our own system

Combining social programs and sick care

Fri, 05 Mar 2010 07:00:00 -0500

Paul Levy posts striking data from a report by The Blue Ridge Academic Health Group. A breakdown of healthcare spend (public health, medicine, the two added together) as a proportion of total GDP follows:

Country — % of GDP on Social Programs | % of GDP on Sick Care | Total % GDP

United States — 2.3% | 16% | 18.3%

Canada — 5.8% | 10% | 15.8%

Netherlands — 9.6% | 9% | 19.6%

Sweden — 11.6% | 9% | 20.6%

That’s striking. Though I’m unsure what to make of it. The report says:

Our current health care system is costly and ineffective to an increasing degree each year because it has too limited a focus – sick care delivery – and pays inadequate attention to health promotion. Moreover, the health promotion programs that are in place rarely focus on social determinants of health such as jobs, housing, education, etc. Instead, the focus largely remains on the health problems and concerns of individuals, rather than on the problems endemic to a population.

We know that public health has much to do (most?) with extending life expectancy to its current peak. Medicine, or sick care, has much to do with extending the lives of individuals.

If a fairer distribution of health spend between public health and medicine is the answer then we have a long way to go. The reality, of course, is that public health doesn’t make money. I guess that just needs to be mentioned.

Also worth noting is the report’s mention of a lack of attention to environmental factors contributing to health (of which health services play a relatively minor role) in health promotion programs. Currently jobs are tough to get. Efforts to get anyone and everyone in a house have proved disastrous. Education is great in this country…if you’re in the right community, even that statement is debated.

Rambling is most of what this is. But I think an important consideration to think about is how we, as a country, approach reimbursing for wellness programs. It works. It prevents things. Though it may not save any money on total health care dollars spent, it’s good for people.

The commute is the best part of the day

Thu, 04 Mar 2010 20:17:16 -0500

The conference board says workers’ “commute to work ranks number one as the most satisfying aspect of one’s job.”

Youch.

Links: Design in healthcare

Tue, 02 Mar 2010 22:56:41 -0500

Marketplace story on Sharp Memorial and its use of evidence-based design to build a hospital. Bottom line: better healing.

PSFK presents Ten Radical Rules for Better Healthcare by UK design firm Priestmangoode

Ayyy. Love cost shifting. As defendable as it might be,...

Tue, 02 Mar 2010 07:00:00 -0500

Ayyy.

Love cost shifting. As defendable as it might be, it’s just not defendable in reality.

Video

Fri, 26 Feb 2010 12:26:54 -0500

soupsoup: Shep Smith destroys Sen. Thune’s false claim that...

Fri, 26 Feb 2010 07:05:00 -0500

soupsoup:

Shep Smith destroys Sen. Thune’s false claim that Senate health bill will increase premiums: “That’s not true, Senator”

"Five out of every $6 in health care spending today is paid for by someone other than the patient."

Fri, 26 Feb 2010 07:00:00 -0500

“Five out of every $6 in health care spending today is paid for by someone other than the patient.”

- Marketplace

The joy of the chase, the reality of slogging

Thu, 25 Feb 2010 07:12:00 -0500

Love this. First the glorious luster of the idea in finding the next big thing:

Google is famously creative at encouraging these breakthroughs; every year, it holds an internal demo fair called CSI — Crazy Search Ideas — in an attempt to spark offbeat but productive approaches.

And then the reality of improvement sets in:

But for the most part, the improvement process is a relentless slog, grinding through bad results to determine what isn’t working.

Progress, it seems, is so much about the grind. Idea-coming-up-with is glorious and absolutely fun to think about. But the making-things-better part is hard, grind it out work. It’s work.

(Indented remarks from Steven Levy’s look into Google’s algorithm)

Wired, Found: The Future of Medicine

Thu, 25 Feb 2010 07:00:00 -0500

Wired, Found: The Future of Medicine

Lessons From a Blue-Collar Millionaire

Wed, 24 Feb 2010 07:38:00 -0500

Lessons From a Blue-Collar Millionaire:

Companies that actually (actually!) mean what they say about the culture being most important always seem to be successful. But the thing that’s difficult for me to understand is why so many continue to pay lip service to culture’s importance. Naive on my part? I don’t think so. But I’m biased.

Enter Nick’s Pizza and Pub (they use checklists too!):

Sarillo has built his company’s culture by using a form of management best characterized as “trust and track.” It involves educating employees about what it takes for the company to be successful, then trusting them to act accordingly. The alternative is command and control, wherein success is the boss’s responsibility and employees do what the boss says. Think of the Navy SEALs versus the National Guard. Both approaches can work, but they produce very different cultures. If done right, moreover, trust and track can allow a company to be nimble, flexible, and productive enough to perform at the highest level through good economies and bad.

Trust. Wild concept.

Designing Food

Mon, 22 Feb 2010 06:28:48 -0500

The Columbus Dispatch (emphasis added):

The nation’s largest pediatricians group wants warning labels on foods that pose choking risks, and it is asking companies to design safer foods and redesign those - such as the hot dog - that are known hazards.

Design solves problems.

"It’s close to 11 p.m., and the jet touches down in White Plains. Leaving the small corporate-jet..."

Sun, 21 Feb 2010 01:38:10 -0500

“It’s close to 11 p.m., and the jet touches down in White Plains. Leaving the small corporate-jet terminal with her luggage, she walks toward a black Mercedes that is idling at the sidewalk. She walks past it — it’s waiting for someone else on another plane — and heads to her own car in a nearby parking lot. She grabs her keys, loads her bag in the back and drives herself home.”

- From a NY Times profile of Xerox’s CEO. She’s changing the company’s culture. And she’s doing it by being real.

MGH plans museum to showcase its story

Thu, 18 Feb 2010 07:15:01 -0500

MGH plans museum to showcase its story:

This is a uniquely cool idea. It’s not one that would work for all, a place has to have important history to open a museum, but flaunt it if you have it.

Hospital-Clean Hands, Without All the Scrubbing

Thu, 18 Feb 2010 07:08:31 -0500

Hospital-Clean Hands, Without All the Scrubbing

Results Unproven, Robotic Surgery Wins Converts

Tue, 16 Feb 2010 06:50:56 -0500

Results Unproven, Robotic Surgery Wins Converts

Expecting a Surge in U.S. Medical Schools

Mon, 15 Feb 2010 06:36:38 -0500

Expecting a Surge in U.S. Medical Schools

What goes around comes around

Fri, 12 Feb 2010 13:00:00 -0500

What got Billy Tauzin hired also got him fired.

(Tauzin is one of Washington’s trickier cats; he led Medicare expansion efforts, health reform if you will, that included a nice stream of cash for pharmaceutical companies and the industry lobby thanked him by appointing him president.)

Healthcare goes national

Fri, 12 Feb 2010 06:30:00 -0500

Holy Cross Hospital in Ft. Lauderdale has signed a partnership agreement with Mass General in Boston to provide cancer care services. Total miles between the institutions: 1,478.

Partnerships like this exist across the country, but most are local; for example, a community hospital offers access to physicians at the academic medical center nearby. It works for both organizations: the AMC widens its reach and the community hospital is able to keep patients in its system.

Despite efforts by the likes of Mayo Clinic and Cleveland Clinic who have transplanted their models to different geographic areas, healthcare has largely remained a locally delivered service. Even massive healthcare systems like Catholic Healthcare West or Kaiser generally allow individual hospitals to operate relatively independently. It’s been my view, up to this point, that healthcare would remain local, a national presence being rare.

It’s actually pretty interesting to think about how local healthcare has actually remained, especially when compared to counterparts in other industries. National chains have been developing since McDonalds started doing it in the 1950s.

But partnership agreements like the one between Holy Cross and Mass General could change that. Who wouldn’t choose, if they could, the Mayo Clinic for neurosurgery? Or the Cleveland Clinic for heart treatment? Or Johns Hopkins for a urology procedure? Each of these institutions are ranked first in those respective specialties according to US News.

The point is that Holy Cross and Mass General are onto something. Think of your local community hospital offering the expertise of the nation’s best. It really could be a collection of partnerships with the best around the country. It is especially likely if a particular hospital trails the local competition: the other guy is pretty good at heart care, but we’ve teamed with the Cleveland Clinic to bring you great heart care.

Of course there many obstacles to overcome, namely whether local physicians would be interested in such a model.

But the thought is intriguing. It’s an attempt at physical API.

“…more than half of us are the agents of our own...

Thu, 11 Feb 2010 07:00:00 -0500

“…more than half of us are the agents of our own demise.”

Check out Thomas Goetz’s book “The Decision Tree.”

Evidence

Tue, 09 Feb 2010 06:12:00 -0500

I’m pretty sure this post by Kevin MD is a call for design thinking.