Monitoring

A key to successful health care interventions is following the doctor's orders. Monitoring can help.

Assistive technologies are old hat, but a team of researchers at the University of Texas at Arlington (among other institutions) is working to provide a more robust, all-inclusive option for elderly individuals who'd prefer to age gracefully within their own domiciles. In theory, sensors could be embedded throughout seniors' homes in order to "detect when the residents have sleepless nights or forget to take their medication." From there, caregivers would be alerted and could react remotely via a web-based communications portal. The UTA lab that's perfecting the idea currently utilizes a single room equipped with cameras, motion detectors and robots, and professors / students keep a close eye on any movement that gets recorded and transferring to computers for processing. If all goes well, a collaboratively built "home of the future" will actually be on display at CES 2009, likely showcasing some of these very advancements.

Privatizing Education

Steve Yamarik helps to make the case for privatizing education. Schooling offers no positive externalities .

Estimating Returns to Schooling from State-Level Data: A Macro-Mincerian Approach

In this paper, we use information from U.S. states to determine the social return to schooling. We estimate a macro-Mincerian model where aggregate earnings (or income) depend upon physical capital, labor, average years of schooling and average labor force experience. We find that the social return to U.S. schooling is 9 to 16 percent, which matches estimates of the private return found in the labor literature. Our results therefore provide evidence that U.S. schooling is indeed productive, but generates no positive externalities.

Assorted Health Econ Links

1. A great graphic showing diseases and their genetic links.

2. The placebo effect. Taking it seriously.

3. Myth or science?

4. Peter Orszag on health care taking lessons the same lessons from psychology as behavioral economics.

5. Even small gains over placebos are important.

6. Is the placebo effect just regression to the mean? We seldom run studies where we compare treatment to placebo AND no treatment.  So it is often hard to identify the placebo effect separately from the natural improvements that can occur over time. Here they look at pain and placebos by eliminating the confounding effects of time.

Hospital Data

A recent speaker in my health economics class pointed us to quality data for hospitals in Wisconsin (wicheckpoint.org), produced by the Wisconsin Hospitals Association. They also produce inpatient and outpatient billing data from those same hospitals (wipricepoint.org).

Age of Consent

The Onion Op-eds tackle the issue of age of consent laws in the funny - but serious - way only they can. Our laws are very different from the rest of the developed world.

Comparing Health Plans

Radio Times interviews a political scientist who compared the candidate's plans for health care.

Radio Times with Marty Moss-Coane

Programs for 10/13/2008 to 10/17/2008
Monday 10/13/2008
Hour One
In the last presidential debate, John McCain referred to health care as a responsibility while Barack Obama called it a right. These statements are at the core of how the candidates have shaped their health care proposals. We turn to political science professor JONATHAN OBERLANDER whose comparison of the two plans was recently published in the New England Journal of Medicine. Listen to this show via Real Audio | mp3 

Links to their plans can be found here.

Shocking

Krugman wins Nobel. By himself. This is kind of shocking for many reasons. More when I have time.

Presidential Health Care

The candidates on health care.

McCain  v. Obama

Insurance Exchange

Pro and Con. Well sort of.

Healthcare: Right or Responsibility?

The candidates were asked "Is health care a privilege, right or responsibility? I'm not sure that question really means anything. After all, what is a RIGHT in a world with scarcity? It can not mean access to an infinite amount of care at a zero price. So then what does it mean? The definitions are below, along with the candidates answers via youtube.

privilege: a right or immunity granted as a peculiar benefit, advantage, or favor ; especially : such a right or immunity attached specifically to a position or an office

right: something to which one has a just claim: as a: the power or privilege to which one is justly entitled

responsibility: the quality or state of being responsible: as a: moral, legal, or mental accountability

Problem Definition

I stumbled upon this quote from Bertrand Russell:

The greatest challenge to any thinker is stating the problem in a way that will allow a solution.

Bertrand Russell
British author, mathematician, & philosopher (1872 - 1970)

It's why we spend so much time on Problem Definition in BUS 230.

Productivity Pr0n

Merlin Mann has my number. He knows that for me, productivity Pr0n is my procrastination.  I love the irony in that, but really I should just try to get some things done, instead of oogling the latest desktop tweaks on lifehacker.

R.I.P., Productivity Pr0n

Friends, I’m done with “productivity” as a personal fetish or hobby. There are countless sites that are all too happy to vend stroke material for your joyless addiction to puns about procrastination and systems for generating more taxonomically satisfying meta-work. But, presently, you won’t find so much of that here.

Except inasmuch as it can help move aside barriers to finishing the projects that you claim matter to you, “productivity” is often a sprawling ghetto of well-marketed nonsense for people who really just need a ritalin and a hug. So, for myself, random tips and lists that aren’t anchored to solving a real-world problem for a smart but flawed adult with a mind are dead to me. Pour a forty on ‘em.

From now on, I’m going to talk about how people make stuff. Books, art, code, buildings, ballets, companies, furniture, whimsical hats, songs, or what have you. But understand: this isn’t just for fancy people and fine arts majors.

Covering The Uninsured

I've just read large chunks of Gruber's piece in the JEL (here is a previous draft).  He points out the interesting dynamics of the uninsured population.

In addition, there are important dynamics within the uninsured population that are missed by this point-in-time estimate. A problem with the CPS estimate is that it is a strange hybrid of a point-in-time estimate and a backwards look at the previous year. Other surveys that are less widely cited provide different perspectives on the uninsured, as reviewed in Congressional Budget Office (2007). The Congressional Budget Office finds that other surveys that ask about uninsurance at particular point in the year provide estimates very similar to the CPS. But they also find that estimates of uninsurance over an entire calendar year are only about one-half to two-thirds as large as point-intime estimates; correspondingly, estimates of the number of individuals uninsured at any point in the last year are on the order of 40–50 percent higher than point-in-time estimates. These findings highlight the dynamic nature of uninsurance.

And the heart of the matter can be found at the end of the piece.

Measures that are being discussed today under the guise of cost control are very modest. Initiatives such as medical electronic records, increased preventive and maintenance care, and reduced medical errors will at best reduce health care costs by only a few percentage points, and are just as likely to raise costs (with increasing quality). With health care costs rising at 7–10 percent per year, this is not enough. To fundamentally control health care costs we need to actually be willing to deny care that does little for health—but which consumers now want. This would be accomplished either through government technology policy, medical standards, or global provider budgets.

There remains considerable controversy, however, over the appropriate level of such government interventions—or whether they are necessary at all. Some argue that past health care spending advances are well justified by improvements in population health (Cutler 2004). Others argue that there are huge variations in health care practices across the United States with no tangible benefits (e.g., Jonathan S. Skinner, Douglas O. Staiger, and Elliott S. Fisher 2006). These two views are not mutually inconsistent: the first speaks to the average value of medical care over time, the second to the marginal value of additional health care at a point in time. But until we can resolve these discrepancies and understand more fully which health care spending is justified and which is not, we are not prepared to take on the American public on cost control. The fundamental insight of this round of reform is therefore to not hold the attainable goal (universal coverage) hostage to the (currently) unattainable goal, fundamental health care cost control.

This makes me very pessimistic about the prospects in the US, as we would not settle for government limitations on what we can spend privately. It seems difficult in the UK as well.

Patients “cannot, in one episode of treatment, be treated on the NHS and then allowed, as part of the same episode and the same treatment, to pay money for more drugs,” the health secretary, Alan Johnson, told Parliament, according to the Times. “That way lies the end of the founding principles of the NHS,” which is supposed to guarantee equal care to all, regardless of ability to pay.

Returning to the aforementioned Gruber piece Arnold Kling and a commenter make some useful observations:

He fails to mention the fact that the Massachusetts plan has been a disappointment. Nor does he mention his own deep involvement in the plan, which might affect his objectivity in the matter.

And the comments from Bob Goldberg point out:

Good pick on the Gruber piece.. Gruber also fails to mention that such programs simple replace private coverage and personal responsibility for payment with public assumption of the costs and risks. By about 50 percent. Talk about inefficiency. He should know since both he and David Cutler (one of the most thoughtful health care economists around and most substantial) wrote about a decade ago. (See, David M. Cutler and Jonathan Gruber, “Does Public Insurance Crowd Out Private Insurance?” The Quarterly Journal of Economics, Vol. 111, No. 2 (May 1996), pp. 391–430. And also, Jonathan Gruber and Kosali Simon, “Crowd-Out Ten Years Later: Have Recent Public Insurance Expansions Crowded Out Private Health Insurance?” NBER Working Paper No. w12858, January 2007, and Noelia Duchovny and Lyle Nelson, “The State Children’s Health Insurance Program,” Congressional Budget Office, May 2007. In turn, the underwriting models that would normally apply in insurance are tossed out the window. When you make the purchase of a good or service nearly risk free -- as with housing or home ownership -- guess what happens? Markets can't sustain the subsequent behavior without continued government expansion of subsidies, support and regulation and then costs at some point become prohibitive and lead to rationing.

Health Mashups

Here is a mashup between google maps and some quality assurance data for hospitals.

US Hospital Finder.

SiCKO

Thanks to a fellow student, here is a link which allows you to watch SiCKO for free:

Watch "Sicko" Movie

Reading Research

The New York Times has a great Health related section this week.  In particular they have this graphic, which details how to read (skeptically) medical research.  Its good advice for reading all kinds of research.