Doing Better by Doing Less: Approaches to Tackle Overuse of Services

Experts have projected that as much as a third of U.S. health care spending is unnecessary and wasteful. Of the estimated $765 billion of health care dollars wasted in 2009, a quarter --$210 billion -- was spent on the overuse of services, which includes services that are provided more frequently than necessary or services that are higher-cost, but no more beneficial than lower-cost alternatives.This paper provides a summary of the problem of overuse in the U.S. health care system. The analysis gives an overview of the provision of medically inappropriate and unnecessary services that drive up health care spending without making a positive impact on patients' health outcomes. It also describes approaches that have already been used to address overuse of health care services and outlines the broader payment reforms needed to minimize incentives to overdiagnose and overtreat.This overuse of services has implications for both health care costs and outcomes. There is substantial variation in the level of inappropriate use across different health care services. Research shows that the rates at which particular procedures, tests, and medications were performed or prescribed when clinically inappropriate ranged from a low of 1 percent to a high of 89 percent

How Does the Quality of U.S. Health Care Compare Internationally?

Explores definitions of high-quality health care and evidence for comparing U.S. health care with care in other countries. Discusses measures of specific types of care; findings on over-utilization, patient safety, and uninsurance; and implications

How Will Comparative Effectiveness Research Affect the Quality of Health Care?

Outlines how the use of comparative effectiveness research on the relative merits of a healthcare intervention compared with others could improve quality of care and outcomes. Presents challenges in enhancing CE research and expanding its adoption

Essai de Détermination d’une Fonction d’Epargne Nationale pour Madagascar, Approche Econométrique

Dans  le  contexte  actuel  ou  l’economie  du  marche  domine  presque  la  majorit´e  de  l’activite de  production,  le  passage  de  chaque  pays  par  le  syst`eme  lib´eral  est  incontournable.  Ainsi,  la mise  en  place  d’un  marche  financier  devient  une  pr´eoccupation  de  nombreuse  ´economie  dont Madagascar  figure  parmi  les  pays  qui ;  (depuis  l’ann´ee  2009),  devrait ´eriger  ce  systeme.Parler  de  marche  financier  suscite  l’idee  d’un  lieu  de  rencontre  entre  Offre  d’epargne  et  de Demande  de  capitaux,  longtemps  precise  par  les  theoriciens  ´economiques  d’un  endroit  ou  le liberalisme  economique  et  financier  retrouve  son  ultime  apogee.  Il  doit  y  avoir,  par  voie  de consequence,  une  certaine  potentialite  au  niveau  des  acteurs  du  marche,  mais  ce  qui  nous pr´eoccupe en ce qui concerne ce concept, c’est la capacite que repr´esente l’Offre  ›  d’epargne sur  le  marche.  Pour  ce  qui  est  de  la  Demande  cela  est  d´eja  effectue  il  y  a  des  annees  par des experts et faisait l’objet d’une ´etude sp´ecifique sur le projet ayant les mˆemes objectifs que la  philosophie  d’une ´edification  d’un  march´e  financier. Certes,  le  march´e  peut ˆetre  mis  en  place,  mais  est-ce  qu’il  peut  g´erer,  voire  drainer,  la  ca- pacit´e  d’´epargne  du  pays ?  C’est  cette  question  qui  -  dans  le  pass´e  -  est  d´ej`a  trait´ee  par  une autre  ´etude,  induit  un  nouveau  probl´ematique  relatif  au  potentiel  d´eterminants  de  l’´epargne nationale;  objet  mˆeme  de  l’existence  du-dit  march´e. D’apr`es la th´eorie orthodoxe, l’´epargne est le solde entre le revenu et la consommation glo- bale, et n’est expliqu´ee, par ailleurs, que par le niveau de l’investissement ; or on sait que dans la  r´ealit´e,  le  comportement  d’un  agent  ´economique  dans  l’utilisation  de  son  revenu  est  dict´e par  plusieurs  param`etres.  Il  est  alors  n´ecessaire  de  pr´eciser  que  l’approche  th´eorique  relative a`  l’´epargne  est  insuffisant  si  on  ne  se  r´ef`ere  qu’au  structure  ´economique  des  pays  en  voie  de d´eveloppement dont Madagascar fait partie. Il faut dire que la relation I=S, fr´equemment uti- lis´e par les ´economistes th´eoriciens occidentaux, demeure trop simpliste et doit ˆetre compl´et´ee par  d’autres  facteurs,  ´etant  donn´e  que  pour  financer  ces  investissements,  les  pays  en  voie  de d´eveloppements  font  imp´erativement  recours  a`  d’autres  types  de  financements. Ainsi d´emontr´e, Il nous appartient, dans cet article, de chercher les diff´erentes variables qui d´eterminent  le  niveau  de  l’´epargne  nationale  malagasy,  et  de  concevoir  en  cons´equence,  une fonction  d’´epargne  nationale  conform´ement  a`  l’exigence  de  notre  ´economie.  Une  corr´elation doit  ˆetre,  a`  cet  effet,  ´etablie  entre  la  part  de  l’´epargne  nationale  par  rapport  au  PIB,  et  les diff´erentes  variables  exog`enes  y  aff´erentes. En  ce  qui  concerne  les  exp´eriences  d’autres  pays  pour  ce  qui  est  de  la  formation  d’une fonction  d’´epargne,  quelques  auteurs  comme  Kavatri  et  Diaw  ont  pour  leur  part  essay´e  de mener  des  ´etudes  sur  les  ´economies  du  S´en´egal  et  du  Rwanda,  et  ont  r´eussi  a`  d´egager  une fonction  d’´epargne  nationale  pour  ces  pays  respectifs.  Bien  que  ces  pays,  aient  a`  peu  pr`es  la mˆeme structure ´economique que Madagascar quinze ans auparavant, on pense que les variables obtenue  dans  ces  pays  pourront  nous  aider  a`  indiquer  une  piste pour  celui  de  Madagascar.  En proc´edant a` des techniques ´econom´etriques et a` l’estimation de la fonction d’´epargne malagasy, on  a  observ´e qu’elle  est influenc´ee par  le FBCF,  le  taux  de  change  effectif r´eel, le  service  de  la dette, le PNB par habitant et enfin le taux d’int´erˆet r´eel. Ces variables influences a` long terme le  niveau  de  l’´epargne  nationale  a`  Madagascar.Dans le court terme, par contre, l’´epargne nationale malagasy est expliqu´ee par le FBCF priv´e et public, les recettes fiscales, le taux d’inflation, le service de la dette et enfin le taux de crois- sance  ´economique.  Une  autre  relation  nous  a  permis  ´egalement  de  d´egager  que  la  propension marginale a` ´epargner s’´el`eve a` un taux de 43% a` Madagascar. Enfin, par rapport a` ces r´esultats, nous  avons  ´emis  dans  cet  article  un  certain  nombre  de  recommandations  afin  de  bien  mener une politique de croissance sans pour autant se perdre dans le processus de l’´evolution de notre capacit´e  d’´epargne  nationale

Automating Administrative Approvals at Syracuse University with InfoReady

When COVID hit, Syracuse University needed a solution to process multi-step approvals – fast. That meant thinking creatively and out of the box because when time, accuracy, and error-free routing are critical, traditional submission systems aren’t ideal. That’s precisely why Syracuse turned to InfoReady. And what the InfoReady platform did so powerfully in streamlining limited submissions also turned out to work well for research travel applications, visiting scholar requests, research identification, and essential research approval

Special Article: One Resident\u27s Perspective on a Different Style of Psychopharmacological Practice

This article provides a comparison of psychopharmacological practices in the U.S. and France. The prescription as well as proscription of various classes of psychotropic drugs are considered. Even though the general guidelines of psychopharmacological practice remain the same, the details vary considerably and are determined especially by commercial factors. INTRODUCTION Though a comparison of current clinical psychopharmacological practices in France and the U.S. is an unaddressed topic, these contrasts may be quite striking to an American-trained psychiatrist. The following observations are based on my two month inpatient experience as a fourth-year psychiatric resident at a public psychiatric institution located in Montpellier, France (1987). This article was written in collaboration with Dr. Blayac who is one of the regional center directors for the French equivalent of the FDA

Heterogeneity in the Effect of Common Shocks on Healthcare Expenditure Growth

Health care expenditure growth is affected by important unobserved common shocks such as technological innovation, changes in sociological factors, shifts in preferences and the epidemiology of diseases. While common factors impact in principle all countries, their effect is likely to differ across countries. To allow for unobserved heterogeneity in the effects of common shocks, we estimate a panel data model of health care expenditure growth in 34 OECD countries over the years 1980 to 2012 where the usual fixed or random effects are replaced by a multifactor error structure. We address model uncertainty with Bayesian Model Averaging, to identify a small set of important expenditure drivers from 43 potential candidates. We establish 16 significant drivers of healthcare expenditure growth, including growth in GDP per capita and in insurance premiums, changes in financing arrangements and some institutional characteristics, expenditures on pharmaceuticals, population aging, costs of health administration, and inpatient care. Our approach allows us to derive estimates that are less subject to bias than in previous analyses, and provide robust evidence to policy makers on the drivers that were most strongly associated with the growth in health care expenditures over the past 32 years

Gender Inequality and Economic, Social and Policy Right: Situational Analysis with Women of De Locality of Velingara-Senegal

This study is stating the political and socio-economic rights on the conditions of women in the municipalities of Kounkan and Diaob -Kabendou Department of V lingara Senegal Method The study was made during the month of May 2013 After a documentary of policies and guidelines on the political and economic rights of women in terms of women s access to land and water a quantitative and qualitative aresearch from questionnaire interview and focus group was made Depending on the type of research software Epi- info and SPSS were used to capture control validate and analyse data Results The study was made with 448 women within the women s promotion group or not leaders or not with an age ranging from 18 to 92 years Pular 69 constitute the majority ethnic 85 5 of women were married 40 60 of women were not educated 48 80 of women were farmer However 35 5 were satisfied with the area They reported acquire farmland mainly from their husbands 45 40 and by inheritance 23 6 Generally Small businesses 44 4 and household activities 29 5 were women s occupations 56 5 of women had a national identity and voter registration card 60 90 of couples make decisions together 28 90 of women belonged to decision-making bodies 57 1 of women had experienced violence 73 40 of them were aware of the help and assistance structures However concerning violence within couples 64 of abused women within the couple noted a change in attitude after mediation F a mily 43 1 and the district chief or notable 32 8 are the remedies most famous women Conclusion Despite the positive development of human rights in Senegal many actions are to be undertaken in the municipalities of Kounkan and Diaob -Kabendou for the reality gap is known and fought for and that women enjoy and exercise like men fundamental rights recognized for good health to the person regardless of their gende

The Clinical Utility of a Computerized Cognitive Assessment to Predict Incident Amnestic Mild Cognitive Impairment and Alzheimer’s Disease

Detecting the initial signs of neurodegeneration is integral for early diagnosis and intervention. Computerized cognitive assessments are accessible, efficient, and precise tools for identifying cognitive impairment and risk of neurodegeneration. While computerized instruments can be feasibly administered repeatedly for longitudinal cognitive monitoring, their clinical utility compared to conventional paper-and-pencil tools is yet unknown. The present study examined the utility of a computerized task, the One Card Learning (OCL) test, to detect conversion to dementia and associate with amyloid (Aβ) imaging markers using single and repeated test administration compared to the Montreal Cognitive Assessment (MoCA) and Rey Auditory Verbal Learning Test (RAVLT). The primary and secondary outcomes were conversion from cognitively normal (CN) to amnestic mild cognitive impairment (aMCI) or Alzheimer’s disease (AD) over a four-year study period and positron emission tomography estimates of Aβ, respectively. Data were collected from the Alzheimer’s Disease Neuroimaging Initiative 3 longitudinal cohort study. Participants were older adults aged 56 to 98 years who were CN at baseline. Results showed that the OCL did not better predict conversion to aMCI or AD from cognitive health compared to the MoCA or RAVLT when assessed at baseline or over repeated administrations. Unadjusted baseline OCL performance associated with Aβ status comparably to the MoCA and RAVLT. While repeated MoCA scores provided the strongest estimate of Aβ accumulation, OCL score trajectories uniquely detected diminished practice effects associated with pathological Aβ accumulation. The OCL may offer distinct clinical utility to detect preclinical AD biomarker accumulation. Future research is needed to examine the application of computerized assessments before they are fully integrated into clinical practice