Hospitals and market share: Is market power good or bad?

David Cutler, Professor of Applied Economics at the Department of Economics and Kennedy School of Government in Harvard University published with Fiona Scott Morton in 2013 at JAMA Hospitals, market share and consolidation. They said in their conclusion:

" A central economic question about the emerging health system is whether consolidation of large hospital institutions is beneficial or harmful. The answer is not always the same because it depends on the environment in which consolidation occurs, who is consolidating, how large each organization is in its different markets,and whether the combined entity improves quality of care.

Having policy makers be smart about how hospitals and other health care institutions are allowed to consolidate is critical to ensuring that the population is receiving the best care possible at reasonable, affordable prices".

Recently it has appeared a report done by FTI consulting that says: "Hospital mergers offer substantial benefits for patients and communities. This study provides a comprehensive review and analysis of hospital merger studies and trends that uncovers a reality rooted in research and quite different than what many people think". FTI consulting report (2014)

Two interesting papers to read this 2015 and analyse the benefits and harms of market power in the health care sector.

Reading it we probably could understand and anticipate what will happen (or happening now!) in Spain in general and in Catalonia and Barcelona in particular in the private health care sector market and the behaviour of the different actors: health care organiazations, insurances, doctor companies, and consumers.

photo: (*) Photosolde
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merry christmas and happy new year 2015

designed by: Soldevila. disseny, comunicació i art
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Data: the most valuable commodity

Data is becoming a "commodity". The important point today is HOW we USE the data NOT the data itself. The data itself is like a barrel of oil: It's basically the same product regardless of the producer.

If we believe in this idea we could understand also that the current definition of "personal data" is evolving. The report published by World Economic Forum in collaboration with The Boston Consulting Group in 2013 Unlocking the value of personal data: from collection to usage (2013) explains how the world and the use of personal data are changing:

"What is considered personal data is increasingly contextual; it changes with personal preferences, new applications, context of uses, and changes in cultural and social norms. Traditionally, organizations have used a variety of techniques to de-identify data and create value for society while protecting an individual’s privacy. Such data was not subject to the same rules as the Personal Identificable Information (PII) as an individual could not be identified from it.

Today technological advances and the ability to associate data across multiple sources is shifting boundaries of what is or is not PII, including potential re-identification of previously anonymized data.

This issue is the subject of significant debate with some arguing that this means that all data is effectively personally identifiable and should be treated as such. Others urge caution, arguing that this would curtail many of the beneficialuses of anonymous data with minimal gains in privacy. A shift in approach to thinking less about the data and more about the usage could offer a way forward.

If the usage impacts an individual directly it would require different levels of governance than data which is used in an aggregated and anonymized manner.

• Related post: data is now touching everyone lifes

photo: (*) Photosolde
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What motivates people to display philanthropic behaviour?

The main drivers of philanthropic donation behaviour are defined by Eight Mechanisms:

1. Awareness of need
2. Solicitation
3. Costs and benefits
4. Altruism
5. Reputation
6. Psychological benefits; impure altruims or warm glow
7. Values
8. Efficacy

I would like to focuse in the concepts of altruism, warm glow and efficacy.

• Altruism: Acts of philanthropy can be inspired by a ‘true’ or ‘pure’ concern for the well-being of recipients or the creation of a public good or service. People simple demand more for the public good.
• Impure altruism or warm glow: Some people get some private benefits (positive reputation, a sense of duty or satisfaction... ) from their gift per se, like a "warm glow". Its a selfish motive but with no bad connotations.
• Efficacy: People are more likely to engage in philanthropic behaviour when they perceive their contribution to be more effective.

These concepts are not contradictories, but probably the mechanisms of donation could differ if your are a small donor, a big philantropist or your are company. Probably you will put emphasis or priorizes these three concepts in a different way.

Acces to related articles (in pdf):

• Testing Mechanisms for Philanthropic Behaviour (2011)
• Eight Mechanisms that Drive Charitable Giving (2011)
• Impure altruism-warm glow (1990)

pd: Discussion cycle in Barcelona organized by Ivàlua and Obra social "la Caixa" New Forms of Philanthropy and Social Transformation

photo: (*) Photosolde
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from old managers to the young ones: emerging-markets growth, disruptive technology, and aging populations

Managers aim to improve their performance every day, but in many cases, doing a little better is not enough. Change is hard and risky. Many managers wait until their backs are against the wall before they start rethinking their bussiness models. Social scientists and behavioral economists find that we "human beings" are biased toward the status quo and resist changing our assumptions and approaches even in the face of the evidence. Is this true for the new Millenial-Y generation or it will be different?

To celebrate McKinsey Quarterly’s 50th anniversary Mckinsey has published this article about Management intuition for the next 50 years

The collision of technological disruption, rapid emerging-markets growth, and widespread aging are the three causes that will put the new managers at the edge of a cliff:

• Dynamism in emerging markets: Do you know where Taiyuan is?
• Technology and connectivity: Do you know the Moore's law? 
• Aging populations: Fertility rate projections 

Related post: Where are we?

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International Day Surgery activity: how many doctors are interested in looking that?

OECD Health Statistics 2014 (the new name of the online database OECD Health Data) offers the most comprehensive source of comparable statistics on health and health systems across OECD countries. It is an essential tool to carry out comparative analyses and draw lessons from international comparisons of diverse health systems.

One interesting area to compare is the surgical procedures, specially the variations between countries using day surgery. OECD compares data from 1990 until now of a short list of surgical procedures like cataract, tonsillectomy, repair of inguinal hernia or cholescystectomy... showing the total number of procedures performed as inpatient cases, day cases or in certain instances, as outpatient cases. Also as a percentage and per 100.000 population

Some questions a doctor observing data should ask himself:

• Why our country is different from countries like us?
• Why are we doing less/more day surgery than others?
• Are these variations reflecting innapropiate use of inpatien rates?
• Are we under-use some recommended practice?
• Are the incentives payment affect our surgical decisions?
• Is the property of hospital affecting? public vs private hospital
• Is an organizational matter? how the hospital is organized
• Is a problem of my department?

Related Publications: OECD 2012. How many surgical procedures performed as inpatient and day cases

Definition: Day surgery.

• Day-care discharge: Is the release of a patient who was formally admitted in a hospital for receiving planned medical and paramedical services, and who was discharged on the same day.
• Outpatient: Procedures on patients who are not formally admitted in hospital or in any other health care facility: 1) Procedures performed in outpatient departments in hospitals;: 2) Procedures performed in emergency departments; 3) Procedures performed outside hospitals (ambulatory sector).

Photo: W. Eugene Smith—Time & Life Pictures/Getty Images
Dr. Ernest Ceriani makes a house call on foot, Kremmling, Colo., 1948. __________________________________________________________________________

Catalan Results Centre Reports in Health: a transparency and benchmark step

The Catalana Results Centre is a tool that measures, evaluates and disseminates the results achieved in the field of health care for members of the various agents Integrated Public Use Healthcare System of Catalonia. The Results Centre also measure, evaluates and disseminates biomedical research centers and institutes of health research.

It's a potent tool for transparency and benchmarking and to facilitate joint decision making for the quality of the health care delivered to the population of Catalonia.

• Here you will find the latest reports of these topics here: Latest reports
• If you want to download the data you can go to the tab "Open Data" or the section "Results of your center. You could download in excel or csv format all data: Open Data

Now you can dowload the results about biomedical research 2012 data. Basic and applied research realized by our hospitals and research centers. Data about inputs, outputs and less outcomes.

This effort to put all the results together is the first step to compare and think:

• Are we doing "too much" research? 
• Are we doing "relevant research". 

The answer is: Less Research, Better Research, Relevant Research: Related post

"That's one small step for a man, one gian leap for mankind".

Photo: Ralph Morse—Time & Life Pictures/Getty Images. Portraits of Smokers in 1964, When Cigarettes Were First Called Killers. Not published in LIFE. "Among graduates of college, the death rate was 1,439 [per 100,000] for smokers, 676 for those who did not smoke."

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