Decision making in health care involves consideration of a complex set of diagnostic, therapeutic and prognostic uncertainties. Medical therapies have side effects, surgical interventions may lead to complications, and diagnostic tests can produce misleading results. Furthermore, patient values and service costs must be considered. Decisions in clinical and health policy require careful weighing of risks and benefits and are commonly a trade-off of competing objectives: maximizing quality of life vs maximizing life expectancy vs minimizing the resources required. This text takes a proactive, systematic and rational approach to medical decision making. It covers decision trees, Bayesian revision, receiver operating characteristic curves, and cost-effectiveness analysis; as well as advanced topics such as Markov models, microsimulation, probabilistic sensitivity analysis and value of information analysis. It provides an essential resource for trainees and researchers involved in medical decision modelling, evidence-based medicine, clinical epidemiology, comparative effectiveness, public health, health economics, and health technology assessment.
The Canadian health care system is so indisputably tied to our national identity that its founder, Tommy Douglas, was voted the greatest Canadian of all time in a CBC television contest. However, very little has been written to date on how Medicare as we know it was developed and implemented. This collection fills a serious gap in the existing literature by providing a comprehensive policy history of Medicare in Canada.
Making Medicare features explorations of the experiments that predated the federal government’s decision to implement the Saskatchewan health care model, from Newfoundland’s cottage hospital system to Bennettcare in British Columbia. It also includes essays by key individuals (including health practitioners and two premiers) who played a role in the implementation of Medicare and the landmark Royal Commission on Health Services. Along with political scientists, policy specialists, medical historians, and health practitioners, this collection will appeal to anyone interested in the history and legacy of one of Canada’s most visible and centrally important institutions.
The definitive story of American health care today--its causes, consequences, and confusions
In March 2010, the Affordable Care Act was signed into law. It was the most extensive reform of America’s health care system since at least the creation of Medicare in 1965, and maybe ever. The ACA was controversial and highly political, and the law faced legal challenges reaching all the way to the Supreme Court; it even precipitated a government shutdown. It was a signature piece of legislation for President Obama’s first term, and also a ball and chain for his second.
Ezekiel J. Emanuel, a professor of medical ethics and health policy at the University of Pennsylvania who also served as a special adviser to the White House on health care reform, has written a brilliant diagnostic explanation of why health care in America has become such a divisive social issue, how money and medicine have their own--quite distinct--American story, and why reform has bedeviled presidents of the left and right for more than one hundred years.
Emanuel also explains exactly how the ACA reforms are reshaping the health care system now. He forecasts the future, identifying six mega trends in health that will determine the market for health care to 2020 and beyond. His predictions are bold, provocative, and uniquely well-informed. Health care--one of America’s largest employment sectors, with an economy the size of the GDP of France--has never had a more comprehensive or authoritative interpreter.
The U.S. healthcare system is in critical condition--but this should come as a surprise to no one. Yet until now the solutions proposed have been unworkable, pie-in-the-sky plans that have had little chance of becoming law and even less of succeeding. In Code Red, David Dranove, one of the nation's leading experts on the economics of healthcare, proposes a set of feasible solutions that address access, efficiency, and quality.
Dranove offers pragmatic remedies, some of them controversial, all of them crucially needed to restore the system to vitality. He pays special attention to the plight of the uninsured, and proposes a new direction that promises to make premier healthcare for all Americans a national reality. Setting his story against the backdrop of healthcare in the United States from the early twentieth century to the present day, he reveals why a century of private and public sector efforts to reform the ailing system have largely failed. He draws on insights from economics to diagnose the root causes of rising costs and diminishing access to quality care, such as inadequate information, perverse incentives, and malfunctioning insurance markets. Dranove describes the ongoing efforts to revive the system--including the rise of consumerism, the quality movement, and initiatives to expand access--and argues that these efforts are doomed to fail without more fundamental, systemic, market-based reforms. Code Red lays the foundation for a thriving healthcare system and is indispensable for anyone trying to make sense of the thorny issues of healthcare reform.
"Doubt is our product," a cigarette executive once observed, "since it is the best means of competing with the 'body of fact' that exists in the minds of the general public. It is also the means of establishing a controversy." In this eye-opening expose, David Michaels reveals how the tobacco industry's duplicitous tactics spawned a multimillion dollar industry that is dismantling public health safeguards. Product defense consultants, he argues, have increasingly skewed the scientific literature, manufactured and magnified scientific uncertainty, and influenced policy decisions to the advantage of polluters and the manufacturers of dangerous products. To keep the public confused about the hazards posed by global warming, second-hand smoke, asbestos, lead, plastics, and many other toxic materials, industry executives have hired unscrupulous scientists and lobbyists to dispute scientific evidence about health risks. In doing so, they have not only delayed action on specific hazards, but they have constructed barriers to make it harder for lawmakers, government agencies, and courts to respond to future threats. The Orwellian strategy of dismissing research conducted by the scientific community as "junk science" and elevating science conducted by product defense specialists to "sound science" status also creates confusion about the very nature of scientific inquiry and undermines the public's confidence in science's ability to address public health and environmental concerns Such reckless practices have long existed, but Michaels argues that the Bush administration deepened the dysfunction by virtually handing over regulatory agencies to the very corporate powers whose products and behavior they are charged with overseeing. In Doubt Is Their Product Michaels proves, beyond a doubt, that our regulatory system has been broken. He offers concrete, workable suggestions for how it can be restored by taking the politics out of science and ensuring that concern for public safety, rather than private profits, guides our regulatory policy. Named one of the best Sci-Tech books of 2008 by Library Journal!
The HMO system is often praised for cutting runaway costs. It is supposed to act as a powerful market force to stop greedy doctors and hospitals from treating patients like pi-atas, to be cut open for profit. Health Against Wealth reveals that when you are confronting cancer, heart disease, or psychiatric illness, when you face a medical emergency or your child requires complex pediatric surgery, all those cost-saving rules and artful ways of keeping doctors frugal can turn against you. Wall Street Journal reporter George Anders explains why " managed care " is so appealing to employers and insurers and how HMO bureaucrats can thwart necessary, even life-saving treatment under the guise of cost efficiency. Health Against Wealth takes an unflinching look at the profit-hungry entrepreneurs who have poured into this new" health industry" and provides alarming examples of political manipulation by increasingly powerful HMO lobbyists. At the same time, the book explores the hopes and frustr
The U.S. health care system is in crisis. At stake are the quality of care for millions of Americans and the financial well-being of individuals and employers squeezed by skyrocketing premiums—not to mention the stability of state and federal government budgets.
In Redefining Health Care, internationally renowned strategy expert Michael Porter and innovation expert Elizabeth Teisberg reveal the underlying—and largely overlooked—causes of the problem, and provide a powerful prescription for change.
The authors argue that competition currently takes place at the wrong level—among health plans, networks, and hospitals—rather than where it matters most, in the diagnosis, treatment, and prevention of specific health conditions. Participants in the system accumulate bargaining power and shift costs in a zero-sum competition, rather than creating value for patients. Based on an exhaustive study of the U.S. health care system, Redefining Health Care lays out a breakthrough framework for redefining the way competition in health care delivery takes place—and unleashing stunning improvements in quality and efficiency.
With specific recommendations for hospitals, doctors, health plans, employers, and policy makers, this book shows how to move health care toward positive-sum competition that delivers lasting benefits for all.
Decision making in health care means navigating through a complex and tangled web of diagnostic and therapeutic uncertainties, patient preferences and values, and costs. In addition, medical therapies may include side effects, surgery may lead to undesirable complications, and diagnostic technologies may produce inconclusive results. In many clinical and health policy decisions it is necessary to counterbalance benefits and risks, and to trade off competing objectives such as maximizing life expectancy vs optimizing quality of life vs minimizing the required resources. This textbook plots a clear course through these complex and conflicting variables. It clearly explains and illustrates tools for integrating quantitative evidence-based data and subjective outcome values in making clinical and health policy decisions. An accompanying CD-ROM features solutions to the exercises, PowerPoint® presentations of the illustrations, and sample models and tables.
The health care system in Canada is much-discussed in the international sphere, but often overlooked when it comes to its highly decentralized administration and regulation. Health Systems in Transition: Canada provides an objective description and analysis of the public, private, and mixed components that make up health care in Canada today including the federal, provincial, intergovernmental and regional dynamics within the public system. Gregory P. Marchildon’s study offers a statistical and visual description of the many facets of Canadian health care financing, administration, and service delivery, along with relevant comparisons to five other countries’ systems.
This second edition includes a major update on health data and institutions, a new appendix of federal laws concerning select provincial and territorial Medicare legislation, and, for the first time, a comprehensive and searchable index. It also provides a more complete assessment of the Canadian health system based on financial protection, efficiency, equity, user experience, quality of care, and health outcomes.
Balancing careful assessment, summary, and illustration, Health Systems in Transition: Canada is a thorough and illuminating look at one of the nation's most complex public policies and associated institutions.
Every one of us is unique. With recent advances in technology, we now know that that statement is more true that ever: we are each individuals, right down to a molecular level ? a one-of-akind combination of genes, proteins, and metabolism. So why does healthcare still take a one-size-fits-all approach? The same methods are used on everyone to diagnose illness, and the same drugs are used to treat it ? despite the fact that those methods and treatments are not effective for everyone and are even harmful for some. Shouldn't our medicine be tailored to our differences? The Personalized Medicine Revolution explores recent advances in genomics, the study of the human genome ? as well as its cousins proteomics, metabolomics, microbiomics, and the like ? and explains how technology is even now changing the way medicine is delivered. Along the way, it takes the reader through the five critical healthcare areas that will be transformed most radically by personalized medicine ? prediction, prevention, diagnosis, treatment, and monitoring ? and examines the practical and ethical issues involved. Finally, it details how readers can use personalized medicine to take charge of their own health and build a stronger and safer medical system.