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Have a look at this paper http://publications.cpa-apc.org/browse/documents/2 On 20-Sep-11, at 5:24 AM, vijaya madhavan wrote: > Amy , Ben and all > > My understanding was that there has been enough information > available in the public domain re life expectancy v economic status > of the country. > I assumed that was already well past the starting point in this > discussion. > > The Gapminder presentation of these figures are really clever in > their simplicity for conveying to a broad audience. Thanks to Paul > and Ash for the links. > > There have been a few publications about the percentage of GDP spent > on health in countries but they dont make allowances for the fact > that all healthcare is not funded through public , insurance based > or from NFP organisations private health expenditure is not > insurance funded. > A steadily increasing proportion of healthcare is privately funded. > > There are probably many cultural and socio economic factors > associated with how public and private services are used at a micro > level to get a reliable per patient difference value.. > > To illustrate the complexity and the potential variabilty that > makes analysis difficult - > In the BRIC countries a proportion of individuals who reach a > certain income level pay for undocumented healthcare funded > themselves. > (the numbers are growing in relation to the increase in personal > disposable incomes). > This is not documented or available to analyse - there is probably > not even a paper trail as medical records and stay with the patient. > There are no advantages to disclosing these to outside agencies and > revealing ill health may have unfavorable consequences (for jobs, > socially is an impediment to marriage etc) > > The under 40s in better income private sector jobs are being > introduced to higher degree of employer founded private medical > insurance but the pattern not entirely similar to either the US > based model where a signifcant part of an individuals lifetime > healthcare could be funded by the insurer. > Neither is it is restricted to a select list of acute conditions > that UK PMI schemes cater to. > > My own numercially based business data observations comparing the > patterns of self pay / private insurance use in private healthcare > in the UK v India, Pakistan, Malaysia, Singapore, parts of South > America is that in these countries, some of the Middle East , the > use of selfpay for health is similar to that of self employed > business owners in the UK with one difference- in the UK access to > private acute care is limited ( the private sector is not geared to > handle emergency admissions of any volume and more importantly the > NHS provides an "adequate" service) > > There is also a signficant use of personally sourced health > promotion initiatives: > not insignificant numbers of private dieticians in Indian cities who > customise diet plans for a whole family ,paying for a > physiotherapist to improve mobility by older people, occupational > therapists working with architects to help design "granny flats" in > self build homes. > Alternative medicine systems - private use of TCM in some Chinese > cities has increased amongst Shanghai office workers > (available through public sector ). > > Bringing this to the table: > > The question of how much the 9 healthy people would be prepared to > pay for the care of 1 sick person ? > > Its a very interesting question as it bears a parallel to the key > question asked of marketing departments in a business- > how much is the customer prepared to pay for the product/services, > never mind what it cost to produce the product/service. > > Any successful business owner knows thatif you get that right , you > have nailed pricing. Is there a parallel lesson for healthcare there. > My business education is very basic but I am sure there is some > expertise in the area from organisations like the Gates Foundation. > > My own perspective is an anthrolopological view - i.e studying > cultural impacts qualitatively within society ( participative > observation is a personal hobby) > > > 1. If you have reasonably good publically funded services , people > are prepared to pay higher taxes especially if there is a perception > that their governments will make good decisions on their behalf. > ( I have data for some European countries but cannot provide them on > a public forum as obtained from a commercial contract) > But have had this view freely expressed by Scandinavan colleagues/ > classmates in graduate business school so those of you with access > to resources should be able to find some relevant material > > 2. In the UK, some disillusionment with political marketing but the > votes are aligned to the hope of increased public funding in health > services. > > 3. The BRIC countries - the growing middle class (i.e growing > numbers of increased tax contributors to tax revenues for > governments) are sceptical about increasing taxes to support public > spending: they dont believe that increasing public spending is > "good bang for buck" > > China has a slightly different cultural and political demographic > but in India & Brazil economic growth is predominantly propelled by > private initiative, personal funding into education in India that > translates into a knowledge based industry and favorable overseas > investment in manufacture twinned with local enterprise in Brazil > are the drivers. > > But this tends to be balanced by an increased flexibility by > healthcare providers to discount treatments for poorer patients. > This may be because inequality is accepted as a fact of life in > these societies; but the reality is is it not always as harsh (yes > still has a long way to go !). But access to treatments that would > have been impossible for some really poor people is sometimes > available through this flexibility. > > > From a business perspective- historically life insurers in Britain > have been able to grow their books with limited data sets. > When the Health IT programmes were initiated in the UK they did > consider the value (to them) of using better quality of information > based decision making but the investment needed to achieve this > would flatline their profits for the next decade. > They have mostly abandoned any major changes to their models because > of the costs involved. > Cuurently the care insurance industry is topical in the UK and no > doubt there will be some interest in the access to health > commisioning data from public sector. > > What I am leading to is that there is enough evidence available to > indicate that richer nations have higher life expectancy when you > look at gross figures. But not anywhere enough understanding of how > data mining within subgroups can be achieved to get meaningful > knowledge. > > Are we not ethically oblidged to question what proportion of the > spend for achieving better health/healthcare should be spent on > health interventions v overall economic development of a local area > > Should the question be which path should get the majority share ? > > Vijaya > > On 20 September 2011 02:41, Dr. Amy Price <[log in to unmask]> wrote: > Dear Ash and all, > > > > It would be interesting to see the life expectancy between nations > of similar economic status but who differ in terms of private pay > insurance or social healthcare systems. It would be quite revealing > to note also to what extent treatments and drugs unapproved by > social medicine systems or the FDA impact lifespan and quality of > life. I guess what is the money spent per patient differences > between privately held insurance/self pay/socialized medicine would > be great to know as well. I have heard so much political marketing > I have no idea what the facts on these issues reveal. > > > > Amy > > > > Amy Price > > Http://empower2go.org > > Building Brain Potential > > > > > > > > From: Evidence based health (EBH) [mailto:[log in to unmask] > ] On Behalf Of Ash Paul > Sent: 19 September 2011 05:08 PM > > > To: [log in to unmask] > Subject: Re: What single idea will make the biggest impact on > healthcare today? > > > > > > > Dear Paul, > > There is a wonderful You Tube video on the subject of life > expectancy versus per capita income, which you can see at: > > http://www.youtube.com/user/TheOuroboros21#p/u/6/r2ygwTBNjAw > > Regards, > > Ash > > From: Paul Elias <[log in to unmask]> > To: [log in to unmask] > Sent: Monday, 19 September 2011, 21:07 > Subject: Re: What single idea will make the biggest impact on > healthcare today? > > > Dear Paul, this is an excellent graph/map....very troubling too...I > think that GDP to life expectancy is very informative as is...yet a > graph like this may be of utility if we could see per capita income > or average income etc...plotted to life expectancy....GDP may be too > broad a metric...yet the association is clearly there... > > > > > > > > > > > > Best, > > > > Paul E. Alexander > > > > > > > > --- On Mon, 9/19/11, Paul Glasziou <[log in to unmask]> wrote: > > > From: Paul Glasziou <[log in to unmask]> > Subject: Re: What single idea will make the biggest impact on > healthcare today? > To: [log in to unmask] > Received: Monday, September 19, 2011, 5:49 AM > > A lovely graph of GDP vs Life expectancy at: <http://filipspagnoli.files.wordpress.com/2008/08/life-expectancy-and-gdp-per-capita-correlation.jpg > > Cheers Paul Glasziou On 9/19/2011 2:35 PM, Paul Elias wrote: > > well, to add to that, we can argue that a measure is a nation's > economic well being or economic strength, is a measure and proxy for > its health and health care system..show me your economy, and I will > tell you about your nation's health....that simple. > > > > > > > > > > > > Best, > > > > Paul E. Alexander > > > > > > --- On Sun, 9/18/11, vijaya madhavan <[log in to unmask]> > wrote: > > > From: vijaya madhavan <[log in to unmask]> > Subject: Re: What single idea will make the biggest impact on > healthcare today? > To: [log in to unmask] > Received: Sunday, September 18, 2011, 5:10 PM > > Maybe the answer comes from beyond healthcare- > > after all ill health at any point only affects less than 10% of the > population. > > A major proportion of those affected have chronic disease > > > > Chronic disease has reasonable causal relationships with lifestyle - > > atleast some of the evidence based risk reduction of many chronic > diseases are linked to lifestyle modifcation. > > > > It is easier to modify your lifestyle if you have economic > independence. > > > > With economic independence you : > > Eat better* applies to the urban less privilidged in developed > countries too. > > Have better access to education and therefore jobs, technology in > agriculture etc > > Have safer working environments: you can afford the luxury > > Safer communities: less war and crime?? > > Clean water > > And an individual gets a chance to pay for the most effective simple > treatments if you do need them and welfare based systems become > viable to fund more. > > > > With the first 5 freely available there will be a lot less needed of > the last - so the suppy meets demand and the development of . > > If you are economically independent then you have a better chance of > sustaining economic growth in your region: > > (after all upto 70% of GDP in the developed nations comes from small > businesses, nearly 50% from businesses with less than 10 employees) > > > > Maybe prevention needs to start at a stage outside healthcare itself. > > > > Vijaya Madhavan > > Director > > Personalised Intelligence Ltd > > Business Consultant (former physician) > > > > > > > > > > On 15 September 2011 16:45, Katharine Ballard > <[log in to unmask]> wrote: > > -- > Paul Glasziou > Bond University > Qld, Australia 4229 > > >