Health Policy

Health Care Delivery in the United States,

Health Care Delivery in the United States,
11th Edition. Springer Publishing LLC

Gusmano, Michael K. and Victor G. Rodwin, Comparative Health Systems. In Knickman and Kovner (eds.)
04/14/2015

Windows can sometimes be mirrors. A look at health systems abroad can enable us to develop a better understanding of our health system in the United States. An international perspective suggests that the United States has the most expensive health care system in the world, but unlike other wealthy countries, we fail to provide universal health insurance coverage and experience large inequities in access to primary and specialty care. Health care costs are often a source of financial strain, even bankruptcy, for people with serious illness (Hacker, 2006), and Americans suffer from high rates of mortality that could have been avoided with timely and appropriate access to a range of effective health care services (Nolte & McKee, 2012). There is also evidence that the U.S. health care system squanders resources and fails to address many of its population’s health care needs. Not surprisingly, public opinion polls regularly find that medical professionals and the public are dissatisfied with the system and believe major change is necessary (Blendon, Benson, & Brulé, 2012). 

Power and Priorities: The Growing Pains of Global Health; Comment on “Knowledge, Moral Claims and the Exercise of Power in Global Health”

Power and Priorities: The Growing Pains of Global Health; Comment on “Knowledge, Moral Claims and the Exercise of Power in Global Health”
Int J Health Policy Manag 2015, 4(x), 1–2

Karen A. Grépin
03/05/2015

Shiffman has argued that some actors have a great deal of power in global health, and that more reflection is needed on whether such forms of power are legitimate. Global health is a new and evolving field that builds upon the historical fields of public and international health, but is more multi-disciplinary and inter-disciplinary in nature. This article argues that the distribution of power in some global health institutions may be limiting the contributions of all researchers in the field

The Effect of the Diffusion of the Surgical Robot on the Hospital-level Utilization of Partial Nephrectomy

The Effect of the Diffusion of the Surgical Robot on the Hospital-level Utilization of Partial Nephrectomy
Medical Care, Vol. 53, no. 1, pp. 71-78. DOI: 10.1097/MLR.0000000000000259

Sivarajan, G., G.B. Taksler, D. Walter, C.P. Gross, R.E. Sosa,and D.V. Makarov
01/01/2015

Introduction: The rapid diffusion of the surgical robot has been controversial because of the technology’s high costs and its disputed marginal benefit. Some, however, have suggested that adoption of the robot may have improved care for patients with renal malignancy by facilitating partial nephrectomy, an underutilized, technically challenging procedure believed to be less morbid than radical nephrectomy. We sought to determine whether institutional acquisition of the robot was associated with increased utilization of partial nephrectomy.

Methods: We used all payer data from 7 states to identify 21,569 nephrectomies. These patient-level records were aggregated to the hospital-level then merged with the American Hospital Association Annual Survey and publicly available data on timing of robot acquisition. We used a multivariable difference-in-difference model to assess at the hospital-level whether robot acquisition was associated with an increase in the proportion of partial nephrectomy, adjusting for hospital nephrectomy volume, year of surgery, and several additional hospital-level factors.

Results: In the multivariable-adjusted differences-in-differences model, hospitals acquiring a robot between 2001 and 2004 performed a greater proportion of partial nephrectomy in both 2005 (29.9% increase) and 2008 (34.9% increase). Hospitals acquiring a robot between 2005 and 2008 also demonstrated a greater proportion of partial nephrectomy in 2008 (15.5% increase). In addition, hospital nephrectomy volume and urban location were also significantly associated with increased proportion of partial nephrectomy.

Conclusions: Hospital acquisition of the surgical robot is associated with greater proportion of partial nephrectomy, an underutilized, guideline-encouraged procedure. This is one of the few studies to suggest robot acquisition is associated with improvement in quality of patient care.

Shanghai rising: health improvements as measured by avoidable mortality since 2000

Shanghai rising: health improvements as measured by avoidable mortality since 2000
International Journal of Health Policy Management. 2015, 4(x), 1–6

Gusmano, Michael K., and Victor G. Rodwin, Chunfang Wang, Daniel Weisz, Li Luo, and Fu Hua
12/27/2014

Over the past two decades, Shanghai, the largest megacity in China, has been coping with unprecedented growth of its economy and population while overcoming previous underinvestment in the health system by the central and local governments. We study the evolution of Shanghai’s healthcare system by analyzing “Avoidable Mortality” (AM) – deaths amenable to public health and healthcare interventions, as previously defined in the literature. Based on analysis of mortality data, by cause of death, from the Shanghai Municipal Center for Disease Control and Prevention, we analyze trends over the period 2000–10 and compare Shanghai’s experience to other mega-city regions – New York, London and Paris. Population health status attributable to public health and healthcare interventions improved dramatically for Shanghai’s population with permanent residency status. The age-adjusted rate of AM, per 1,000 population, dropped from 0.72 to 0.50. The rate of decrease in age-adjusted AM in Shanghai (30%) was comparable to New York City (30%) and Paris (25%), but lower than London (42%). Shanghai’s establishment of the Municipal Center for Disease Control and Prevention and its upgrading of public health and health services are likely to have contributed to the large decrease in the number and rate of avoidable deaths, which suggests that investments in public health infrastructure and increasing access to health services in megacities – both in China and worldwide – can produce significant mortality declines. Future analysis in Shanghai should investigate inequalities in avoidable deaths and the extent to which these gains have benefitted the significant population of urban migrants who do not have permanent residency status.

The Top Ten Global Health Supply Chain Issues: Perspectives from the Field

The Top Ten Global Health Supply Chain Issues: Perspectives from the Field
Operations Research for Health Care. 3(4) 226-230.

Privett, N. and D. Gonsalves
12/01/2014

In the battle for global health, supply chains are often found wanting. Yet most of what is known about in-country pharmaceutical supply chains resides in the experiences of individual stakeholders, with limited amounts of this knowledge captured in technical reports and papers. This short communication taps into the collective experience and wisdom of global health supply chain professionals through interviews and surveys to identify and prioritize the top 10 global health pharmaceutical supply chain challenges: (1) lack of coordination, (2) inventory management, (3) absent demand information, (4) human resource dependency, (5) order management, (6) shortage avoidance, (7) expiration, (8) warehouse management, (9) temperature control, and (10) shipment visibility. As such, this work contributes to the foundational knowledge of global health pharmaceutical supply chains. These challenges must be addressed by researchers, policy makers, and practitioners alike if global pharmaceutical supply chains are to be developed and improved in emerging regions of the world.

Syndemic Vulnerability, Sexual and Injection Risk Behaviors, and HIV Continuum of Care Outcomes in HIV-Positive Injection Drug Users

Syndemic Vulnerability, Sexual and Injection Risk Behaviors, and HIV Continuum of Care Outcomes in HIV-Positive Injection Drug Users
AIDS & Behavior, Sep 2014. DOI: 10.1007/s10461-014-0890-0

Mizuno, Y., D.W. Purcell, A.R. Knowlton, J.D. Wilkinson, M.N. Gourevitch, and K.R. Knight
09/24/2014

Limited investigations have been conducted on syndemics and HIV continuum of care outcomes. Using baseline data from a multi-site, randomized controlled study of HIV-positive injection drug users (n = 1,052), we examined whether psychosocial factors co-occurred, and whether these factors were additively associated with behavioral and HIV continuum of care outcomes. Experiencing one type of psychosocial problem was significantly (p < 0.05) associated with an increased odds of experiencing another type of problem. Persons with 3 or more psychosocial problems were significantly more likely to report sexual and injection risk behaviors and were less likely to be adherent to HIV medications. Persons with 4 or more problems were less likely to be virally suppressed. Reporting any problems was associated with not currently taking HIV medications. Our findings highlight the association of syndemics not only with risk behaviors, but also with outcomes related to the continuum of care for HIV-positive persons.

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