Paper of the Week

18 11, 2019

Can equity be measured as accurately as quality?

2019-11-18T11:02:01+00:00

Paper of the Week: 18th November 2019 This week’s blog is brought to you by: Professor Sir Muir Gray Full reference and title from the journal: Whitehead J. et al (2019), How can the spatial equity of health services be defined and measured? A systematic review of spatial equity definitions and methods, Journal of Health Services Research & Policy Vol. 24(4) 270–278, DOI: 10.1177/1355819619837292. https://journals.sagepub.com/doi/abs/10.1177/1355819619837292?journalCode=hsrb Authors conclusion There appeared to be general agreement that spatial equity is difficult to define…Although a wide variety of methods were used, the Gini coefficient was identified as the most common method of spatial equity analysis. 3V bottom line Equity is difficult to measure accurately but it should be included in every report [...]

Can equity be measured as accurately as quality?2019-11-18T11:02:01+00:00
11 11, 2019

Buyer beware! Does the seller’s definition of value match your values?

2019-11-11T14:00:58+00:00

Paper of the Week: 11th November 2019 This week’s blog is brought to you by: Dr Tim Wilson Full reference and title from the journal: Bending the cost curve: time series analysis of a value transformation programme at an academic medical centre Chatfield SC, Volpicelli FM, Adler NM, et al. BMJ Qual Saf 2019;28:449–458. Emerging principles for health system value improvement programmes Moriates C, Valencia V. BMJ Qual Saf 2019;28:434–437. Authors conclusion: By the beginning of 2014 it had become apparent that our own health system, NYU Langone Health (NYULH), had substantial opportunity to improve value. From 2010 to 2013, our institutional losses on Medicare patients had more than doubled. … the American Association of Medical Colleges-Council of Teaching Hospitals (COTH) quarterly survey of [...]

Buyer beware! Does the seller’s definition of value match your values?2019-11-11T14:00:58+00:00
4 11, 2019

Urgent! Higher value urgent care only comes with a systems perspective

2019-11-04T07:42:06+00:00

Paper of the Week: 4th November 2019 This week’s blog is brought to you by: Dr Tim Wilson Full reference and title from the journal: Convenient primary care and emergency hospital utilisation, Edward W. Pinchbeck,  Journal of Health Economics 68 (2019) 102242. Link to paper, click here Authors conclusion: Participation and utilisation decisions lie at the heart of many public policy questions. Convenience-oriented primary care services divert three times as many patients from emergency visits, largely because patients can attend without appointments. 3V bottom line: High value interventions are neglected in favour of lower value interventions when we do not think of populations and outcomes that matter. 3VH - Implications for value: This analysis in this interesting paper [...]

Urgent! Higher value urgent care only comes with a systems perspective2019-11-04T07:42:06+00:00
28 10, 2019

Paper of the Week: 28th October 2019 – We need to talk about value

2019-10-28T10:56:11+00:00

This week’s blog is brought to you by: Dr Tim Wilson Full reference and title from the journal: Can patient centred care plus shared decision making equal lower costs? Gemma Venhuizen, BMJ 2019;367:l5900 Link to paper: https://doi.org/10.1136/bmj.l5900   Authors conclusion: “At Bernhoven, 70% of patients referred for eye care are seen by an optometrist instead of an ophthalmologist. In that way, a consultation costs €40 (£36; $44) instead of €225, and waiting lists have decreased.” (sic)  3V bottom line: The result from this paper are encouraging, but language matters. Especially when talking about value-based healthcare. So instead of focusing on lower costs, the author should have talked about “resources being freed up from lower value care for higher value”. [...]

Paper of the Week: 28th October 2019 – We need to talk about value2019-10-28T10:56:11+00:00
22 10, 2019

Paper of the Week – 22nd October 2019: The law of Diminishing Returns is evidence based

2019-10-22T08:40:50+00:00

This weeks Paper of the Week is brought to you by: Professor Sir Muir Gray Full reference and title from the journal: Estimating the Marginal Productivity of the English National Health Service From 2003 to 2012, Lomas, J et al (2019), Value in health 22;995-1002. Web Link to Paper:   https://doi.org/10.1016/j.jval.2019.04.1926 Authors conclusion:  “Taking cancer in 2012 as an illustrative example, the expenditure elasticity is interpreted as saying that a 1% increase in overall NHS expenditure leads to a 1.027% increase in cancer expenditure. The outcome elasticity suggests that cancer mortality is reduced by 0.361% as a result of a 1% increase in cancer expenditure. As outlined in the section “Translating mortality effects into quality-adjusted life-years”, these estimated [...]

Paper of the Week – 22nd October 2019: The law of Diminishing Returns is evidence based2019-10-22T08:40:50+00:00
9 10, 2019

Paper of the Week: 9th October 2019 – Can we spend too little or too much on healthcare?

2019-10-09T10:54:40+00:00

This week’s blog is brought to you by: Dr Tim Wilson Full reference and title from the journal: What level of domestic government health expenditure should we aspire to for universal health coverage? McIntyre D. et al (2017) Health Economics, Policy and Law, 12, 125–137 Web link to paper, please click here Authors conclusion: “Our analyses point towards a target of government spending on health of at least 5% of GDP for progressing towards universal health care. This can be supplemented by a per capita target of $86 to promote universal access to primary care services in low-income countries.” 3V bottom line: At a governmental level, any money going to healthcare represents budget that could otherwise be spent [...]

Paper of the Week: 9th October 2019 – Can we spend too little or too much on healthcare?2019-10-09T10:54:40+00:00
30 09, 2019

Paper of the Week: 30th September 2019 – Overuse of low value dependence forming medications is common (and more likely if you live in a deprived area)

2019-09-30T08:56:49+00:00

This week’s blog is brought to you by: Professor Alf Collins, Clinical Director for Personalised Care, NHS England and Improvement.   Full reference and title from the journal: Link to Public Health England Prescribed Medicines Review - Click here Authors conclusion In England in the year 2017 to 2018, 1-in-4 adults in England were prescribed benzodiazepines, z-drugs, gabapentinoids, opioids for chronic non-cancer pain, or antidepressants. There are large variations in standardised rates of prescribing at the level of CCGs. The rate of prescribing and the time receiving a prescription increase with deprivation. Longer-term prescribing is widespread. Aside from antidepressants, the medications reviewed are all licensed and indicated for (usually) short-term treatment of acute conditions. Patients described not being [...]

Paper of the Week: 30th September 2019 – Overuse of low value dependence forming medications is common (and more likely if you live in a deprived area)2019-09-30T08:56:49+00:00
24 09, 2019

Paper of the Week: 24th September 2019 – Finite resources come in many forms, especially carbon

2019-09-24T09:57:57+00:00

This week’s blog is brought to you by: Managing Director, Dr Tim Wilson Full reference and title from the journal: International comparison of health care carbon footprints, Peter-Paul Pichler et al 2019 Environ. Res. Lett. 14 064004. Web Link to Paper: https://iopscience.iop.org/article/10.1088/1748-9326/ab19e1/meta#erlab19e1s3 Authors conclusion: The health care sectors of the 36 countries studied were responsible for 1.6 Gt of CO2 emissions or 4.4% of the global total in 2014 (35.7 Gt). The health carbon footprints of China, the US, Japan, India and Germany were similar to the total national footprints of Canada, Italy, Greece, Finland, and Hungary respectively. In an international ranking of total national carbon footprints, the health carbon footprints of China and the US would rank [...]

Paper of the Week: 24th September 2019 – Finite resources come in many forms, especially carbon2019-09-24T09:57:57+00:00
10 09, 2019

Paper of the Week: 10th September 2019 – At last, value measured by the opportunity cost of an intervention

2019-09-10T09:43:21+00:00

This week’s blog is brought to you by: Professor Sir Muir Gray Full reference and title from the journal: Uterus at a price: Disability insurance and hysterectomy Fan E. (et al) Journal of Health Economics 66 (2019) 1-17 Link to Paper: https://www.sciencedirect.com/science/article/abs/pii/S0167629618308142?dgcid=rss_sd_all Authors conclusion: Taiwanese Labor, Government Employee, and Farmer Insurance programs provide 5 to 6 months of salary to enrollees who undergo hysterectomies or oophorectomies before their 45th birthday. These programs create incentives for more and earlier treatments, …..Induced hysterectomies increase benefit payments and surgical costs, at about the cost of a mammogram and 5 pap smears per enrollee. 3V bottom line: Expressing value in terms of other things that could be one with the same amount [...]

Paper of the Week: 10th September 2019 – At last, value measured by the opportunity cost of an intervention2019-09-10T09:43:21+00:00
23 08, 2019

Paper of the Week: 23rd August 2019 – Yet again, more is not always better

2019-08-23T17:59:14+00:00

Full reference and title from the journal: Intensive Glucose Control in Patients with Type 2 Diabetes — 15-Year Follow-up Reaven P.D. et al (2019) N Engl J Med 2019;380:2215-24. This week’s blog is brought to you by: Professor Sir Muir Gray WEB LINK TO PAPER Authors conclusion: “In conclusion, in this group of participants with type 2 diabetes who were at high risk for cardiovascular disease, 5.6 years of intensive glucose lowering to a glycated hemoglobin level of 6.9% did not reduce the incidence of major cardiovascular events over a follow-up of 13.6 years or reduce total mortality or improve quality of life over a total follow-up of 15 years. Although there was a significantly lower risk of [...]

Paper of the Week: 23rd August 2019 – Yet again, more is not always better2019-08-23T17:59:14+00:00