I agree with Adam.
At heart, economists engaged in normative economics are collectivist mystics who believe to be presiding, likle little benevolent tinhorn dictators,over the human analogue if a cattle farm.
Cattle farms are managed to maximize the weight of salable meat off the herd, even if that means starving some cows and generously feeding others. The human analogue of cattle farms, according to economists, is to be run so as to maximize a mystical something called "social welfare." With appeal to a bastardized version of Benthamite utilitarianism, economists believe that they know how to define, measure and maximize "social welfare" (see the attached). All that is required is a suspension of credulity and a bit of legerdemain.
I am glad to have found in Adam a kindred soul that sees through this professional fraud -- which is really selling a distinct ethical doctrine in the guise of science. Luckily, the malpractice system does not extend to economic "science."
Have a happy Labor Day weekend, you all. If you don't have a Labor Day weekend this weekend, you're un-American, that is, you are not exceptional.
Uwe
-----Original Message-----
From: Anglo-American Health Policy Network [mailto:[log in to unmask]] On Behalf Of Oliver,AJ
Sent: Friday, August 31, 2012 1:34 PM
To: [log in to unmask]
Subject: Re: Score cards for take-up of Nice approvals
Related to this, and something I've gone on about to the point of boring myself (so why should I spare anyone else?) is the implicit assumption that the appropriate objective of a health care system (as opposed to a health care treatment) is the maximisation of health, and that CEA is the appropriate tool to meet that objective. The first clause is clearly nonsense, and the second clause is more opaque nonsense. And we have hundreds of 'experts' populating international conferences, spending money that could be better spent elsewhere, going on about the economics of this, and the economics of that, when, in fact, the extent of their knowledge of economic theory could be written on the back of a postage stamp. It's all too much like the emperor's new clothes.
On 28 Aug 2012, at 21:44, "Tom Foubister" <[log in to unmask]> wrote:
> Valerie
>
> PCTs do not receive additional funding for compulsory take up of Nice recommendations (I can't remember if they did at the very beginning, they may have done, not sure, but not over time) - hence the reduction in, or elimination of, coverage for some existing covered services as PCTs attempted to make room for Nice approvals. On May's point below - certainly, Nice recommendations had to be funded by the NHS, but funding had to come from existing budgets. However, much of the history of this was taking place at a time of growing funding for the NHS overall, so arguably yes, Nice coverage and spending increases were related, but indirectly.
>
> Hospitals do receive payment from different PCTs. But all PCTs (or what they're changing into) pay the same centrally-set tariff for the same service (a DRG-type payment).
>
> So re what happens when two or more purchasers dealing with one hospital have different coverage policies: someone please say if this is mistaken, but if a purchaser does not cover a service for which a tariff exists, it will not purchase the care designated by that tariff (though I don't think this is a situation that arises, but it may be); and if a purchaser covers something for which a tariff does not exist, it will have to pay the difference. Assuming of course that the hospital has the capacity (eg supplies in stock...) to provide. That is the picture in principle - what specifically happens in practice, which often differs from what happens in principle, I don't know.
>
> Despite what Rudolf writes below, I find it difficult to understand the focus of the DH here on hospitals, as this coverage variation issue (and postcode lottery), in so far as it is an inpatient care question, largely comes down to decisions made by purchasers (excepting Nice's recommendations around practice guidelines etc, and excepting services for which hospitals receive funding direct from the DH rather than PCTs).
>
> Unless hospitals are expected to incorporate higher cost new technologies into tariffs which are based on prior less expensive technologies, which I don't think they are.
>
> Tom
> -----Original Message-----
> From: May Tsung-Mei Cheng <[log in to unmask]>
> Sender: Anglo-American Health Policy Network <[log in to unmask]>
> Date: Tue, 28 Aug 2012 19:34:27
> To: <[log in to unmask]>
> Reply-To: May Tsung-Mei Cheng <[log in to unmask]>
> Subject: Re: Score cards for take-up of Nice approvals
>
> Scoring hospitals may be an effective way to reduce the wide geographic variations that has long been observed in the uptake of NICE recommendations by hospitals including the use of cancer drugs. As to who pays, my understanding is that the NHS must fund all NICE recommendations. So NICE recommendations sometimes lead to an increase in NHS spending.
>
> May
>
> -----Original Message-----
> From: Anglo-American Health Policy Network [mailto:[log in to unmask]] On Behalf Of Rudolf Klein
> Sent: Tuesday, August 28, 2012 2:58 PM
> To: [log in to unmask]
> Subject: Re: Score cards for take-up of Nice approvals
>
> Jp-
>
> Not really. There are appeal procedures and GPs would have to give good reason for ignoring NICE recommendations.
>
> GPs prescribing drugs etc. is a relatively straightforward matter and doesn't give much scope for conspiracy theories. Giving greater visibility to what GPs are doing - score cards etc. - is one more attempt to reduce postcode rationing, I reckon.
>
> It's much more difficult to know about the extent to which hospitals follow NICE recommendations because of lack of data. Occasional surveys suggest great variations ( as always in the NHS ) in implementation. So score cards may be a good way of opening this particular can.
>
>
> Rudolf
> -----Original Message-----
> From: Joseph White <[log in to unmask]>
> To: rudolfklein30 <[log in to unmask]>
> Cc: AAHPN <[log in to unmask]>
> Sent: Tue, Aug 28, 2012 4:02 pm
> Subject: Re: Score cards for take-up of Nice approvals
>
> ah, but if the GPs are in charge, they can decide it's not appropriate regardless of what NICE says, right? Wouldn't that follow?
>
> Not that anything follows any logic in this reform.
>
> cheers,
> Joe
>
> On Tue, Aug 28, 2012 at 10:12 AM, Rudolf Klein <[log in to unmask]> wrote:
> What's new ? The NHS Constitution - introduced in 2008, reaffirmed by present govt.= states :" You (i.e. the patient) have the right to drugs and treatments that have been recommended by NICE for use in the NHS, if your doctor says that they are clinically appropriate for you".
>
> Rudolf Klein
>
>
> -----Original Message-----
> From: Tom Foubister <[log in to unmask]>
> To: AAHPN <[log in to unmask]>
> Sent: Tue, Aug 28, 2012 12:55 pm
> Subject: Score cards for take-up of Nice approvals
>
> It is difficult to tell from this story (below) whether there is in fact some concrete compulsion to make available Nice-recommended drugs, or whether the line being pursued is a straightforward 'name and shame'
> one. It seems, in spite of the rhetoric, to be the latter.
>
> The focus here is on hospitals (although it's not clear it's just that
> - indirectly on purchasers perhaps), but it's hard to see how a hospital can act unilaterally to introduce a new more expensive treatment/technology and not make a loss without the agreement of the purchaser to pay above and beyond the existing tariff - at least until tariffs are reviewed.
>
> Maybe this is how the government intends to 'not interfere' in purchasing decisions. But I'm wondering if it will be particularly effective.
>
> Is there any comparable use of scorecard-type mechanisms for new drugs/technologies provision in any part of the US health system? If so, are there any positive/negative lessons to be drawn? And would US experience even be relevant to the phenomenom of poor areas vs middle class areas (as opposed to United vs Aetna) we have here?
>
> Tom
>
> http://www.guardian.co.uk/society/2012/aug/28/scorecards-nhs-inequality-over-drugs
>
> Scorecards' to end inequality over NHS drugs
> Measure aims to tackle regional disparity of medicines and treatments
>
> Press Association
> The Guardian, Tuesday 28 August 2012
>
> The new rules will allow the public to compare the speed at which NHS
> hospitals roll out new care methods and drugs.
>
> NHS "scorecards" are to be introduced to tackle the regional disparity
> of medicines and treatments.
>
> Under the scheme, expected to be launched before autumn, hospitals will
> have "no excuse not to provide the latest approved drugs and
> treatments", the Department of Health said.
>
> Hospitals that delay acting on guidance from the health watchdog, the
> National Institute for Health and Clinical Excellence (Nice), will be
> forced to explain holdups to patients, it said.
>
> The new rules will allow the public to compare the speed at which NHS
> hospitals roll out new care methods and drugs.
>
> Currently some primary care trusts delay offering new drugs as
> recommended by Nice, while other areas use them on patients straight
> away.
>
> Under the scheme, NHS organisations will be automatically added on to
> publicly available lists of what drugs are available in local areas.
>
> It is hoped the rules will create a level playing field for treatments
> such as IVF, for which patients living in different regions have had
> varying levels of opportunity for the treatment.
>
> Last year, a report found more than 70% of NHS trusts ignored Nice
> guidance to offer infertile couples three chances at IVF, and some
> stopped funding treatment.
>
> Some of Nice's most recent guidance, recommending an extended time to
> administer a clot-busting drug to treat stroke patients, for example,
> will soon have to be taken on by all hospitals.
>
> The Department of Health said the uptake of new drugs and treatments
> will also be made quicker by setting up a new group to help local NHS
> organisations implement the guidelines.
>
> The health minister, Paul Burstow, said: "Patients have a right to
> drugs and treatments that have been approved by Nice. This new regime
> will be a catalyst for change - we are determined to eradicate
> variation and drive up standards for everyone.
>
> "NHS organisations must make sure the latest Nice-approved treatments
> are available in their area, and if they are not, then they will now be
> responsible for explaining why not.
>
> "Being transparent with data like this is the hallmark of a 21st
> century NHS. It is a fundamental tool to help healthcare professionals
> improve patient care."
>
> Please access the attached hyperlink for an important electronic communications disclaimer: http://lse.ac.uk/emailDisclaimer
Please access the attached hyperlink for an important electronic communications disclaimer: http://lse.ac.uk/emailDisclaimer
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