Biocat 2013 report: Catalan life science statuts and analysis

The 2013 Biocat Report shows that the life sciences sector in Catalonia has reached a turning point.

We are facing two key challenges: generating and capturing value, on one hand, and promoting growth, on the other.  And this is at a difficult moment, marked by a profound economic crisis and changes in the research and production models that are affecting the sector.

The analysis in the chapters of the report identifies challenges for all of the stakeholders in the BioRegion, both public and private. The data shows:

• We must maintain support for innovation and entrepreneurship in the public arena —seeking out maximum efficiency in management of the knowledge generated and its transfer.
• We must also encourage companies —large and small— to participate in international research programs and public-private partnerships in order to bring innovation to the market and, in short, to the people.
• We must promote growth, establishing measures that facilitate market access and internationalization, but also guidance programs to support project maturation.

Europe will be key over the coming two years —launch of the Horizon 2020 program, defining RIS3 strategies, calls for the European Institute of Innovation and Technology’s KIC— but success will depend in large part on the players in the ecosystem aligning under a common vision.

Català Document complet (PDF)
English Executive Summary (PDF)  The full English version will be available shortly
Castellano Resumen Ejecutivo (PDF)








photo: © Dani: Creative Commons ShareAlike licence
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merry christmas and happy new year 2014

designed by: jsoldevila
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Spanish National Health Service: diagnosis and proposals to move forward

The Spanish Association of Health Economics has launched the 2nd diagnostic report on the Spanish National Health Service (SNHS) made by several of its members (50). The first diagnostic report was done in 2008.

The report consists of four broad based chapters:

1. Financing and Public Coverage: (published 10th december 2013)
2. Healthcare Organisation: (expected 17th december 2013)
3. Health Policies: (expected 14th january 2014)
4. Good Health Governance: (expected 21 january 2014)

The objectives of this document are to diagnose the SNHS, put together a set of proposals (a total of 166) and measures to support its solvency and then place these factors under discussion.

A good report to read not only economists. The Association invite all health care professionals, patients, politicians and citizens to discuss the ideas.

Acces: 
Summary and proposals (in english)
Permanent discussion and acces to documents: 

photo: (*) Photosolde
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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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