the relevance gap between researcher's interests and society: A proposals open to criticism

Paul Nightingale and Alister Scott from the University of Sussex at the Science Policy Research Unit  published in 2007 the article Peer review and the relevance gap: ten suggestions for policy-makers

The paper explores how academic research becomes divorced from wider society and the consequences of this for both society and academia.

They suggest 10 suggestions for policy-makers:

1. Do not fund research again that comes to the conclusion that ‘more research is needed’.
2. Funders should recognise the distinction between relevance and academic impact.
3. Within peer review, encourage and protect research that aims to be relevant and interdisciplinary, and ensure that protection is effective.
4. Stop using interdisciplinarity as a proxy for relevance and focus on relevance itself.
5. Funders should end the ‘closed shop’ whereby academics have a monopoly on research funding.
6. Funding bodies should insert explicit relevance criteria within the peer-review process, and provide guidance to reviewers on what those criteria are and how they should be treated.
7. Only fund research that shows a clear and rigorous understanding of the diverse actors involved in the field of enquiry, and their questions and needs.
8. Funding agencies should recognise that relevant research is intensive and requires long-term commitment.
9. Funding agencies should recognise the inherent limitations of ‘knowledge transfer’.
10. Policy-makers should recognise vested interests within the existing research community, and how they might invoke the three Sirens of: academic objectivity; academic autonomy; and academic quality, to avoid having to deal with relevance criteria.

Last sentence of the article: "Put a closer focus on society’s real research needs, rather than those agendas currently being defined and appropriated by a small coterie of professionals." 

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Ed Clark—Time & Life Pictures/Getty Images. View across the Pont Alexandre III bridge toward the Grand Palace, Paris, 1946.

clinical governance, clinical management, clinical practice

Do "clinical governance" definitions adequately distinguish between governance, management and practice functions?

The article published by Niamh M. Brennan, Maureen A. Flynn (2013) introduces three definitions to put the term in the correct place.

Clinical governance has benn viewed by many authors as an "umbrella term" and too ambiguous. The study finds 29 different definitions.

Definitions of clinical governance, clinical management, clinical practice proposed by the authors:

• Clinical governance. Structures, systems, and standards applying to create a culture, and direct and control clinical activities. Clinical accountability and responsibility, a sub-set of clinical governance, involves the monitoring and oversight of clinical activities, including regulation, audit, assurance and compliance by governors (such as boards of directors), regulators (such as governments and professional bodies), internal auditors and external auditors.

• Clinical management. Processes and procedures, including resourcing clinical staff, by managers to efficiently, effectively and systematically deliver high quality, safe clinical care.

• Clinical practice. Delivery by clinicians of high quality, safe clinical care in compliance with clinical policies and performance standards, in the interests of patients.

Two important questions to consider for those health care institutions that are trying to define who want to be:

"For effective governance, it is important that there be division of duties between governance roles and management and practice roles. It is a fundamental principle of governance that governors cannot oversee and monitor their own work."

"Clinical quality will not improve unless governors, managers and practitioners take personal responsibility for the positions they hold and the functions they perform."

photo: (*) Photosolde
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We don't know what we 're doing in medicine.... or yes we know!

This sentence was expressed by Dr. Eddy on February, 4 1990 in Detroit Free Press. He recognized the importance of the gaps in medical decision making and the effect in the efficent use of healtch care resourses.

The empirical work of Dr. John Wennberg  and various colleagues tried to find some arguments to explain that. They focused on the study of "Small Area Variations (SAV)" the phenomenom that refers to the wide variations in the per-capita utilization rates for many medical and surgical procedures that are commonly found in comparing small, contiguus hospital service markets.

They have argued that much of the observed variation is closely related to the degree of physician uncertainty with respect to diagnosis and treatment and the differences in local opinions. He's the founder editor of  The Dartmouth Atlas of Health Care 

Is there any small area variations (SAV) evidence in Spain?: Take a look at ATLAS VPM a brilliant initiative coordinated by Enrique Bernal Delgado PhD in Medicine. Senior Researcher of the Research Unit in Health Services and Policies of Aragon Institute of Health Science.

They have published 8 Atlas:

8 Potentially Preventable Hospitalizations related to exacerbation of chronic diseases
7 Variability in Hospitalizations of older people in the NHS
6 Variability in Hospitalizations due to oncological surgery in the NHS
5 Variability in Hospitalizations due to mental health problems in acute care hospitals.
4 Variability in Hospitalization due to cardiovascular problems and procedures in the NHS
3 Variability in Pediatric Hospitalizations due to surgical and diagnostic procedures selected
2 Variability in General Surgery Interventions in the NHS
1 Variability in Orthopaedic Surgery and Traumatology. Hip fracture, knee replacement and hip replacement

photo: (*) Photosolde
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copagament-copago-copayment: evidence data in Catalonia

 

Co-payments (Co-pay, user charge): A fixed monetary payment that is made by the patient to the provider at the time of service.

PAYING FOR FORMERLY FREE MEDICINES IN SPAIN (july 2013). This working paper is the first attempt to provide accurate estimates of the overall impact at the regional level of a cost sharing reform on pharmaceutical prescriptions with regional variants established in Spain since July 2012 in the framework of heavy austerity reforms on public financing.

Conclusions:
It would be a mistake to increase cost sharing on medication across chronic and effective treatments. If one thing is clear from randomised and natural experiments, it is that cost sharing should be lower the greater the need for the treatment and the more effective that treatment is.

The high concentration of expenditure in patients with chronic conditions suggests the maintenance of low rates, together with the application of upper limits to the amount payable out of the patient’s pocket, either as a monetary amount that would be the same for all, or – a finer adjustment – as a percentage of each patient’s income. Otherwise, the cost in the form of greater use of emergency and hospital services may more than cancel out the savings made through cost sharing for chronic patients.

After decades trying unsuccessfully to reduce drug spending in the Spanish national health system through actions on prices and prescribers, the copayment established in mid 2012 led to a dramatic reduction in the use of drugs whose effect on health is not known.

Although the new copayment is modulated by income, a small portion of patients supports a large part of the expense.

Without disaggregated data is not possible to know who have reduced their use or what medicines are being left to take. Perhaps the moral abuse is reduced without adverse health effects, or even improving. But certain groups of patients may be enduring a financial burden or reducing the use of treatments needed, with high cost in terms of health loss.

Authors:
Jaume Puig-Junoy
University Lecturer at the Department of Economics and Business at Universitat Pompeu Fabra, Main Researcher of the Centre for Research in Health and Economics (CRES). Interesting to visit his blog: pilleconomics

Beatriz González López-Valcárcel
Full Professor of Quantitative Methods in Economics from University of Las Palmas de Gran Canaria, Associate Researcher of Centre for Research in Health and Economics (CRES).

Santiago Rodríguez Feijoo
Full Professor of Quantitative Methods in Economics from University of Las Palmas de Gran Canaria.

W. Eugene Smith—Time & Life Pictures/Getty Images (1951)
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is there any relation between life expectancy and health expenditure? OCDE Health data

 

Health spending continues to stagnate: Health spending remained flat across OECD countries in 2011 as the economic crisis continued to have an impact, particularly in those European countries hardest hit by the crisis according to the new data published by OECD.

• Greece, overall health spending dropped by 11% both in 2010 and 2011 after a yearly growth rate of more than 5% on average between 2000 and 2009. 
• Ireland, Iceland and Spain also experienced two consecutive years of negative growth in health spending. 
• Estonia and the Czech Republic, saw severe falls in spending in 2010 followed by a modest rebound in 2011. 
• Portugal and Italy, may have delayed cuts in 2010, but then reduced public health spending in 2011.
• Only two OECD countries – Israel and Japan – have seen an acceleration in health spending since 2009 compared with the period before. 

ACCES:  OECD Health Data 2013.
ACCES:  On-line database

Interesting to acces to the interactive charts about Life Expentancy, Health Expenditure, and Health Risks (smoking, alcohol). You can compare a single country with the OECD average.
Play a little bit with Spain.

ACCES:  Health Data Visualisations

photo: (*) Photosolde
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The Technology sector in Catalonia. Baròmetre del Sector Tecnològic a Catalunya 2013

The Technology Sector in Catalonia 2013 is the fifth edition of this report. It provides comprehensive analysis of the country’s Information and Communication Technology (ICT) field. The nation’s ICT is well-consolidated and now has the potential to become one of Catalonia’s strategic sectors and growth drivers.

Some conclusions:

• While the crisis has affected the sector, the ICT field has fared much better than other industries.
• Internationalisation is a necessity, not an alternative. The firms that are internationalising, their markets have shrunk less and they are less dependent on public administration contracts. Furthermore, 43.6% of internationalising firms have seen a significant rise in their workforces whereas for non-international firms, this figure is 32.3%. The former have also experienced marked growth in both the number of their clients and turnover.
• The crisis has directly affected R&D but the outlook for 2013 appears to be brighter, especially for the internationalising firms, which envisage spending more on it this year. There is also a slight drop in the number of companies not carrying out R&D. Even so, universities have been particularly hard-hit by cuts in research. There seem to be more university-company technology transfers and collaboration, although there is still much to be done, especially with regards to Small and Medium-sized Enterprises (SMEs) and micro-firms.
• The areas identified by the sector in 2013 as the technologies of the future were mobile computing, cloud computing and smart cities.
• Two major sectorial weaknesses are that many firms cater to the domestic market and that this has shrunk. Hurdles to internationalisation and the sectors lack of lobbying power are further weaknesses.
• Two major strengths are the Barcelona Brand and Catalan research capabilities. The competitiveness of firms, talents and staff are also plus points.
• Major threats are: lack of funding to drive the growth of new but well-established firms; the ‘brain drain’ caused by the crisis; a falling share in strategic sectors such as Health.
• With regard to opportunities, the sector stresses the hopes pinned on Mobile World Capital, and on the fact that Catalonia is a leader in areas such as Health, Smart Cities, Online Banking; Cultural Content.

Accés al document  Català, Castellà, English Report /Informe 2013
photo: (*) Photosolde
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if you'd like to understand what health economics is, don't miss Kenneth J. Arrow

In the introduction of the book "The Economics of Health and Health Care" from Sherman Folland, Allen C. Goodman and Miron Stano, the authors define: Health Economics is the study how resources are allocated to and within the health economy. The study of the production of health care and its distribution across population fall within this definition.

If you would like to understand a little bit more about what Health Economics is about, I recommed you to read one of the most influential articles in the health economics discipline:

UNCERTAINTY AND THE WELFARE ECONOMICS OF MEDICAL CARE by Kenneth Arrow published by the American Economic Review in 1963!.

Kenneth J. Arrow is an American economist and joint winner of the Nobel Memorial Prize in Economics with John Hicks in 1972.

The article finishes with this Postcript:

"I wish to repeat here what has been suggested above in several places: that the failure of the market to insure against uncertainties has created many social institutions in which the usual assumptions of the market are to some extent contradicted. The medical profession is only one example, though in many respects an extreme one. All professions share some of the same properties. The economic importance of personal and especially family relationships, though declining, is by no means trivial in the most advanced economies; it is based on non-market relations that create guarantees of behavior which would otherwise be afflicted with excessive uncertainty. Many other examples can be given. The logic and limitations of ideal competitive behavior under uncertainty force us to recognize the incomplete description of reality supplied by the impersonal price system."

Acces: Uncertainty J.K. Arrow (1963)

Francis Miller—Time & Life Pictures/Getty Images.
Not originally published in LIFE, but printed elsewhere in the years since. Martin Luther King Jr. addresses the crowd during the March on Washington for Jobs and Freedom, August 28, 1963.

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