The model confirms that living in a democratic system positively affects human development measured by life expectancy and literacy rates even controlling for GDP. By analyzing interaction effects they find that the performance of democracy is rather independent of the circumstances. However, democracy leads to more redistribution in favor of health provision in more unequal societies.

Month of birth and children's health in India

A recent working paper from World Bank-Month of birth and children's health in India

Summary: The authors use data from three waves of the India National Family Health Survey to explore the relationship between the month of birth and the health outcomes of young children in India. They find that children born during the monsoon months have lower anthropometric scores compared with children born during the fall and winter months. The authors propose and test four hypotheses that could explain such a correlation. The results emphasize the importance of seasonal variations in affecting environmental conditions at the time of birth and determining the health outcomes of young children in India. Policy interventions that affect these conditions could effectively impact the health and achievement of these children, in a manner similar to nutrition and micronutrient supplementation programs.

Quitting Smoking is not easy

Today, 21 percent of Americans smoke, down from 28 percent in 1988. Off-again-on-again smoking and serial quitting are common, as is the long-term use of nicotine gum and patches.

“It takes the average smoker 8 to 10 times before he is able to quit successfully,” said Dr. Steven A. Schroeder, director of the Smoking Cessation Leadership Center at the University of California, San Francisco.

-Lessons for Other Smokers in Obama’s Efforts to Quit

Washing-machine model of addiction treatment

Every year, state and federal governments spend more than $15 billion, and insurers at least $5 billion more, on substance-abuse treatment services for some four million people. That amount may soon increase sharply: last year, Congress passed the mental health parity law, which for the first time includes addiction treatment under a federal law requiring that insurers cover mental and physical ailments at equal levels...

“What we have in this country is a washing-machine model of addiction treatment,” said A. Thomas McClellan, chief executive of the nonprofit Treatment Research Institute, based in Philadelphia. “You go to Shady Acres for 30 days, or to someclinic for 60 visits or 60 doses, whatever it is. And then you’re discharged and everyone’s crying and hugging and feeling proud — and you’re supposed to be cured.”

He added: “It doesn’t really matter if you’re a movie star going to some resort by the sea or a homeless person. The system doesn’t work well for what for many people is a chronic, recurring problem.”

-Drug Rehabilitation or Revolving Door?

The Best of New York Times

Investors Buy U.S. Debt at Zero Yield ;

In the market equivalent of shoveling cash under the mattress, hordes of buyers were so eager on Tuesday to park money in the world’s safest investment, United States government debt, that they agreed to accept a zero percent rate of return.

Weak Oversight Lets Bad Hospitals Stay Open;

Mistakes happen even at good hospitals, of course. But evidence shows that University, which is owned by the State University of New York system, is not a good hospital. In fact, in late 2006 a state commission recommended that it be scaled back and merged with another hospital.

$73 an Hour: Adding It Up





The Pain May Be Real, but the Scan Is Deceiving

Primal, Acute and Easily Duped: Our Sense of Touch;

Touch also turns out to be easy to fool. Among the sensory tricks now being investigated is something called the Pinocchio illusion. Researchers have found that if they vibrate the tendon of the biceps, many people report feeling that their forearm is getting longer, their hand drifting ever further from their elbow. And if they are told to touch the forefinger of the vibrated arm to the tip of their nose, they feel as though their nose was lengthening, too.

Some tactile illusions require the collusion of other senses. People who watch a rubber hand being stroked while the same treatment is applied to one of their own hands kept out of view quickly come to believe that the rubber prosthesis is the real thing, and will wince with pain at the sight of a hammer slamming into it. Other researchers have reported what they call the parchment-skin illusion. Subjects who rubbed their hands together while listening to high-frequency sounds described their palms as feeling exceptionally dry and papery, as though their hands must be responsible for the rasping noise they heard. Look up, little Pinocchio! Somebody’s pulling your strings.

In Defense of Teasing

Scorpios Get More Asthma, but Astrology Isn’t to Blame

Another book on Pensions

When the Good Pensions Go Away: Why America Needs a New Deal for Pension and Healthcare Reform
by Thomas J. Mackell

What could be bigger than the financial crisis

Michael O. Leavitt, the Bush administration’s secretary of health and human services, said in a September speech that, at its present growth rate, health care spending “could potentially drag our nation into a financial crisis that makes our major subprime mortgage crisis look like a warm summer rain.”

-British Balance Benefit vs. Cost of Latest Drugs

Healthcare costing templates

Developing costing tools - methods guide

Costing Templates

Obsessive-compulsive disorder: cost template

Depression: costing template

Tuberculosis: costing template

Hypertension - costing template

Bipolar disorder: costing template

Anaemia management in chronic kidney disease: costing template

Familial breast cancer: costing template

Urinary incontinence: costing template

Dementia: costing template


Obesity: costing template

Heavy menstrual bleeding: costing template

Antenatal and postnatal mental health: costing template

Four commonly used methods to increase physical activity: costing template

Brief interventions and referral for smoking cessation: costing template

Prevention of sexually transmitted infections and under 18 conceptions: costing template

Conduct disorder in children - parent-training/education programmes: Costing template and report

Acutely ill patients in hospital: costing template

Head injury: costing template

Attention deficit hyperactivity disorder (ADHD): costing template

Prostate cancer: costing template

Asthma (uncontrolled)- omalizumab: Costing template

Psoriasis - infliximab: Costing template

Head injury: costing template

Stroke: costing template

Irritable bowel syndrome: costing template

Urinary tract infection in children: costing template

What price is life?

If the Hardys lived in the United States or just about any European country other than Britain, Mr. Hardy would most likely get the drug, although he might have to pay part of the cost. A clinical trial showed that the pill, called Sutent, delays cancer progression for six months at an estimated treatment cost of $54,000.

But at that price, Mr. Hardy’s life is not worth prolonging, according to a British government agency, the National Institute for Health and Clinical Excellence. The institute, known as NICE, has decided that Britain, except in rare cases, can afford only £15,000, or about $22,750, to save six months of a citizen’s life....

The institute has analyzed the cost-effectiveness of surgical operations, cancer screening tests and medical devices. For example, it found that drug-coated cardiac stents were worth only $450 more than bare-metal ones. In the United States, stent price differences are often far wider....

After consulting a citizens group, the institute decided that the nation should spend the same amount saving or improving the life of a 75-year-old smoker as it would a 5-year-old....

The institute’s decision-making process involves a series of independent assessments, consultations with manufacturers, committee meetings, comment periods for outsiders and appeals that, taken together, Dr. Rawlins described as “procedural justice,” or “muddling through elegantly.” While the institute provides advice, decisions are made by one of three committees made up of doctors, nurses and economists from outside the government.

-British Balance Gain Versus Cost of Latest Drugs

The Invisible Cure: Africa, the West, and the Fight Against AIDS

Helen Estein at Google

What is the Real Fiscal Challenge?

Busting the Budget: Healthcare Costs or Entitlement Programs

On Monday, September 15th, six experts in fiscal policy and healthcare policy debated the nature of the nation’s pending fiscal crisis at the National Press Club. Moderated by TaxVox editor Howard Gleckman, the event featured Henry Aaron and Alice Rivlin of the Brookings Institution, Julie Barnes and Maya MacGuineas of the New America Foundation, Robert Greenstein of the Center for Budget and Policy Priorities, and Eugene Steuerle of the Peterson Foundation.

Henry Aaron warned that long-term deficit projections would be unsustainable, but argued that two questions must be answered: what causes these deficits and what should the solution be? Although the answers need not be the same, Aaron explained that healthcare cost growth is both the primary driver, and should be the primary solution. He offered 5 conclusions:

* Projected deficits are large and unsustainable.
* Spending cuts and Social Security reform can help reduce them a little bit, and should be undertaken.
* Healthcare spending, and the taxes needed to pay for them, should continue to grow faster than GDP.
* Healthcare cost growth can be slowed considerably, greatly reducing the projected deficit.
* The problem of future deficits is not an entitlement problem, but a problem of large and growing costs in the overall healthcare system.

Alice Rivlin then suggested that the panelists were in fact debating the wrong question. Rather than arguing over whether closing the fiscal gap should focus on entitlements reform or healthcare reform or tax reform, they should recognize that all three are important. Rivlin explained the there are really two problems driving entitlement growth – demographics and healthcare cost growth. Because of demographics, Social Security costs will rise rapidly over the next two decades and then begin to level off. Medicare and Medicaid, on the other hand, will rise steadily indefinitely. This means that Social Security is important in the short-term, while healthcare entitlements drive the deficit further into the future. Rivlin suggested five main solutions to the looming fiscal crisis:

* Encourage people to work longer by both reforming Social Security and changing rules and incentives in private pensions.
* Encourage more efficient distribution of medical care, using Medicare and Medicaid to lead payment system reform.
* Move toward universal healthcare coverage with spending controls.
* Shift healthcare expenses to the private sector where possible.
* Reform the tax code to make it more equitable and efficient so that it can bring in the needed revenue without being overly burdensome to the economy.

Indonesia Fact of the Day

Economic costs of poor hygiene and sanitation in Indonesia reached an estimated US$6.3 billion, or 2.3 percent of GDP in 2006.

-Economics of Sanitation

Development Link of the Day

How to construct compost-producing toilets