Frailty: time for a new approach to health care?

In The Lancet Healthy Longevity, Joanna Blodgett and colleagues1 provide important evidence that frailty can be observed and measured in younger age groups (ie, in individuals aged ≥20 years), and is perhaps more relevant for predicting health outcomes than age. Except for women aged younger than 35 years, the results show an overall increase in mean frailty levels in all age groups for both men and women, accompanied by stable frailty lethality, from 1999 to 2018 in the USA. This increase poses some serious challenges for population health management. If people are not only failing to delay the onset of frailty in later years, but are also experiencing frailty earlier in life, this trend will result in a big challenge for health systems. [Opening paragraph]<br

Disagreement on cancer drug decisions in Europe

ObjectivesDespite the efforts of the European Union (EU) to promote voluntary cooperation among Health Technology Assessment (HTA) agencies, different reimbursement decisions for the same drug are made across European countries. The aim of this paper is to compare the agreement of cancer drug reimbursement decisions using inter-rater reliability measures.MethodsThis study is based on primary data on 161 cancer drug reimbursement decisions from nine European countries from 2002 to 2014. To achieve our goal, we use two measures to analyze agreement, in other words, congruency: (i) percentage of agreement and (ii) the κ score.ResultsOne main conclusion can be drawn from the analysis. There is a weak to medium agreement among cancer drug decisions in the European countries analyzed (based on the percentage of agreement and the κ score). England and Scotland show the highest consistency between the two measures, showing a medium agreement. These results are in line with previous literature on the congruency of HTA decisions.ConclusionsThis paper contributes to the HTA literature, by highlighting the extent of weak to medium agreement among cancer decisions in Europe

Assessing the dangers of a hospital stay for patients with developmental disability In England, 2017-19

People with developmental disability have higher health care needs and lower life expectancy compared with the general population. Poor quality of care resulting from interpersonal and systemic discrimination may further entrench existing inequalities. We examined the prevalence of five avoidable in-hospital patient safety incidents (adverse drug reactions, hospital-acquired infections, pressure ulcers, postoperative pulmonary embolism or deep vein thrombosis, and postoperative sepsis) for four developmental disability groups (people with intellectual disability, chromosomal abnormalities, pervasive developmental disorders, and congenital malformation syndrome) in the English National Health Service during the period April 2017-March 2019. We found that the likelihood of experiencing harm in disability groups was up to 2.7-fold higher than in patients without developmental disability. Patient safety incidents led to an excess length-of-stay in hospital of 3.6-15.4 days and an increased mortality risk of 1.4-15.0 percent. We show persisting quality differences in patients with developmental disability, requiring an explicit national policy focus on the needs of such patients to reduce inequalities, reach parity of care, and lower the burden on health system resources

Living longer in declining health: factors driving healthcare costs among older people

Background Developed countries are facing challenges in caring for people who are living longer but with a greater morbidity burden. Such people are likely to be regular users of healthcare. Objectives Our analytical aim is to identify factors that explain healthcare costs among: (1) people over 55 years old; (2) the top 5% and 1% high-cost users among this population; (3) those that transition into the top 5% and 1% from one year to the next; (4) those that appear in the top 5% and 1% over multiple years; and (5) those that remain in the top 5% and 1% over consecutive years. Methods The data covered 2011 to 2017 and comprised 1,485,170 observations for a random sample of 224,249 people aged over 55 years in the Catalan region of Spain. We analysed each person's annual healthcare costs across all public healthcare settings related to their age, gender, socio-economic status (SES), whether or not and when they died, and morbidity status, through Adjusted Morbidity Groups. Results After controlling for morbidity status, the oldest people did not have the highest costs and were less likely to be among the most costly patients. There was also only a modest impact on costs associated with SES and with dying. Healthcare costs were substantially higher for those with a neoplasm or four or more long term conditions (LTCs), costs rising with the complexity of their conditions. These morbidity indicators were also the most important factors associated with being and remaining in the top 5% or top 1% of costs. Conclusion Our results suggest that age and proximity to death are poor predictors of higher costs. Rather, healthcare costs are explained mainly by morbidity status, particularly whether someone has neoplasms or multiple LTCs. Morbidity measures should be included in future studies of healthcare costs

What happens when the tasks dry up? Exploring the impact of medical technology on workforce planning

Increasing evidence suggests that new technologies tend to substitute for low skilled labour and complement highly skilled labour. This paper considers the manner in which new technology impacts on two distinct groups of highly skilled health care labour, cardiologists and cardiac surgeons. We consider the diffusion impact of PCI as it replaces CABG in the treatment of cardiovascular disease in the English NHS, and explicitly estimate the degree to which the cardiac surgical workforce reacts to this newer technology. Using administrative data we trace the complementarity between CABG and PCI during the mature phase of technology adoption, mapped against an increasing employment of cardiologists as they replace cardiothoracic surgeons. Our findings show evidence of growing employment of cardiologists, as PCI is increasingly expanded to older and sicker patients. While in cardiothoracic surgery, surgeons compensate falling CABG rates in a manner consistent with undertaking replacement activity and redeployment. While for cardiologists this reflects the general findings in the literature, that new technology enhances rather than substitutes for skilled labour, for the surgeons the new technology leads to redeployment rather than a downsizing of their labour

Opioid abuse and austerity: Evidence on health service use and mortality in England

Opioid abuse has become a public health concern among many developed countries, with policymakers searching for strategies to mitigate adverse effects on population health and the wider economy. The United Kingdom has seen dramatic increases in opioid-related mortality following the financial crises in 2008. We examine the impact of spending cuts resulting from government prescribed austerity measures on opioid-related hospitalisations and mortality, thereby expanding on existing evidence suggesting a countercyclical relationship with macroeconomic performance. We take advantage of the variation in spending cuts passed down from central government to local authorities since 2010, with reductions in budgets of up to fifty percent in some areas resulting in the rescaling of vital public services. Longitudinal panel data methods are used to analyse a comprehensive, linked dataset that combines information from spending records, official death registry data and large administrative health care data for 152 local authorities (i.e., unitary authorities and county councils) in England between April 2010 and March 2017. A total of 280,827 people experienced a hospital admission in the English National Health Service because of an opioid overdose and 14,700 people died from opioids across the study period. Local authorities that experienced largest spending cuts also saw largest increases in opioid abuse. Interactions between changes in unemployment and spending items for welfare programmes show evidence about the importance for governments to protect populations from social-risk effects at times of deteriorating macroeconomic performance. Our study carries important lessons for countries aiming to address high rates of opioid abuse, including the United States, Canada and Sweden

Opioid abuse and government austerity cuts: mortality and hospitalisations in England increased in line with unemployment

Rocco Friebel, Laia Maynou, and Katelyn Yoo estimate the impact of social sector spending cuts resulting from austerity measures on opioid-related hospitalisations and mortality in England. They call for more and targeted spending on the social sector, policies that address systematic inequalities, and improved macroeconomic conditions that are critical in curtailing the opioid epidemic

Efficiency and productivity gains of robotic surgery: The case of the English National Health Service

This paper examines the effect of new medical technology (robotic surgery) on efficiency gains and productivity changes for surgical treatment in patients with prostate cancer from the perspective of a public health sector organisation. In particular, we consider three interrelated surgical technologies within the English National Health System: robotic, laparoscopic and open radical prostatectomy. Robotic and laparoscopic techniques are minimally invasive procedures with similar clinical benefits. While the clinical benefits in adopting robotic surgery over laparoscopic intervention are unproven, it requires a high initial investment cost and carries high on-going maintenance costs. Using data from Hospital Episode Statistics for the period 2000-2018, we observe growing volumes of prostatectomies over time, mostly driven by an increase in robotic-assisted surgeries, and further analyse whether hospital providers that adopted a robot see improved measures of throughput. We then quantify changes in total factor and labour productivity arising from the use of this technology. We examine the impact of robotic adoption on efficiency gains employing a staggered difference-in-difference estimator and find evidence of a 50% reduction in length of stay, 49% decrease in post-length of stay and 44% and 46% decrease in postoperative visits after 1 year and 2 years, respectively. Productivity analysis shows the growth in radical prostatectomy volume is sustained with a relatively stable number of urology surgeons. The robotic technique increases total production at the hospital level between 21% and 26%, coupled with a 29% improvement in labour productivity. These benefits lend some, but not overwhelming support for the large-scale hospital investments in such costly technology

What happens when the tasks dry up? Exploring the impact of medical technology on workforce planning

Increasing evidence suggests that new technologies tend to substitute for low skilled labour and complement highly skilled labour. This paper considers the manner in which new technology impacts on two distinct groups of highly skilled health care labour, cardiologists and cardiac surgeons. We consider the diffusion impact of PCI as it replaces CABG in the treatment of cardiovascular disease in the English NHS, and explicitly estimate the degree to which the cardiac surgical workforce reacts to this newer technology. Using administrative data we trace the complementarity between CABG and PCI during the mature phase of technology adoption, mapped against an increasing employment of cardiologists as they replace cardiothoracic surgeons. Our findings show evidence of growing employment of cardiologists, as PCI is increasingly expanded to older and sicker patients. While in cardiothoracic surgery, surgeons compensate falling CABG rates in a manner consistent with undertaking replacement activity and redeployment. While for cardiologists this reflects the general findings in the literature, that new technology enhances rather than substitutes for skilled labour, for the surgeons the new technology leads to redeployment rather than a downsizing of their labour

Análisis de la convergencia de las regiones de la zona euro (1990-2010)

Ekonomia eta Moneta Batasuna jaio zenetik, Europar Batasuneko herrialde bakoitzak bere politikak ezarri ditu konbergentzia ekonomikoa lortzeko. 1990-2010 aldian 17 herrialdez osatutako batasunak biltzen dituen 174 eskualdeen konbergentzia aztertuko dugu. Espazio-denborazko eredua ekonometrikoa zehaztu dugu, beta-konbergentzia baldintzatua eta konbergentzia-sigma hipotesiak erabiliz. Ereduaren aldagai dependenteak BPG per capita eta produktibitatea dira, eta aldagai esplikatiboakk, berriz, aldagaia ekonomiko errealak dira. Euro-guneko herrialdeetan beta- konbergentzia ikusten dugu BPG per capitari dagokionez, baina produktibitateari dagokionez dibergentzia dago, nahiz pautak herrialde mailan bakarrik gertatzen diren. Hau da, berretsita geratzen da gure hipotesia; herrialde-mailako pautak direla dira konbergentzia hipotetikora garamatzatenak eta produktibitatearen portaera txarra, dudarik gabe, euro-guneko herrialdeetan biztanleria aktiboaren jokabide ezberdinaren ondorio dela.Since the birth of Economic and Monetary Union (EMU), policies have been implemented in the Member States of the European Union (EU) to lead them towards economic convergence. This article analyses the convergence of the 174 regions that exist in the 17 euro-zone countries in the years from 1990 to 2010. The article specifies a space-time econometric model using the hypotheses of conditioned beta-convergence and sigmaconvergence. The dependent variables of the model are per capita GDP and productivity and the explanatory variables are real economic variables. Beta-convergence is found to exist between the countries of the euro-zone in terms of per capita GDP, but there is divergence in terms of productivity, though only at country level. In other words, the hypothesis is confirmed that it is guidelines at country level that lead to hypothetical convergence and that the unfavourable performance of productivity is due, without doubt, to differences in behaviour between the active populations of the different euro zone countries.Desde el nacimiento de la Unión Económica y Monetaria (UEM), se han implantado políticas en los diferentes países miembros de la Unión Europea (UE) para conducirlos hacia la convergencia económica. Analizamos la convergencia de las 174 regiones que existen en los 17 países de la zona euro en el periodo 1990-2010. Especificamos un modelo econométrico espacio-temporal, utilizando las hipótesis de beta-convergencia condicionada y de sigmaconvergencia. Las variables dependientes del modelo son el PIB per cápita y la productividad y las variables explicativas son variables económicas reales. Encontramos que existe beta- convergencia entre los países de la zona euro en términos de PIB per cápita, pero divergencia en términos de productividad, si bien las pautas se producen sólo a nivel de país. Es decir, se confirma nuestra hipótesis de que son las pautas a escala país las que conducen a la hipotética convergencia y que el comportamiento desfavorable de la productividad se debe, sin duda, a un diferente comportamiento de la población activa entre los diferentes países de la zona euro