2012 Potpourri XIII

Research reported in Health Affairs examines cancer care spending and outcomes, defined as mortality and survival, in the United States and European countries.  The United States obviously spends more on cancer care, largely due to use of drugs not paid for in Europe and for other expensive treatments.  But mortality is better for most cancers in the United States and survival times are also greater.  The authors find that even after the extra spending, almost $600 billion in additional value is delivered to US patients, based on valuing a year of life at a relatively low $150,000.  Another article that shows that sometimes more spending does lead to better patient outcomes.  (HA Article)

A viewpoint in the Journal of the American Medical Association examines the potential role of genetic technologies to help reduce health spending.  Most new technology adds to health spending and the authors acknowledge that genomic testing and treatments can be expensive.  But they point out that they also can be used to identify patients who are at low risk for disease and patients for whom treatments would be unnecessary or futile.  The cost of many genetic tests is also decreasing.  Physicians, however, will need better clinical decision support to help realize the potential of genomics.   (JAMA Viewpoint)

The medical community is awash in clinical care guidelines, both in the United States and abroad, and physicians are often unable to figure out which is best or even subject to conflicting guidelines.  Several organizations are working to try to harmonize guidelines internationally and give physicians guidance on which ones have the most evidence to support them, according to an article in the Annals of Internal Medicine.  One such group in the Guidelines International Network, which represents organization in 46 countries.  The organization has developed principles to ensure high-quality and trustworthy guidelines.   (Annals Article)

The Wall Street Journal reports that Rhode Island’s Medicaid program appears to have found a way to create substantial savings once it was freed from federal mandates.  With the waiver, Rhode Island was able to move its Medicaid beneficiaries to managed care programs, which an independent evaluation has found is saving money, will not lessening care, in fact probably improving it.      The annual savings were about $55 million and the program is not fully implemented yet.   There is absolutely no reason why there should be any federal involvement in Medicaid; the states are perfectly capable of designing and funding their own programs for low-income people.   (WSJ Article)

The University of Wisconsin Population Health Institute has ranked the health of all the counties in the United States, based on a variety of measures and databases, and looks at health behaviors, attributes of clinical care, socio-demographic factors and physical environment.  Counties in the northern states tend to have higher rates of excessive drinking.  Southern counties have higher rates of  teen births and children in poverty and motor vehicle crash deaths are lowest in the upper Midwest and Northeast.    (U. Wisc. Report)

Doctors are under pressure to improve patient satisfaction.  A viewpoint in the Journal of the American Medical Association explores how this pressure is sometimes inimical to the best interests of patients, particularly because doctors may feel they need to  respond to patient requests for particular treatments, which may not really help the patient and may be potentially harmful to them.  The viewpoint focuses on requests for pain medications, which are often abused.  Policymakers need to be careful how they frame patient satisfaction measures to ensure that patient-reported satisfaction accounts for the need for a physician to use good judgement.   (JAMA Viewpoint)