In many medical care markets with limited profit potential, firms often have little incentive to innovate. These include the market for rare diseases, "neglected" tropical diseases, and personalized medicine. Governments and not-for-profit organizations promote innovation in such markets but empirical evidence on the policy effect is limited. We study this issue by analyzing the impact of a demand-side policy in Japan, which reduces the cost sharing of patients with some rare and intractable diseases and attempts to establish and promote the treatment of those diseases. Using clinical trials data taken from public registries, we identify the effect of the policy using a difference-in-difference approach. We find that the demand-side policy increased firms' incentive to innovate: firm-sponsored clinical trials increased 181% (0.16 per disease per year) when covered by the policy. This result indicates that the demand-side policy can be an important part of innovation policies in markets with limited profit potential.
{"title":"Promoting Innovation in Small Markets: Evidence from the Market for Rare and Intractable Diseases","authors":"Toshiaki Iizuka, Gyo Uchida","doi":"10.2139/ssrn.2805411","DOIUrl":"https://doi.org/10.2139/ssrn.2805411","url":null,"abstract":"In many medical care markets with limited profit potential, firms often have little incentive to innovate. These include the market for rare diseases, \"neglected\" tropical diseases, and personalized medicine. Governments and not-for-profit organizations promote innovation in such markets but empirical evidence on the policy effect is limited. We study this issue by analyzing the impact of a demand-side policy in Japan, which reduces the cost sharing of patients with some rare and intractable diseases and attempts to establish and promote the treatment of those diseases. Using clinical trials data taken from public registries, we identify the effect of the policy using a difference-in-difference approach. We find that the demand-side policy increased firms' incentive to innovate: firm-sponsored clinical trials increased 181% (0.16 per disease per year) when covered by the policy. This result indicates that the demand-side policy can be an important part of innovation policies in markets with limited profit potential.","PeriodicalId":307802,"journal":{"name":"Z-Medicine eJournal","volume":"143 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123275862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. García Molina, Liliana Chicaíza, Alexander Moreno Calderón, V. Prieto Martínez, Adriana Linares Ballesteros, I. Sarmiento
Objective: To estimate the cost-effectiveness of 18FDG-PET/CT compared to CT followed by 18FDG-PET/CT as a confirmatory test for a positive case at the end of treatment in patients less than 18 years with Hodgkin lymphoma.Materials and Methods: A decision tree in TreeAge® was built to compare the use of 18FDG-PET/CT with CT followed by 18FDG-PET/CT as a confirmatory test for a positive case in detecting residual lesion at end of treatment in pediatric patients with Hodgkin lymphoma. The perspective was that of the health system, including all direct costs. All monetary amounts are expressed in Colombian pesos of 2010. The outcome was measured in life years gained. The data of the operating characteristics of the tests were taken from the literature. We calculated the cost-effectiveness ratio. The threshold was 3 times the per capita GDP per life year gained (the Colombian 2010 per capita GDP was $12,047,418 COP). In the absence of reported data for life expectancy of true positives and false negatives, deterministic and probabilistic sensitivity analyzes were performed, in order to identify the effect of differential life expectancy upon the 18FDG-PET/CT cost effectiveness.Results: Assuming a difference of 13.4 years in the life expectancy of true positives vs false negatives, the cost of an additional life year gained with 18FDG-PET/CT compared to CT followed by 18FDG-PET/CT as a confirmatory test for a positive case in the evaluation at the end of treatment in pediatric patients with Hodgkin lymphoma was 2 789 788 (COP). The results were sensitive to the differential life years gained between true positive and false negative cases, the prevalence of residual lesion, the operating characteristics of the tests and the cost of 18FDG-PET/CT. 18FDG-PET/CT becomes cost effective for life expectancy differences of at least a year.Conclusion: If the differential life-expectancy between true positives and false negatives is at least one year, using 18FDG-PET/CT in the evaluation at the end of the treatment of pediatric patients with LH is a cost-effective strategy for Colombia. The size of the differential may have effects on the cost-effectiveness of 18FDG-PET/CT at other stages of diagnosis or treatment.
{"title":"Cost-Effectiveness of 18FDG-PET/CT Compared to CT Followed by 18FDG-PET/CT as a Confirmatory Test for a Positive Case in the Evaluation at the End of Treatment in Patients with Hodgkin Lymphoma","authors":"M. García Molina, Liliana Chicaíza, Alexander Moreno Calderón, V. Prieto Martínez, Adriana Linares Ballesteros, I. Sarmiento","doi":"10.2139/SSRN.2194558","DOIUrl":"https://doi.org/10.2139/SSRN.2194558","url":null,"abstract":"Objective: To estimate the cost-effectiveness of 18FDG-PET/CT compared to CT followed by 18FDG-PET/CT as a confirmatory test for a positive case at the end of treatment in patients less than 18 years with Hodgkin lymphoma.Materials and Methods: A decision tree in TreeAge® was built to compare the use of 18FDG-PET/CT with CT followed by 18FDG-PET/CT as a confirmatory test for a positive case in detecting residual lesion at end of treatment in pediatric patients with Hodgkin lymphoma. The perspective was that of the health system, including all direct costs. All monetary amounts are expressed in Colombian pesos of 2010. The outcome was measured in life years gained. The data of the operating characteristics of the tests were taken from the literature. We calculated the cost-effectiveness ratio. The threshold was 3 times the per capita GDP per life year gained (the Colombian 2010 per capita GDP was $12,047,418 COP). In the absence of reported data for life expectancy of true positives and false negatives, deterministic and probabilistic sensitivity analyzes were performed, in order to identify the effect of differential life expectancy upon the 18FDG-PET/CT cost effectiveness.Results: Assuming a difference of 13.4 years in the life expectancy of true positives vs false negatives, the cost of an additional life year gained with 18FDG-PET/CT compared to CT followed by 18FDG-PET/CT as a confirmatory test for a positive case in the evaluation at the end of treatment in pediatric patients with Hodgkin lymphoma was 2 789 788 (COP). The results were sensitive to the differential life years gained between true positive and false negative cases, the prevalence of residual lesion, the operating characteristics of the tests and the cost of 18FDG-PET/CT. 18FDG-PET/CT becomes cost effective for life expectancy differences of at least a year.Conclusion: If the differential life-expectancy between true positives and false negatives is at least one year, using 18FDG-PET/CT in the evaluation at the end of the treatment of pediatric patients with LH is a cost-effective strategy for Colombia. The size of the differential may have effects on the cost-effectiveness of 18FDG-PET/CT at other stages of diagnosis or treatment.","PeriodicalId":307802,"journal":{"name":"Z-Medicine eJournal","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122412781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Liliana Chicaíza, Mario García Molina, S. Oviedo, J. Marín, PÍO IVAN GOMEZ-SANCHEZ
Objective: To estimate the incremental cost-effectiveness ratio of different diagnostic schemes in newborns of mothers with a clinical history of infection with Toxoplasma gondii during the pregnancy, in order to increase the detected cases of congenital toxoplasmosis.Methods: We built a decision tree in TreeAge®, with identified infection cases as an outcome, in which three diagnostic strategies were considered: i) IgG, IgM and IgA together, in the face of negative results in IgA and IgM, Western Blot confirmation, and in the face of negative results in the all three tests but IgG positive, monthly monitoring of the newborn for six months and then every three months until the first year with with IgG; ii) IgM and IgA together, with Western -Blot confirmation for negatives; and iii) Western Blot. The costs were included from the perspective of the Colombian health system, expressed in Colombian pesos of 2010. The information of medicines costs was obtained from 2008 SISMED, and the value of the procedures was calculated by adjusting the values of the Manual of Rates ISS 2001 30% (1), these values were compared with information of the costs supplied by three EPS. The discount rate was 0%. Sensitivity analyzes were performed univariate and probabilistic cost-effectiveness. Univariate and probabilistic sensitivity analyzes were performed for costs and effectiveness.Results: The most effective and expensive strategy is i) (based on IgG, IgM and IgA), followed by ii) (based on IgM and IgA and iii) (Western Blot). The incremental cost effectiveness ratio (ICER) of strategy ii) against iii) is $ 6,189,871. This ICER is sensitive to the cost and the sensitivity of Western Blot, and the prevalence of congenital toxoplasmosis. The ICER of strategy i) against ii) is $ 65,529,979, a result that is sensitive to the prevalence of congenital toxoplasmosis, the sensitivity of the joint test of IgM and IgA and the sensitivity of Western Blot. The probabilistic sensitivity analysis shows that, for a willingness to pay (WTP) per correctly identified case below $6,5 million pesos, the strategy with higher probability of being cost effective is iii); between $6,5 million and $74 million pesos, is strategy ii); for a WTP above $74 million pesos, is strategy i).Conclusions: The cost-effective alternative for Colombia depends on the WTP for additional case of congenital toxoplasmosis detected. Below $6,5 million pesos, strategy iii) is more likely to be cost effective; between $6,5 million and $74 million pesos, strategy ii); and above $74 million pesos, strategy i). The WTP should take into account the cost for the society of neurological lesions and blindness caused by the infection. As the results are sensitive to the prevalence of the infection, it is important to advance in the knowledge of this value for different regions in the country.
{"title":"Cost Effectiveness of Diagnostic Strategies for Detecting Congenital Toxoplasmosis in Newborns","authors":"Liliana Chicaíza, Mario García Molina, S. Oviedo, J. Marín, PÍO IVAN GOMEZ-SANCHEZ","doi":"10.2139/SSRN.2194571","DOIUrl":"https://doi.org/10.2139/SSRN.2194571","url":null,"abstract":"Objective: To estimate the incremental cost-effectiveness ratio of different diagnostic schemes in newborns of mothers with a clinical history of infection with Toxoplasma gondii during the pregnancy, in order to increase the detected cases of congenital toxoplasmosis.Methods: We built a decision tree in TreeAge®, with identified infection cases as an outcome, in which three diagnostic strategies were considered: i) IgG, IgM and IgA together, in the face of negative results in IgA and IgM, Western Blot confirmation, and in the face of negative results in the all three tests but IgG positive, monthly monitoring of the newborn for six months and then every three months until the first year with with IgG; ii) IgM and IgA together, with Western -Blot confirmation for negatives; and iii) Western Blot. The costs were included from the perspective of the Colombian health system, expressed in Colombian pesos of 2010. The information of medicines costs was obtained from 2008 SISMED, and the value of the procedures was calculated by adjusting the values of the Manual of Rates ISS 2001 30% (1), these values were compared with information of the costs supplied by three EPS. The discount rate was 0%. Sensitivity analyzes were performed univariate and probabilistic cost-effectiveness. Univariate and probabilistic sensitivity analyzes were performed for costs and effectiveness.Results: The most effective and expensive strategy is i) (based on IgG, IgM and IgA), followed by ii) (based on IgM and IgA and iii) (Western Blot). The incremental cost effectiveness ratio (ICER) of strategy ii) against iii) is $ 6,189,871. This ICER is sensitive to the cost and the sensitivity of Western Blot, and the prevalence of congenital toxoplasmosis. The ICER of strategy i) against ii) is $ 65,529,979, a result that is sensitive to the prevalence of congenital toxoplasmosis, the sensitivity of the joint test of IgM and IgA and the sensitivity of Western Blot. The probabilistic sensitivity analysis shows that, for a willingness to pay (WTP) per correctly identified case below $6,5 million pesos, the strategy with higher probability of being cost effective is iii); between $6,5 million and $74 million pesos, is strategy ii); for a WTP above $74 million pesos, is strategy i).Conclusions: The cost-effective alternative for Colombia depends on the WTP for additional case of congenital toxoplasmosis detected. Below $6,5 million pesos, strategy iii) is more likely to be cost effective; between $6,5 million and $74 million pesos, strategy ii); and above $74 million pesos, strategy i). The WTP should take into account the cost for the society of neurological lesions and blindness caused by the infection. As the results are sensitive to the prevalence of the infection, it is important to advance in the knowledge of this value for different regions in the country.","PeriodicalId":307802,"journal":{"name":"Z-Medicine eJournal","volume":"75 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133984967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
An increasing number of Americans are obese, with a body mass index of 30 or more. In fact, the latest estimates indicate that about 30% of Americans are currently obese, which is roughly a 100% increase from 25 years ago. It is well accepted that weight gain is caused by caloric imbalance, where more calories are consumed than expended. Nevertheless, it is not clear why the prevalence of obesity has increased so dramatically over the last 30 years. We simultaneously estimate the effects of the various socio-economic factors on weight status, considering in our analysis many of the socio-economic factors that have been identified by other researchers as important influences on caloric imbalance: employment, physical activity at work, food prices, the prevalence of restaurants, cigarette smoking, cigarette prices and taxes, food stamp receipt, and urbanization. We use 1979- and 1997-cohort National Longitudinal Survey of Youth (NLSY) data, which allows us to compare the prevalence of obesity between cohorts surveyed roughly 25 years apart. Using the traditional Blinder-Oaxaca decomposition technique, we find that cigarette smoking has the largest effect: the decline in cigarette smoking explains about 2% of the increase in the weight measures. The other significant factors explain less.
{"title":"The Socio-Economic Causes of Obesity","authors":"C. Baum, Shin-Yi Chou","doi":"10.3386/W17423","DOIUrl":"https://doi.org/10.3386/W17423","url":null,"abstract":"An increasing number of Americans are obese, with a body mass index of 30 or more. In fact, the latest estimates indicate that about 30% of Americans are currently obese, which is roughly a 100% increase from 25 years ago. It is well accepted that weight gain is caused by caloric imbalance, where more calories are consumed than expended. Nevertheless, it is not clear why the prevalence of obesity has increased so dramatically over the last 30 years. We simultaneously estimate the effects of the various socio-economic factors on weight status, considering in our analysis many of the socio-economic factors that have been identified by other researchers as important influences on caloric imbalance: employment, physical activity at work, food prices, the prevalence of restaurants, cigarette smoking, cigarette prices and taxes, food stamp receipt, and urbanization. We use 1979- and 1997-cohort National Longitudinal Survey of Youth (NLSY) data, which allows us to compare the prevalence of obesity between cohorts surveyed roughly 25 years apart. Using the traditional Blinder-Oaxaca decomposition technique, we find that cigarette smoking has the largest effect: the decline in cigarette smoking explains about 2% of the increase in the weight measures. The other significant factors explain less.","PeriodicalId":307802,"journal":{"name":"Z-Medicine eJournal","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124844658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2000-05-01DOI: 10.7208/9780226309972-012
Jay Bhattacharya, Janet Currie
We use data from the third National Health and Nutrition Examination Survey to examine the prevalence and determinants of poor nutritional outcomes among American youths. One strength of our analysis is that we focus on an array of nutritional outcomes, and we find in fact that the determinants of these outcomes vary considerably form outcome to outcome. We interpret our results using a model in which investments in health capital are affected by both resource constraints and a human capital production function that summarizes available nutrition information. We find that although many youths suffer from nutrient deficiencies, these conditions are not generally sensitive to measures of resource constraints, and hence are unlikely to be due solely to a shortage of food. Conversely, we find that our proxies for information matter. Our results suggest that broad-based policies designed to alter the composition of the diet may hold the greatest promise for addressing the nutritional problems of American youths.
{"title":"Youths at Nutritional Risk: Malnourished or Misnourished?","authors":"Jay Bhattacharya, Janet Currie","doi":"10.7208/9780226309972-012","DOIUrl":"https://doi.org/10.7208/9780226309972-012","url":null,"abstract":"We use data from the third National Health and Nutrition Examination Survey to examine the prevalence and determinants of poor nutritional outcomes among American youths. One strength of our analysis is that we focus on an array of nutritional outcomes, and we find in fact that the determinants of these outcomes vary considerably form outcome to outcome. We interpret our results using a model in which investments in health capital are affected by both resource constraints and a human capital production function that summarizes available nutrition information. We find that although many youths suffer from nutrient deficiencies, these conditions are not generally sensitive to measures of resource constraints, and hence are unlikely to be due solely to a shortage of food. Conversely, we find that our proxies for information matter. Our results suggest that broad-based policies designed to alter the composition of the diet may hold the greatest promise for addressing the nutritional problems of American youths.","PeriodicalId":307802,"journal":{"name":"Z-Medicine eJournal","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2000-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128285762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
`Defensive medicine' is a potentially serious social problem: if fear of liability drives health care providers to administer treatments that do not have worthwhile medical benefits, then the current liability system may generate inefficiencies many times greater than the costs of compensating malpractice claimants. To obtain direct empirical evidence on this question, we analyze the effects of malpractice liability reforms using data on all elderly Medicare beneficiaries treated for serious heart disease in 1984, 1987, and 1990. We find that malpractice reforms that directly reduce provider liability pressure lead to reductions of 5 to 9 percent in medical expenditures without substantial effects on mortality or medical complications. We conclude that liability reforms can reduce defensive medical practices.
{"title":"Do Doctors Practice Defensive Medicine?","authors":"Daniel P. Kessler, M. Mcclellan","doi":"10.2307/2946682","DOIUrl":"https://doi.org/10.2307/2946682","url":null,"abstract":"`Defensive medicine' is a potentially serious social problem: if fear of liability drives health care providers to administer treatments that do not have worthwhile medical benefits, then the current liability system may generate inefficiencies many times greater than the costs of compensating malpractice claimants. To obtain direct empirical evidence on this question, we analyze the effects of malpractice liability reforms using data on all elderly Medicare beneficiaries treated for serious heart disease in 1984, 1987, and 1990. We find that malpractice reforms that directly reduce provider liability pressure lead to reductions of 5 to 9 percent in medical expenditures without substantial effects on mortality or medical complications. We conclude that liability reforms can reduce defensive medical practices.","PeriodicalId":307802,"journal":{"name":"Z-Medicine eJournal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1996-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130168313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To protect patient confidentiality, Abiomed, makers of the AbioCor artificial heart, adopt a 30-day "quiet period" surrounding implantations, which is construed by mainstream media as a "news blackout." In late 2002, James Quinn, the fifth transplant recipient, dies after 289 days. A month later, in a New York Times article describing Quinn's pain and suffering, Quinn's widow claims that her husband had not been adequately informed of the likely ordeal. This case raises issues about transparency and communication with stakeholders. The A-case may lead some students to focus on the public sensationalism surrounding the Quinn story, but a closer examination of the case reveals that the more urgent issue for AbioMed is getting the stalled clinical trial back on track and raising a slumping stock price. The B-case provides a detailed epilogue, including reactions to the Quinn's informed consent lawsuit and AbioMed's handling of the on-going clinical trial and investor relations. Excerpt UVA-BC-0204 January 25, 2010 ABIOMED AND THE ABIOCOR CLINICAL TRIALS (A) On November 5, 2001, James Quinn became the fifth recipient of the AbioCor implantable replacement heart; he lived for 289 days. About a month after his death, the New York Times ran an article chronicling Quinn's experience. According to Irene Quinn, the patient's wife, the Quinns had not been prepared for the pain and suffering they would endure. Irene faulted the experimental procedure for James' poor quality of life in his remaining days. While the Quinns adored their surgeon, they came to regret their participation in the AbioCor clinical trial, fired a patient advocate who was to assist them with ethical decisions, and hired a malpractice attorney. Long before the clinical trials began, Abiomed, maker of the artificial heart, had carefully considered how to ethically manage their many stakeholders' information needs. Before enrolling a patient in a clinical trial, the company counseled the patient about what to expect, formalizing these conversations with an “informed consent” agreement. Regarding transparency during the clinical trial, the company had to weigh the “good” of protecting patient confidentiality against the “good” of disclosing news and keeping investors and the public informed about experimental results. To avoid the kind of sensational media reporting that had besieged previous artificial heart recipients, the company went to great lengths to manage the expectations of a public eager for a medical breakthrough. Reasoning that putting patients first had to be the highest priority, Abiomed adopted a 30-day “quiet period” before reporting any news related to a new implantation. Although some had questioned Abiomed's communication policies prior to the Times article, the company had managed initially to attract favorable media attention. But circumstances had begun to sour. General economic conditions stagnated following the terrorist attacks of September 11, 2001. Then, when Ab
{"title":"Abiomed and the Abiocor Clinical Trials (a)","authors":"E. A. Powell, R. Goldberg","doi":"10.2139/ssrn.2973874","DOIUrl":"https://doi.org/10.2139/ssrn.2973874","url":null,"abstract":"To protect patient confidentiality, Abiomed, makers of the AbioCor artificial heart, adopt a 30-day \"quiet period\" surrounding implantations, which is construed by mainstream media as a \"news blackout.\" In late 2002, James Quinn, the fifth transplant recipient, dies after 289 days. A month later, in a New York Times article describing Quinn's pain and suffering, Quinn's widow claims that her husband had not been adequately informed of the likely ordeal. This case raises issues about transparency and communication with stakeholders. The A-case may lead some students to focus on the public sensationalism surrounding the Quinn story, but a closer examination of the case reveals that the more urgent issue for AbioMed is getting the stalled clinical trial back on track and raising a slumping stock price. The B-case provides a detailed epilogue, including reactions to the Quinn's informed consent lawsuit and AbioMed's handling of the on-going clinical trial and investor relations. Excerpt UVA-BC-0204 January 25, 2010 ABIOMED AND THE ABIOCOR CLINICAL TRIALS (A) On November 5, 2001, James Quinn became the fifth recipient of the AbioCor implantable replacement heart; he lived for 289 days. About a month after his death, the New York Times ran an article chronicling Quinn's experience. According to Irene Quinn, the patient's wife, the Quinns had not been prepared for the pain and suffering they would endure. Irene faulted the experimental procedure for James' poor quality of life in his remaining days. While the Quinns adored their surgeon, they came to regret their participation in the AbioCor clinical trial, fired a patient advocate who was to assist them with ethical decisions, and hired a malpractice attorney. Long before the clinical trials began, Abiomed, maker of the artificial heart, had carefully considered how to ethically manage their many stakeholders' information needs. Before enrolling a patient in a clinical trial, the company counseled the patient about what to expect, formalizing these conversations with an “informed consent” agreement. Regarding transparency during the clinical trial, the company had to weigh the “good” of protecting patient confidentiality against the “good” of disclosing news and keeping investors and the public informed about experimental results. To avoid the kind of sensational media reporting that had besieged previous artificial heart recipients, the company went to great lengths to manage the expectations of a public eager for a medical breakthrough. Reasoning that putting patients first had to be the highest priority, Abiomed adopted a 30-day “quiet period” before reporting any news related to a new implantation. Although some had questioned Abiomed's communication policies prior to the Times article, the company had managed initially to attract favorable media attention. But circumstances had begun to sour. General economic conditions stagnated following the terrorist attacks of September 11, 2001. Then, when Ab","PeriodicalId":307802,"journal":{"name":"Z-Medicine eJournal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116487163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The high and rising cost of US medical care is partially attributable to legally enforced rigidities in the health care system. By relaxing restrictions, the government can unlock competitive forces that drive prices down and empower individuals to avoid unnecessary, expensive medical services. A more open health care market would give providers incentives to innovate in ways that not only improve the quality of care but also reduce the cost of offering it. In this report, I suggest that significant cost savings can be achieved by encouraging medical tourism, empowering "mid-level" providers, using administrative law procedures as an alternative to malpractice litigation, reducing the scope of drug patents, and switching prescription medicines to over-the-counter dispensing.
{"title":"Medical Cost Containment: A Microeconomic Approach","authors":"Marc D. Joffe","doi":"10.2139/ssrn.3191337","DOIUrl":"https://doi.org/10.2139/ssrn.3191337","url":null,"abstract":"The high and rising cost of US medical care is partially attributable to legally enforced rigidities in the health care system. By relaxing restrictions, the government can unlock competitive forces that drive prices down and empower individuals to avoid unnecessary, expensive medical services. A more open health care market would give providers incentives to innovate in ways that not only improve the quality of care but also reduce the cost of offering it. In this report, I suggest that significant cost savings can be achieved by encouraging medical tourism, empowering \"mid-level\" providers, using administrative law procedures as an alternative to malpractice litigation, reducing the scope of drug patents, and switching prescription medicines to over-the-counter dispensing.","PeriodicalId":307802,"journal":{"name":"Z-Medicine eJournal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130019310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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