25 de febr. 2017

Kenneth J. Arrow the "Albert Einstein of economics"

In October 29th of 1990, Kenneth J. Arrow was invited to give the opening lecture ("Exellence and Equality in Education") in the Economics Faculty at the Pompeu Fabra University founded the same year by the Government of Catalonia. He came to Barcelona with with wife Selma Schweitzer. 

A group of Ph.D students organized a route in Barcelona with them. First we went to visit La Pedrera and then we went to have lunch in Els 4 Gats.

For us, a group of 23 years old, recently graduated economists were a great pleasure and an honour to stay with them.

Kenneth J. Arrow is considered one of the most important economists in economic theory .

Ramon Marimon first dean of the Economics Faculty in 1990 has said about him: "Ken Arrow also pioneered endogenous growth theory by showing how far countries can go by the simple process of ‘learning by doing,’ but now I realize he was referring to his own life…he really did an incredible lot!

As Andreu Mas-Colell said "The surprising thing about him is that he only got one Nobel Prize".

Related post about Kenneth J. Arrow: If you'd like to understand what health economics is, don't miss Ken Arrow __________________________________________________________________________

29 de gen. 2017

clinical trails, conflicts of interest

"if professional societies and medical institutions do not demonstrate vigorous self- regulation and a commitment to keeping patients interests paramount, public trust may diminish, and more external regulation may be imposed" (Bernard Lo)

"Particularly attention must be paid when researchers offer some medical benefit that can be integrated easily into a course of treatment. Although subjects in these trials are offered a treatment of unproven efficacy, many mistakenly believe that they are receiving cutting-edge treatment guaranteed to improve their condition. This therapeutic misconception may be reinforced when subjects receive the experimental treatment from the same physician who has administered all of their care in the past, in contrast to being referred to a clinical investigator located in an academic setting with a reputation for conducting research" (Karine Morine, et al)

photo: (*) Photosolde

8 de gen. 2017

winter is coming and there's no bed in hospital that can resist it

The Nuffield Trust is looking closely at some of the big issues behind pressure on the NHS in winter months. Prof John Appleby Director of Research and Chief Economist presents some solutions:
  • For some hospitals, the answer is simple: providing more beds and more staff will help them weather the storm through winter.
  • For most others, recording bed occupancy in real time rather than taking a snapshot each day will help them to better coordinate the flow of patients.
  • And for virtually all, reducing delays once patients are medically fit to leave hospital is essential.
Recent articles to look forward by Nuffield Trust and The Health Foundation in relation to winter pressures:

1) Winter bed pressures (2016)
2) How to help health care flow to winter pressures (different materials) 

and the Report of the Health Committee appointed by the House of Commons to examine the policy, administration and expenditure of the Department of Health and its associated bodies

3) 3rd Report - Winter pressure in accident and emergency department (2016)

Photo: Aaron Harris / Reuters (2014)

19 de nov. 2016

cowboys doctors or... comforters doctors

David Cutler from Harvard University, et. al in 2015 published a working paper to test whether patient demand-side factors or physician supply-side factors explained regional variations in health care spending. They founded that:
  1. Patient demand was relatively unimportant in explaining variation in spending after accounting for physician beliefs.
  2. Physician organizational factors matter,
  3. The single most important factor is physician beliefs about treatment: 35 percent of end-of-life spending, and 12 percent of U.S. health care spending, are associated with physician beliefs unsupported by clinical evidence.

The authors differentiated two types of doctors.
  • "cowboys": Physicians treating a critically ill patient may decide either to provide intensive care beyond the indications of clinical guidelines (such as implanting a defibrillator to counter severe heart failure),
  • "comforters": Physicians treating a critically ill attempt to make the patient more comfortable by administering palliative care.
The cowboy doctors push the frontier of medicine by going above and beyond clinical evidence showed little or no marginal benefit derived from the extra procedures, resulting in wasteful spending.

The authors say that the healthcare system’s current incentives often do not prompt doctors to ask the right questions, such as whether a proposed treatment truly benefits the patient. “If doctors restrict themselves to performing what is evidence-based, “we can save hundreds of billions of dollars a year.” Doctors tend to follow their own beliefs about the right treatment to use, leaving patients little say in the process. How to treat a patient is often a multiple-choice question without a straightforward, single “correct” answer. Doctors should pay more attention to the patient’s preferences, instead of relying on their own experience.

The research suggests that it’s time for the cowboys to rein themselves in, and learn to listen.

Access to the article (pdf) Physician Beliefs and Patient Preferences (wp 2015)

photo: Leonard McCombe LIFE Magazine

9 d’oct. 2016

some controversies about competition in health care


Vicente Ortún Professor and former Dean of the School of Economic and Business Sciences, University Pompeu Fabra of Barcelona and founder and member of the Center for Research in Economics and Health (CRES), published on 16 of September and article titled "public and private in Health". 

One of the ideas of the article, that he is suggesting since long time ago, is the introduction of "yardstick competition (competence by comparison)" among health care organizations.

For those politicians, journalists, trade unions, associations, experts in talk shows, and people who want to read, learn and study before to make statements without any idea here you have some literature to read.

Competition in UK health care sector by Nuffield Trust (2013).
Competition in hospital sector by OECD (2012)

photo: (*) Photosolde

24 de jul. 2016

When organizations are growing

Larry Grainer wrote this article in 1972. In 1998 it was republished in Harvard Business Review as a Classic. The author removed some outdated material from the opening sections. He also wrote a commentary “Revolution is still inevitable,” to update his observations.

He described in the article how organizations develop and he designed 6 phases of growth that includes in each phase a period of relatively stable growth (evolution) followed by a stage of crisis (revolution) when major organizational change is needed if the company is to carry on growing. This crisis period it's not a bad thing it's a "change period or turning point".
  1. Phase 1: Creativity. Crisis: Leadership
  2. Phase 2: Direction. Crisis: Autonomy
  3. Phase 3: Delegation. Crisis: Control
  4. Phase 4: Coordination. Crisis: Red Tape
  5. Phase 5: Collaboration. Crisis: Internal growth crisis
  6. Phase 6: Alliances
This is still a useful model, however not all businesses will go through these phases and crisis in this order. We could use this as a starting point for thinking about our business growth, and adapt it to our circumstances.

Access to the article (.pdf): Larry Greiner (1998) HBR Classic

photo: (*) Photosolde

10 de juny 2016

Health economics in Spain: two recent interesting articles

Health Economics (2016)

Editorial written by David Cantanero Associate professor at the Department of Economics, University of Cantabria and Juan Oliva Associate professor at the Department of Economics University of Castilla la Mancha

The editorial puts the focus around the eight categories described by Alan Williams in the 1987-plumbing diagram (determinants of health; measurement and valuation of health; economic evaluation of treatment; demand for insurance and healthcare; supply of healthcare; market equilibrium and rationing; system evaluation; planning, budgeting and monitoring).

They put some Spanish papers as an example of how health economics is a powerful tool to evaluate public programs and policies.

Health Care System in Spain (2016)

Written by Guillem López-Casasnovas Professor at the Department of Economics of the Pompeu Fabra University of Barcelona and Beatriz González López-Valcarcel Professor at the Department of Economics of the University of Las Palmas de Gran Canaria

The article overviews the Spanish healthcare system and its idiosyncratic interconnected sources of problems including, a deficit of good governance, inadequate incentives for agents to take proper responsibility, and a lack of a consensus model for articulating the public and private sectors. In this paper the authors propose some antidotes in order to improve the future prospects of the system: to combine governance with autonomy, to change copayments and to modify the institutional architecture in making coverage decisions, by creating an independent agency, along the line of NICE in England. This latter country as well as the Netherlands provides reform lessons from which the Spanish system may learn.

photo: bansky