Why are ACOs doomed for failure?

Among the more ambitious parts of the Patient Protection and Affordable Care Act (2010) is the formation of Accountable Care Organizations (ACOs) that offer fiscal rewards when well-organized, integrated hospital-physician groups can improve quality of care and reduce the cost of Medicare expenditures. After studying the conceptual and operational issues, it is concluded herein that ACOs are in the long-haul doomed for failure since: 1) most hospitals and physicians have major difficulties in consummating tightly coordinated collaborative efforts; 2) providers historically have had a dismal track record in reducing cost, because of existing fee-for-service incentives; and 3) existing regulations do not provide sufficient fiscal rewards to assume the cost of starting an ACO and its possible operational risks.     

Why is a systemic view of health financing necessary?

The mobilization of funds for health care has gained prominent attention around the world. Billions of dollars in new funds are flowing into health care in low- and middle-income countries. Sadly, this money might not be transformed into efficient and effective health care to help poor and vulnerable people in these countries unless nations take a systemic approach to health care financing. This paper outlines key health policy issues and argues that choosing health care financing methods with integrated institutional arrangements and payment systems is critical to providing equitable, efficient, and effective health care for all.     

Why are pharmaceutical companies gradually abandoning vaccines?

During the past fifty years, the number of pharmaceutical companies making vaccines has decreased dramatically, and those that still make vaccines have reduced resources to make new ones. Pharmaceutical companies are gradually abandoning vaccines because the research, development, testing, and manufacture of vaccines are expensive and because the market to sell vaccines is much smaller than the market for other drug products. Congressional action could assure both a steady supply of existing vaccines and the promise of vaccines for the future.     

Why are health plans buying physician groups?

Most insurers say they have no intention of buying doc practices. Those that have done so, say it's just one tool in their accountable care strategy.     

Why are US women not using long-acting contraceptives?

CONTEXT: Given the level of unintended pregnancy in the United States, it is somewhat surprising that hormonal implants and injectables-methods that are long-acting, reversible, highly effective and convenient--have not attained the popularity enjoyed by other medical methods. Knowing the reasons why women have so far spurned these methods might lead to the design and implementation of interventions and targeted social marketing to promote their use. METHODS: Data from the 1993 and 1995 rounds of the National Survey of Women are used to examine the reasons women gave for not having used the implant or injectables, whether they intended to use these methods and how their attitudes toward them may influence their decision to use such methods in the future. Logistic regression models were used to identify the social and demographic characteristics that influence women's decisions not to use these methods. RESULTS: Fewer than 2% of women who were at risk of an unintended pregnancy in 1995 were using the implant, and under 3% were using the injectable. Women gave three major reasons for not using either of these methods: lack of knowledge; fear of side effects or health hazards; and satisfaction with the method they were currently using. Age, education, marital status, parity and current contraceptive method strongly predicted fear of side effects, lack of knowledge and satisfaction with the current method as reasons for not using the implant or the injectable. For example, women aged 30 or older and those with a college education were half as likely as younger women and those with no college education to mention fear of side effects as their main reason for not using the implant. Likewise, single women, women with one or more children and those using a barrier method were 2-3 times as likely as married women, childless women and those using a medical method to attribute nonuse to the implant's side effects. Few women said they intended to use these methods in the next 12 months: 5% for the implant and 10% for the injectable. Single women, women with no college education, women with children, women wanting to have a child (or another child) and women with positive attitudes toward the effect of using an injectable were significantly more likely to say they intended to use the injectable. Nevertheless, substantial proportions of women reported quite negative attitudes about these methods. CONCLUSIONS: The low prevalence of use and the low level of use intention for the implant and for injectables raise questions about the promise for the future of these methods. Each method seems to appeal to certain subgroups of women, however. Thus, if proper interventions and social marketing are targeted to such groups, they may be disabused of misperceptions regarding these methods and possibly become more willing to try them.     

Third mailings in epidemiological studies: are they really necessary?

INTRODUCTION: Whether or not third mailings are appropriate or worthwhile in postal epidemiological studies has not been thoroughly investigated and requires examination. METHODS: A self-completion postal questionnaire of 2184 individuals was conducted in 2000. The socio-demographic and health characteristics of four groups of individuals (first mailing respondents, second mailing respondents, third mailing respondents and non-respondents) were compared. RESULTS: Some significant differences between the groups were found, however, the inclusion of respondents to the third mailing did not significantly change the overall characteristics of respondents compared to non-respondents. DISCUSSION: When differences do exist between respondents and non-respondents, our results suggest that a third mailing is unlikely to remove many of these differences. The study supports our previous suggestion that the effort and resources expended in carrying out a third mailing may not be justified.     

Why we are wasting time in the operating theatre?

Objectives To determine reasons for delay during elective operating lists and suggest solutions. Design Prospective observational study. Setting A large under‐graduate teaching hospital. Participants Fifty‐five consecutive women undergoing elective gynaecological surgery under general anaesthesia. Interventions Every time point of individual patient's passage through the operating theatre (patients sent for, arrival in the anaesthetic room, general anaesthetic commenced, transfer to the operating theatre, surgery started, surgery completed, anaesthetic reversed, patient taken to recovery area) was documented. Main outcome measures Time intervals between the various time points with particular reference to wait by the anaesthetist and surgeon between cases. Results We monitored 55 operations carried out during 22 operating lists. Apart from the surgery itself (median 81 min per procedure), the longest interval was the time taken to get patients into the anaesthetic room from the ward (median 20 min). Although patients waited a median of 10 min before the start of anaesthesia, if the first procedure on the list was excluded, the anaesthetist was waiting for the patient to arrive in the anaesthetic room in 13/30 (43%) cases, wasting a median of 7 min per case. The surgeon had to wait a median of 22.5 min between operations. Conclusions Considerable operating theatre time is wasted while patients are transferred to and from the operating theatre resulting in both anaesthetists and surgeons having to wait between patients in a high proportion of cases, averaging 1 h during a 4 h operating list. Surgery could be made more time efficient by ensuring that patients arrive in the operating theatre complex early enough (to reduce time wasted for anaesthetists and surgeons), and by having two anaesthetists available at the end of surgery, one to reverse the anaesthetic while the other starts the next induction (to reduce time waste for the surgeon), coupled to adequate recovery area capacity. Copyright © 2008 John Wiley & Sons, Ltd.     

Why are workers uninsured? Employer-sponsored health insurance in 1997

This study examines the number of workers in firms offering employee health plans, the number of workers eligible for such plans, and participation in employer-sponsored insurance. Data from the February 1997 Contingent Worker Supplement to the Current Population Survey indicate that 10.1 million workers are employed by firms offering insurance but are not eligible. Not all of these workers are eligible for coverage, most often because of hours of work. Our results indicate that 11.4 million workers rejected coverage when it was offered. Of those, 2.5 million workers were uninsured. Workers cited high cost of insurance most often as the primary factor for refusing coverage.