Monday, 16 April 2018

To optimise the expense, the cost must be reduced

Josep Mª Monguet

It’s well known that the budget allocated to health services has endured brutal cumulative reductions over recent years. This is a detrimental fact, but one can not deny the merit of having suffered and then having survived the cut, the professionals - in the first instance and the users alike. It’s sad but praiseworthy.

The health budget is unlikely to improve in the short to medium term because the situation is what it is and by definition the public deficit has a ceiling. Lamenting that resources were not well managed during the "good times" doesn’t change anything. Although it seems a contradiction, the financial management cannot be improved if the health system and its users, collaboratively, are incapable of reducing the avoidable costs that weigh us down. Only thus we can free up resources and allocate them to make the system more efficient.

The scope of the costs that can be and should be avoided are diverse but I propose that we look at an aspect that, although it has been studied, it may not have been focused upon enough. The question is: Should the lack of patient preparation and inappropriate behaviour, be treated as factors of unjustified increase in health costs? Expressed in other terms: Is it time for patients to assume greater responsibility with regard to their own health? When one talks about patients, does one refer to society as a whole?

By making an informal search in the literature, we can find revealing data. Although the majority of the following examples refer to studies undertaken in the USA, to some extent the conclusions can be extrapolated to our cicumstances.

Obesity/Inactivity: The direct cost of lack of physical activity can represent more than 2% of health expenditure, and the direct cost of inactivity and obesity together could exceed 9% of the health system budget.

Substances: 4% of health expenditure in smokers over 45 years of age is a consequence of smoking. Health costs derived from excess consumption of alcohol can represent an expense equivalent to that derived from smoking. Illegal drugs only account for 20% of the health costs derived from the total consumption of drugs.

Pollution: Air pollution causes 6% of total annual mortality and half can be attributed to motorized traffic.

Work environment: Between 5% and 8% of annual health costs can be attributed to management practices in companies and the impact, among others, on employee stress.

Loneliness: Work is being undertaken to measure the cost of loneliness; 

We can find other cost elements that are as relevant as those listed above. What is the extra-cost of being homeless? What economic impact does the lack of health education (health literacy) imply? What is the cost of not maintaining a balanced diet? What is the extra-cost of therapeutic noncompliance?

The data leaves little room for doubt and it’s time for patients and society to assume responsibility for their health. There is a lot of work to be done, but it’s of the utmost urgency for someone to really lead this question further. Who’s in?

Monday, 9 April 2018

Home sweet home and some other lessons

David Font

An article in the New England Journal of Medicine explains that the Department of Health in Victoria, Australia in 2010, announced the construction of a 500-bed hospital without using bricks. This virtual hospital currently receives 33,000 patients per year. And the introductory paragraph of the article ends by asking: What was the incredible technological progress that made it possible? Caring for the patient at home!

Let's continue without leaving the house. I remember post by Jordi Varela introducing the experience of Buurtzorg Netherlands, the Dutch home care company, described as a success story by King's Fund. During a Congress in Barcelona, I heard Jos de Blok, the leader of the project, explaining the experience as a paradigm of innovation success. Let's see why.

Monday, 2 April 2018

Plea for the end of clinical practice guidelines

James McCormack, a professor of pharmacy at British Columbia University, posted on his YouTube channel, a video clip that adapts the song of the Traveling Wilburys group, "End of the Line", to become "End of the Guidelines". The video begins with a scene from “Life of Brian" where the actor Graham Chapman as a fake Jesus Christ, addresses his followers from the window of his house and says: "You are wrong; you have no need to follow me. Follow no one; be yourselves, each of you is a different person."