Archive for the ‘Health Economics’ Category

the high cost of high-quality healthcare

Thursday, February 22nd, 2018

The UK is unusual in that nearly all its spending on heathcare is done by government, through the National Health Service (NHS). It is unusual also in that its government spending (7.7% of GDP) and total spending (9.7% of GDP) on healthcare is near the bottom of the G7 high-income countries. Only Italy ranks lower. (more…)

the American way of healthcare

Wednesday, February 7th, 2018

The US approach to healthcare is without doubt the worst in the developed world. It is even worse than that of many low-income countries. Much has been written on this, but FT columnist Rana Foroohar manages to add to the discussion. She even writes about her own experience at a National Health Service (NHS) hospital in the UK, where she gave birth to two children. She reports that she was pleased to have all her needs “from basic check-ups to specialist visits — provided quickly and efficiently in the same place”. (more…)

towards the elimination of polio

Sunday, December 31st, 2017

One piece of good news is that that polio has been eliminated in nearly all countries of the world, and is on the verge of being eliminated everywhere. I never knew before that the American medical researcher Jonas Salk (1914-1995), who discovered, developed and introduced the first polio vaccine in 1955, campaigned for mandatory vaccination and never patented his vaccine, so never profited from its use.

The good news rarely unfolds as swiftly as the bad, so this graph dates back to 1980. Polio was once a global scourge, and was endemic in 125 countries as recently as 1988. Polio clings on in Afghanistan, Nigeria, and particularly Pakistan — but the world is on the verge of eliminating it entirely. Jonas Salk, who developed the first polio vaccine in the 1950s, did not patent it, declaring, “could you patent the sun?”

Tim Harford, “A year in charts: From bitcoin to Trump and chess playing robots“, The Big Read, Financial Times, 28 December 2017 (gated paywall).

This chart is one of many in Mr Harford’s column.

Polio is all but eradicated. Number of reported paralytic polio cases (thousands)

price-gouging by big pharma

Sunday, December 10th, 2017

A new pharmaceutical company, with an office in Alabama but no production facilities, has simplified things by charging the same price ($295) for two products (Niacor and SSKI), which previously sold for $32.46 (100 tablets) and $11.48 (30ml) respectively. (more…)

The Heritage Foundation on Health, 1989

Monday, July 31st, 2017

Every once in a while people make the point that much of what eventually became Obamacare came from, of all places, the Heritage Foundation – that is, the ACA is basically what conservatives used to advocate on health care. So I recently reread Stuart Butler’s 1989 Heritage Foundation lecture, “Assuring Affordable Health Care For All Americans” – hmm, where have I seen similar language? — to see how true that is; and the answer is, it really is pretty much true. ….

Overall, what’s striking about the Heritage plan is that it’s not notably more conservative than what Obama actually implemented: a bit less regulation, a substantial amount of additional spending. If Obamacare is an extreme leftist measure, as so many Republicans claim, the Heritage Foundation in the 1980s was a leftist institution.

Paul Krugman, “Heritage On Health, 1989“, The Conscience of a Liberal, 30 July 2017.

Professor Krugman’s blog is gated, but the lecture that he cites is freely available for anyone who would like to read it. It does seem more leftist than conservative. How times have changed since the 1980s!

deaths of despair in the US and the UK

Tuesday, July 25th, 2017

British-American economist Angus Deaton has an excellent column in today’s Financial Times. The main point he makes is that Britain is not likely to experience the ‘deaths of despair’ we see in the USA for two reasons. First, access to painkillers is more restricted in Britain. Secondly, and more importantly, median wages in recent decades have increased in the UK, but not in the USA. (more…)

on the Republican replacement for Obamacare

Friday, July 21st, 2017

Sherry Glied, dean of New York University’s Robert F. Wagner graduate school of public service, said: “I have been doing US health policy for 25 years. This is the greatest, craziest nonsense I have ever seen. This is crazy.”

Barney Jopson, “The steps Donald Trump can take to let Obamacare fail“, Financial Times, 22 July 2017 (gated paywall).

US healthcare reform is on life support

Wednesday, July 12th, 2017

Why is it so difficult for the Republicans to replace Obamacare? Edward Luce reasons that Obamacare is very conservative, and there are no viable conservative alternatives available. During the campaign, I recall that Donald Trump promised to replace Obamacare with a single-payer system, like Medicare in Canada, or the National Health Service in Scotland, but I haven’t heard any support from him for this option since taking office. For that matter, Medicare, Medicaid and the Veterans Administration in the USA are single-payer programmes, so I don’t understand why a single-payer option is anathema to Republicans.

The dilemma is that Republican lawmakers can only agree on the first half of their vow to “repeal and replace” Obamacare. The difficulty with the “replace” portion is that there are no viable conservative healthcare options available. Obamacare itself was a conservative reform. Its key tenets were based on a plan drawn up in the 1990s by the conservative Heritage Foundation as an alternative to the more dirigiste “Hillarycare” — the failed reform effort championed by Hillary Clinton, then first lady. The Heritage Plan then became “Romneycare”, which was enacted in 2006 by Mitt Romney, the then Massachusetts governor.

Obamacare is based on the same principle that individuals buy healthcare policies from private insurance companies on market-based exchanges. It would be hard to come up with something more free market than that.

Edward Luce, “Republican ‘kamikaze’ healthcare plan on life support“, Financial Times, 11 July 2017 (gated paywall).

HIV/AIDS in South Africa

Monday, July 10th, 2017

Despite massive expenditure, South Africa has been unable to control its HIV epidemic.

Ten years ago, [with more than 11 per cent of the population infected by HIV,] South Africa unveiled a long-term plan to tackle its HIV problem. ….

Today HIV prevalence is about 12 per cent, partly reflecting the fact that those with the disease are living longer thanks to better treatment. ….

[But the plan is in trouble.] Even as it aims to reduce a persistently high level of new HIV infections to 100,000 a year by 2022, from 270,000 last year, many civil society groups say that South Africa is falling behind the latest thinking on HIV prevention …. ….

With just over half of the HIV-infected population of 7m taking ARVs [antiretrovirals], South Africa already runs the largest such programme in the world. ….

Clinicians speak of an urgent need to break a “cycle of HIV transmission” from older men to younger women by focusing on the prevention of infection. They estimate hundreds of new cases appear every day and, of the 270,000 people infected last year, 100,000 were young women and girls. ….

[The programme] has come under fire from activists for failing to press the government to follow a World Health Organization recommendation by decriminalising sex workers, which is one of the highest-risk groups. This move would make it easier for them to have access to anti-HIV drugs and stop police taking condoms away from them.

Joseph Cotterill, “South Africa reaches a make-or-break point over HIV“, Financial Times, 6 July 2017 (gated paywall).

deaths of despair in the USA

Sunday, June 11th, 2017

After a century of decreases, the overall death rate for American adults aged 25-44 years rose 8.2 percent between 2010 and 2015. The disturbing trend seems to have continued in 2016.

The opioid epidemic that has ravaged life expectancy among economically stressed white Americans is taking a rising toll among blacks, Hispanics and Native Americans, driving up the overall rate of death among Americans in the prime of their lives.

Since the beginning of this decade, death rates have risen among people between the ages of 25 and 44 in virtually every racial and ethnic group and almost all states, according to a Washington Post analysis. ….

The [death] rate is adjusted for the nation’s changing age profile, and every five-year age group [25-29, 30-34, etc.] … showed an increase in mortality.

Preliminary data from the first half of 2016 suggests that the trend is continuing ….

One clear distinction remains: education level. The only 25-44 group whose death rate is not climbing is people with four-year college degrees. ….

The jump in death rates has been driven in large measure by drug overdoses and alcohol abuse ….

Joel Achenbach and Dan Keating, “Drug crisis is pushing up death rates for almost all groups of Americans“, Washington Post, 9 June 2017.

See also this earlier TdJ blog.