MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Health as Human Capital - Illustrated Research Summaries' source. Sat, 20 Mar 2010 15:50:30 +0100 http://www.medworm.com/index.php?rid=3317700&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2010%2F02%2Fimplementing-evidence-based-care-only.html Three years ago, in January 2007, we wrote a blog (1) about a new “blockbuster” study, the findings of which should have revolutionized cardiology. Results showed that the common procedure of placing “stents” inside heart vessels (at a cost of $15,000 or more each) was no more effective for stable patients, and sometimes more harmful, than taking medication (2). In fact, death rates and repeat heart attacks were even higher in the stent alternative. What a wonderful discovery for managing medical costs: spend less, get equal or better results, and cause less harm. A trifecta of benefits!What has happened to the treatment of blocked arteries in the past three years since? Not much. After a brief dip in the rate of stent use, it appears cardiologists now use more stents than ever, ig... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=3317700 Sun, 28 Feb 2010 00:00:00 +0100 3317700 http://www.medworm.com/index.php?rid=3226888&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2010%2F01%2Fwhy-savings-estimates-for-improved.html This study found that 3.8% of physicians in Louisiana accounted for 72% of all workers’ compensation costs (6). Patients who chose—or happened to have treatment from—“cost intensive physicians” could expect to have five times higher costs, even after adjusting for age, sex, medical condition, and other factors. The remaining 96% of doctors seeing workers’ compensation cases accounted for only 28% of costs. Individual beliefs affect the number of absences for back pain. Workers who have high levels of fear-avoidance beliefs (FAB), beliefs that work will lead to pain, are absent more than workers with similar pain severity but low FAB (3). Health improvement alone does not improve return-to-work following extended absence. European researchers found that improved health did... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=3226888 Sun, 31 Jan 2010 00:00:00 +0100 3226888 http://www.medworm.com/index.php?rid=3181612&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2010%2F01%2Fseeing-is-believing-power-of-consumer.html Now I see!Globally, 150 million people have treatable vision problems that remain uncorrected. Researchers estimate a loss of productive effort amounting to $269 billion per year from education and work these individuals are prevented from achieving (1). That number of people is equivalent to half of our nation’s population being prevented from reading in school, seeing the buttons on a calculator, or having the ability to safely drive a vehicle; a huge and avoidable loss.In our last blog, we discussed what health innovation might look like in a consumer-oriented market. Most of the examples we used were hypothetical, comparing technological advances in consumer goods to what has not happened in delivery of healthcare. Today, we look at a remarkable example of innovation—an inexpensive... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=3181612 Sun, 17 Jan 2010 00:00:00 +0100 3181612 http://www.medworm.com/index.php?rid=3138547&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2010%2F01%2Fif-only-imagine-if-healthcare-were-as.html Let’s say you are hiring someone to fill a high-level position in one of your offices across town. You find a great candidate and offer him a job. He says “Sure, and I expect a large salary. But I will not communicate with you by email or voice mail. You have to come and see me in person if you need anything. ” Sound reasonable? Of course not. But this is what usually happens in healthcare. Although exceptions are becoming more common, as of last year only 36% of doctors had ever used email to communicate with patients (1), and some ask patients to pay a monthly fee for the privilege (2). Why is that? Mostly because our healthcare system has evolved with a third party (insurance or employers or government) deciding what they will pay for, and paying within a structure that does not e... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=3138547 Sun, 03 Jan 2010 00:00:00 +0100 3138547 http://www.medworm.com/index.php?rid=3107890&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2009%2F12%2Fgetting-real-reasons-companies-rarely.html Today’s blog is a response to benefits managers and corporate medical directors who have (and will in the future) exclaimed “these programs were supposed to save us money, so why are your data saying they don’t? Is there something wrong with your analysis?”While I am formally trained in Evaluation Methodology, I recognize that only a few kindred spirits share my passion for this field. This blog doesn’t require that you LOVE evaluation, but it is a little more detailed than usual, because it seems important to explain why our direct evaluations so infrequently show (expected) measurable savings from health improvement programs. There are three overarching reasons, each of which I will highlight briefly.1. Healthcare costs are not a good measure of health status.2. We use real num... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=3107890 Mon, 21 Dec 2009 00:00:00 +0100 3107890 http://www.medworm.com/index.php?rid=3062713&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2009%2F12%2Freduce-absence-improve-productivity.html You could say this is a story of a group of underdogs who become company heroes. Or you could say it is a story of a smart business manager. Either way, it is a success story where a once-disappointing department improved productivity by over 35% and dropped absenteeism by an amazing 70%. How? Aligned incentives. And it all started with a dinner conversation…Let’s start at the beginning.Over their evening meal, one of my colleagues was talking with her husband, “Chris,” about work. His company sells medical supplies, and he had recently been assigned new responsibility for several departments including accounts receivable (AR). Chris soon learned that AR was considered the “problem” department, often blamed for less-than-adequate collection rates and perceived as poor performer... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=3062713 Sun, 06 Dec 2009 00:00:00 +0100 3062713 http://www.medworm.com/index.php?rid=3018400&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2009%2F11%2Fopenness-to-new-ideas-only-cure-then.html It is not hard to learn more. What is hard is to unlearn when you discover yourself wrong (1). ~Martin H. FischerIn the frightening time of the Black Plague, many held strong beliefs about how the disease spread. Clergy claimed it was a punishment directly from God; Hippocratic physicians said it was an imbalance of the body’s four humors; Astrologers attributed it to the proximity of Jupiter, Saturn and Mars; the public was told that bathing and exercise were risky because they opened one’s pores; some even said it could be passed through an evil stare (2, 3). We can only imagine the pervasive panic, fear and misunderstanding that drove people to all sorts of ineffective “preventive” behaviors.Even when the true cause of the Plague was discovered, I wonder how long it took for p... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=3018400 Sun, 22 Nov 2009 00:00:00 +0100 3018400 http://www.medworm.com/index.php?rid=2973347&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2009%2F11%2Fletting-employees-manage-their-own-time.html At the Health as Human Capital Foundation, we often witness scenarios where employees, when given the choice and proper incentives, actually spend company time and money MORE wisely than they would under a strict set of rules or governing policies.This is just that sort of example.Most every company we work with has an extensive paid-time-off policy, detailing what days are allowed, for what purposes, and at what times during the year. There are extensive rules governing its use and tracking their frequency. But it’s worth asking: even when companies spend time and energy defining a thoughtful policy and system, is there an exact amount of time off from work that suits each of us perfectly? What if we allow workers some discretion in how much time off they want?At a recent luncheon, I sp... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=2973347 Sun, 08 Nov 2009 00:00:00 +0100 2973347 http://www.medworm.com/index.php?rid=2926626&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2009%2F10%2Fwhen-someone-else-pays-you-simply-care.html Do you honestly believe that individuals deserve the right and responsibility to make their own choices about health care? Before you answer, remember, the ultimate decision-maker is the one who spends the money. So, giving individual patients control also means putting them in charge of healthcare dollars.When it comes right down to it, most people say they support patient rights, but only in the context of someone else paying the bill. Here’s why those two issues cannot be separated:When discussing health savings accounts with employers, I often hear concern that connecting financial factors to health decisions will lead to employees making bad choices (mostly by not getting the care they need). I hear a widespread belief that asking people to take financial accountability for healthc... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=2926626 Sun, 25 Oct 2009 00:00:00 +0100 2926626 http://www.medworm.com/index.php?rid=2881043&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2009%2F10%2Fpart-iv-business-practicesa-major.html In the previous blog, we covered three out of the four drivers of healthcare costs: 1) Basic costs & bad luck;2) Demographics and labor market; and3) Health status. We learned that #1 and #2 account for a portion of healthcare costs that are non-modifiable, and that health status is a less influential driver than one might expect.We move to the final driver of healthcare costs, which is both modifiable and significant, but unfortunately too often overlooked: business practices. What do we mean? Business practices are the entire set of employee policies and practices captured in everyone’s workplace environment and employment contract—such as how compensation works, how health benefits are structured, how time off is allotted, how employees are trained and managed, etc. In com... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=2881043 Sat, 10 Oct 2009 23:00:00 +0100 2881043 http://www.medworm.com/index.php?rid=2835954&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2009%2F09%2Fhow-much-does-health-drive-healthcare.html When medical and disability costs are high, conventional wisdom assumes there must be more illness driving up costs, right? But how much of total cost can we actually attribute to health status versus other things?Four Parts.There are actually four driving components of health and absence cost, the first three of which we’ll cover here, and the fourth in the next blog. To give away just a little of the secret in advance, it may surprise some readers to learn that health status is not as powerful a predictor of cost as one might expect.Believe it or not, our research on nearly 2 million employees and their families across the US finds that a surprisingly small amount of the variation in healthcare costs can be attributed to health status.We’ve studied how each of four components indepen... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=2835954 Sat, 26 Sep 2009 23:00:00 +0100 2835954 http://www.medworm.com/index.php?rid=2792450&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2009%2F09%2Fwhat-patients-should-be-fighting-for.html If those who have the money are the ones with decision-making power, why not let patients have both? As government and insurers debate over who should grant permission to doctors about which treatments and care regimens are acceptable, why not award ultimate control to the person in the best position to decide—i.e., the person receiving the care?Consider this story:In a radio interview last month, I heard two doctors (specifically, both called “interventional cardiologists”) debating the merits of their preferred approach to unclogging heart arteries. One followed guidelines based on evidence that when patients are stable, medications are as effective—and often safer in the long term—than placing a stent in the artery. The other has a “bias” toward stents, and places an avera... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=2792450 Sat, 12 Sep 2009 23:00:00 +0100 2792450 http://www.medworm.com/index.php?rid=2747282&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2009%2F08%2Fday-entire-work-force-got-sicker-or-did.html Imagine being a benefits manager for a large corporation boasting three straight years of flat medical and absence costs (1). Like many benefits managers, you might be proud and vocal about the many programs you’ve purchased to encourage health and disease management. We have all seen such flat trends attributed to health interventions provided by the employer. This example was no different.If health programs or active management of disease could be credited for a three-year flat trend, how does one explain what then happened to the same company in the following 15 months? Did everyone suddenly become ill in the fall of 2007? Suddenly, chronic diseases and injuries just appeared?To confirm, detailed analysis of health claims shows that virtually every category of illness became more prev... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=2747282 Sat, 29 Aug 2009 23:00:00 +0100 2747282 http://www.medworm.com/index.php?rid=2704887&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2009%2F08%2Fkey-health-reform-issue-no-one-is.html .....we cannot afford (nor should we strive) to provide unlimited medical services to every person in our nation.Almost everyone agrees: healthcare reform is needed, and the call is loud and clear. Silently, decision makers have also agreed NOT to tackle the hard questions that must be answered before any of the debate can be settled.Ultimately, the healthcare crisis is a simple case of limited resources and unconstrained demand. We might wish healthcare reform could simply be about caring for our fellow citizens, or developing superior science, or implementing uniform efficiencies. But it’s not.We have limited time, money, personnel and equipment that can be assigned to this one part of life. And what we spend on healthcare will not be spent on education, housing, food, infrastructure, ... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=2704887 Sat, 15 Aug 2009 23:00:00 +0100 2704887 http://www.medworm.com/index.php?rid=2663625&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2009%2F08%2Fbest-prevention-doesnt-come-from.html I know someone, Jane, who goes to the doctor all the time. She has every ache, bump, rash or other symptom seen by a physician, usually a specialist. Jane often starts a statement with “my (insert a specialist type like orthopedic surgeon) says….” She is vigilant about regular check-ups and timely screening tests, which in her mind means she is practicing prudent prevention.The media (and discussions of healthcare reform), often limit their discussions of prevention to activities like check-ups and screening tests. A recent White House stakeholder’s meeting included suggestions from physicians such as: "the best prevention is providing people with health insurance," and that “employers allot a certain number of hours for regular preventative check-ups” (1) So, it’s no surpris... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=2663625 Sat, 01 Aug 2009 23:00:00 +0100 2663625 http://www.medworm.com/index.php?rid=2616419&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2009%2F07%2Fif-we-ignore-incentives-were-going-to.html Rule: a prescribed guide for conduct or action; a regulation or bylaw governing procedure or controlling conduct (1). Recently I read a sick leave policy that was six pages long. It was very thorough, describing what constituted illness, how the illness would be verified, how long the person had to notify the company of an absence, and many, many more rules. Although the following words were not written on the document, it was clear: “We are worried employees will misuse this policy, so we are trying to imagine and close every loop hole we possibly can.”Coincidentally, this was the same day the news began reporting on a new regulatory framework for financial institutions: trying to avoid a repeat of factors that contributed to the current recession. It got me thinking about how the nee... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=2616419 Sat, 18 Jul 2009 23:00:00 +0100 2616419 http://www.medworm.com/index.php?rid=2572588&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2009%2F07%2Fheres-idea-take-wages-away-from-good.html Congress is considering a bill that would mandate all employers provide seven days of paid sick leave for employees to care for themselves or a family member (1). There is no provision for workers to cash-in unused sick leave or convert to vacation days if unneeded (2), so the only way to get value from this mandated benefit will be to have seven days of illness in one’s family each year. However, the bill does allow employers to require a doctor’s written excuse for illness absences that last three days or longer.Like all such mandates, the bill sponsors believe it will protect workers from unfair treatment; one should not be punished when illness strikes oneself or one’s child. Related media stories focus on single mothers being threatened with termination because their children be... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=2572588 Sat, 04 Jul 2009 23:00:00 +0100 2572588 http://www.medworm.com/index.php?rid=2500922&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2009%2F06%2Fwhen-you-recover-from-economic-storm.html As companies look for ways to cut back in a tough economy, many are freezing salaries and limiting bonus eligibility. While this may seem prudent and logical, performance rewards are the last thing to limit if you intend to retain top performers.With the exception of sales positions, senior executives, hedge-fund managers, and the top dogs at AIG, top performers are already notoriously under-rewarded in U.S. businesses. Compared to base salaries, most companies allocate few resources toward rewards for individual performance. Because companies do a poor job of rewarding performance, those producing exceptional value for a company, paradoxically, will be penalized most by a lack of pay-for-performance. This is partly because it is hard to measure some aspects of performance, and partly beca... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=2500922 Sat, 20 Jun 2009 23:00:00 +0100 2500922 http://www.medworm.com/index.php?rid=2467264&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2009%2F06%2Fculture-of-health-its-more-than.html Every year, a new catch phrase becomes THE focus of corporate health. This year that phrase seems to be the “Culture of Health.” At almost every conference and corporate benefit presentation, a ‘culture of health’ is the gold standard all employers must strive to achieve. And why wouldn’t everyone want to?But by what measure?Disappointingly, more often than not, ‘culture of health’ is a term used to justify existing programs or sell new health-related activities. This thinking implies that how many health-focused activities a company sponsors, or how many health-conducive facilities they have determines whether there is a “culture of health.” I saw one presentation that defined it as a list of programs and facilities (everything from a fitness center, to healthy options i... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=2467264 Mon, 08 Jun 2009 04:00:00 +0100 2467264 http://www.medworm.com/index.php?rid=2433024&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2009%2F05%2Ftwenty-years-laterlet-me-explain-roi-of.html The first time I suggested to an employer that they put all their data in one common database was in 1989. I was a university professor focused on research then, and was advising managers in HR and benefits about healthcare costs. I drew a hub and spokes, showing how we could take a variety of data sources from around the company and put them all in one central place. This way everyone could better understand what was going on in the workforce.Their reaction could best be described as a blank stare. “Why would we do that?” they asked.Little did I know that over the next two decades, I would hear the same question, literally hundreds of times. It comes in many forms:Q: What is the guaranteed value of integrated information? Q: How do you KNOW ahead of time that resources spent on data i... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=2433024 Sun, 24 May 2009 04:00:00 +0100 2433024 http://www.medworm.com/index.php?rid=2401983&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2009%2F05%2Fwhen-problem-goes-beyond-illness.html Trivia Question: The following three questions are part of a screening that is more than 80% accurate at predicting what? (Clue—this is not about life satisfaction or stress.1) Would you describe your work as monotonous?2) How satisfied are you with your job?3) How tense or anxious have you been in the past week. .....Stay tuned for the answer below.Ask your mother--context is everything.We all know that circumstances affect our reactions to specific events. Depending on what “else” is happening at the time, we respond differently to the same challenge. On some days big obstacles are manageable, while on other days a tiny hassle seems insurmountable. Most kids know that having a tummy ache is a good way to avoid difficult circumstances, such as a quiz they aren’t ready for, or a bu... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=2401983 Sun, 10 May 2009 04:00:00 +0100 2401983 http://www.medworm.com/index.php?rid=2373541&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2009%2F04%2Ften-misaligned-financial-policies-that.html Pay is probably the most powerful communication tool an employer has.A book on compensation that I read recently explains very clearly how rewards (all pay, benefits and recognition) deliver the clearest message to employees about what is important to the company, and what the company wants from them. The authors remind readers that "few things get the attention of people in a company as well as pay does (1)." This got me thinking that companies “say” many things with money.Pay—depending on how it is designed—can put employers and employees on the same team, or make them adversaries. It can encourage the top performers, or protect the worst ones. Money talks. In fact, if what company leaders say in words is contradicted by their pay policies, it is more likely that employees will �... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=2373541 Sun, 26 Apr 2009 04:00:00 +0100 2373541 http://www.medworm.com/index.php?rid=2338520&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2009%2F04%2Fdo-we-have-it-backwards-should-we.html An interesting study completed last year should make us all reconsider our typical assumptions about how to improve community health. In short, the study found that communities that experienced a significant influx of jobs and economic opportunity not only had expected improvements in their standard of living, but also increased their practice of healthy behaviors, had improved physical and mental health, less chronic illness, lower reported disability, and felt better.This unique, natural experiment compared tribal populations before and after they opened casinos, to similar tribes who did not have economic development from casinos (1). Those not opening casinos certainly received attention and programs emphasizing tobacco cessation, eating right, taking care of one’s self, and dealing ... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=2338520 Sun, 12 Apr 2009 04:00:00 +0100 2338520 http://www.medworm.com/index.php?rid=2320853&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2009%2F03%2Fhow-health-savings-accounts-save-more.html Health Savings Accounts remain an underappreciated (and sometimes distrusted) tool. When we at the Health as Human Capital Foundation express our support for HSAs as critical to solving the healthcare cost problem, people often assume—incorrectly—that the primary intent is “cost sharing” or “cost shifting.” Make people pay, so they assume responsibility for the expense. Although paying directly for services does encourage people to spend money more carefully, that is NOT our primary reason for supporting HSAs. In fact, when a well-designed HSA approach is funded to cover the full deductible as we recommend, individuals have no additional cost at all!Really, the main reason to put money in the hands of consumers is to change the dynamic of their interactions with the healthcare ... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=2320853 Sun, 29 Mar 2009 04:00:00 +0100 2320853 http://www.medworm.com/index.php?rid=2267194&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2009%2F03%2Fwho-supports-whole-person-rather-than.html In our research for both public and private employers, we find that the top 5% of healthcare consumers in any group cost more than the other 95% combined. They get an amazing amount of healthcare services; the top one percent average 20 different doctors, 20 unique medications (not refills), 60 tests, and 15 procedures in a single year. With this many different healthcare interactions taking place, is it even possible to be safe? Is it possible to keep track of what has occurred, let alone actually have care coordinated? In the current system, I am convinced the answer is ‘no.’For example, I have a relative who is being seen by providers in a managed-care system that uses centralized electronic medical records (EMR). Even there, she has appointments where the neurologist clearly has no... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=2267194 Sun, 15 Mar 2009 04:00:00 +0100 2267194 http://www.medworm.com/index.php?rid=2227527&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2009%2F03%2Freal-help-isnt-giving-to-people-its.html Imagine a reality far worse than our economic recession. What if you were one of the world’s poorest, born to a poor family in a developing nation, uneducated, illiterate, and without opportunities to move up? If someone were to offer you help, what would you want it to be? Would you prefer handouts and strict rules, or would you want to earn your opportunity and make your own decisions? Would others give you that opportunity?Watching recent news on the nearly $800B stimulus package bail-out, I’ve heard countless and differing opinions about what really helps people. Is it more programs, less taxes, more jobs, higher education, or additional training? What kind of and how much assistance should we rely on from others, versus a better chance to help ourselves?The same question lies bene... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=2227527 Sun, 01 Mar 2009 05:00:00 +0100 2227527 http://www.medworm.com/index.php?rid=2190957&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2009%2F02%2Fmost-important-economic-principle-i.html Q: What do the following situations have in common?· Parents of a young teenager who discover 1600 text messages on their monthly cell phone bill,· Bank executives spending government bail-out money on bonuses or office remodeling,· Legislators adding their favorite pet project to an immensely important stimulus bill,· Homeowners who find that they can’t get the prepaid contractor to finish the last part of a remodeling project,· American customers at restaurants in New Zealand (where tips are frowned upon) find the service everywhere is very slow.A: They are all predictable situations based on who bears the cost and who receives the benefit.A simple principle changed my thinking.It’s not often that something you read changes the direction of your career, or even your perspective.... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=2190957 Sun, 15 Feb 2009 05:00:00 +0100 2190957 http://www.medworm.com/index.php?rid=2150876&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2009%2F02%2Fi-dont-have-to-write-blog-this-weeki.html Consider these real scenarios:1) In Belgium, the ministry of health reports that employees in some government departments average 35 days of sick leave per year. The government pays full salaries for unlimited sick leave, which now totals almost 1.3% of GDP. Officials report that most workers on leave have been given a diagnosis of depression and that nothing can be done because: “You can't contradict the opinion of a psychiatrist.” One expert estimates that only 5% are truly “cheating” but that at least 65% of those on government-paid leave could be working. However, they can’t be forced back to work because they have a doctor’s excuse.2) A delivery driver nearing retirement has an ongoing conflict with her boss. According to her, he assigns many more deliveries to her than ot... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=2150876 Sun, 01 Feb 2009 05:00:00 +0100 2150876 http://www.medworm.com/index.php?rid=2113669&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2009%2F01%2Fin-corporate-turf-wars-and-playground.html When I was a kid, there weren’t many organized sports leagues, so we mostly played neighborhood games. A few of us owned baseball gloves and old baseballs, but only the kid on the corner, Charlie, had a bat. Together, we would draw bases with chalk and play. On occasion, when Charlie didn’t make it to first base and we called him “out,” he would get mad and take his bat home, ending the game. Without him we could play catch… but not baseball.I’m not sure what business Charlie went into, but lately I have been wondering if he manages a department in a large organization.We continue to be amazed at compartmentalized, fragmented approaches to problem-solving in large organizations. Usually, we work alongside forward-thinking groups who manage one particular area of a business. The... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=2113669 Sun, 18 Jan 2009 05:00:00 +0100 2113669 http://www.medworm.com/index.php?rid=2081225&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2009%2F01%2Fthird-party-payers-of-gourmet-food-it.html What if?Imagine we decided that access to food was a universal right for U.S. citizens. Instead of providing food stamps or some other currency for purchasing food anywhere, low-income citizens now eat all meals at restaurants that forward the bill to our national government.Because different foods, with different nutritional value, prepared by different chefs, with different methods, in different parts of the country have different costs, the government hires experts to determine the relative value of a given meal. A team of 30 experts assigns meal value, which considers a chef’s expertise in allergen-free cooking, lactose and gluten substitution techniques, organic produce selection, and many other specialized nutritionist and culinary skills. Three of the 30 expert chefs come from reg... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=2081225 Sun, 04 Jan 2009 05:00:00 +0100 2081225 http://www.medworm.com/index.php?rid=2078835&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2009%2F01%2Fthird-party-payers-of-gourmet-food-it.html What if?Imagine we decided that access to food was a universal right for U.S. citizens. Instead of providing food stamps or some other currency for purchasing food anywhere, low-income citizens now eat all meals at restaurants that forward the bill to our national government.Because different foods, with different nutritional value, prepared by different chefs, with different methods, in different parts of the country have different costs, the government hires experts to determine the relative value of a given meal. A team of 30 experts assigns meal value, which considers a chef’s expertise in allergen-free cooking, lactose and gluten substitution techniques, organic produce selection, and many other specialized nutritionist and culinary skills. Three of the 30 expert chefs come from reg... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=2078835 Sun, 04 Jan 2009 05:00:00 +0100 2078835 http://www.medworm.com/index.php?rid=2056250&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2008%2F12%2Fpartnership-not-paternalism-incentives.html Who should decide what is best for an employee’s health?At a recent conference for medical and business professionals, I presented research showing that employees who were paid based on performance were more productive, and had lower benefits costs across a spectrum of job types and different employers. At the same time, we showed an increasing trend in some corporations and government agencies where paid-time-off (PTO) has accumulated to the point where large numbers of employees are facing the dilemma of use-it-or-lose-it. Our suggestion based on the health as human capital paradigm? Redistribute more compensation to pay for performance, reduce PTO by offering a voluntary option to cash-in unused days for more pay, and ask employees to share ownership of their health decisions by openi... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=2056250 Sun, 21 Dec 2008 05:00:00 +0100 2056250 http://www.medworm.com/index.php?rid=2021659&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2008%2F12%2Fnow-that-we-have-recession-its-never.html We’re all spending less and feeling poorer these days; individuals, families, businesses, and government agencies are all trying to squeeze more out of their budgets. In times like these we recognize more than ever that resources are finite, everything is a tradeoff. Spending more on some services means spending less on others. We fret about the effects of detrimental cutbacks, especially in healthcare.But economic pressures also create an environment where minds open themselves to new solutions. We invest more wisely, are willing to reconsider our present course, and perhaps are more willing to consider disruptive solutions to old problems—solutions that had once been feared as too big a risk. Perhaps, feeling frugal, we can redirect ourselves toward a better balance of proven investm... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=2021659 Sun, 07 Dec 2008 05:00:00 +0100 2021659 http://www.medworm.com/index.php?rid=1985093&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2008%2F11%2Fhidden-healthcare-pricing-mris-tell.html How much does the cost of healthcare vary? It never ceases to surprise me.Recently, one of our clients asked us to analyze the cost of MRIs of the knee across six local facilities used by their employees in one metropolitan area. The amounts paid by our client’s two health insurance companies for such MRIs ranged from below $700 to above $2,400, which is more than a three-fold spread! More dramatic: the amount billed to their insurance companies (before discounts were applied) ranged from $1,100 to over $4,000.For those unfamiliar, an MRI (Magnetic Resonance Image) is a type of diagnostic picture taken by an expensive, high-tech machine. MRIs allow an extremely detailed look inside the body to see if something looks amiss. Among many other uses, MRIs are commonly used to better understan... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=1985093 Sun, 23 Nov 2008 05:00:00 +0100 1985093 http://www.medworm.com/index.php?rid=1947418&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2008%2F11%2Fengaging-employees-and-aligning.html Sometimes I worry about the impact of new, top topics. Business headlines are full of reports about the importance of employee engagement (1). It is a significant focus of many national consulting firms—with tools, training, benchmarking and other services to help companies measure and improve engagement levels (2). It is no surprise employee engagement is a hot topic given recent studies. Highly engaged employees are a) more productive, b) absent less, c) less likely to leave, and d) less likely to have an accident or injury.Further, companies with highly engaged employees report better financial results, both revenues and profits. Engagement correlates strongly with positive business outcomes, which catches the attention of executives. Notably, surveys indicate fewer than 30% of all wo... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=1947418 Sun, 09 Nov 2008 05:00:00 +0100 1947418 http://www.medworm.com/index.php?rid=1908896&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2008%2F10%2Fdumbing-down-is-this-what-we-really.html My sympathies to fellow “swing-state” residents who are being bombarded by political ads. By the time this blog is posted, there will—mercifully—be only a week left to endure. For me, it is not just the message volume, abrasive tone, and truth-stretching that wears me down and sends me reaching for the mute button. It’s that we seem to allow and even encourage the polarization and over-simplification of important issues. In political debates, being thoughtful is a sign of weakness; changing course as facts and circumstances evolve is seen as indecision. Even though we know that almost nothing is completely right or completely wrong, we paint issues (and people) as such. Then, after propaganda machines jump on the most frightening, outrageous extremes of an opponent’s position, ... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=1908896 Sun, 26 Oct 2008 04:00:00 +0100 1908896 http://www.medworm.com/index.php?rid=1871067&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2008%2F10%2Fwhy-primary-care-doctors-are-dying.html A True StoryMy coworker’s wife started getting sharp pains across the bridge of her nose and behind her eyes last year. It was uncomfortable and scary. She went to an ENT (ear nose and throat) specialist who suspected a sinus infection. After three rounds of different and progressively stronger antibiotics, a tumor was suspected. When the antibiotics did not solve the problem an inconclusive scope led to a CT scan. When the CT scan did not yield any results, she was directed to a neurologist to have a MRI done. These results did not shed any light either, and the headaches were getting worse, so an invasive procedure was scheduled to investigate what might be happening. Coincidentally, she happened to go to her primary care doctor that week for a check –up.The primary care doctor asked... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=1871067 Sun, 12 Oct 2008 04:00:00 +0100 1871067 http://www.medworm.com/index.php?rid=1837449&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2008%2F09%2Fdont-let-anyone-convince-you-that.html “I was surprised but relieved to get the analytical results from our consultant. Even though the participation rate was very disappointing, the ROI analysis showed we saved money.”I listened to a benefits director explain this. When I expressed some doubt, he pointedly asked “why would they lie?” Although I declined to answer such a touchy question, my mind went to incentives. Perhaps the same consultant recommended the program in the first place and needs to defend his reasoning? Perhaps the benefits director expressed a strong need to justify the money he spent? Perhaps the results weren’t untrue, but more of what my former sales colleague called “showing the truth in its most favorable light.”Since completing doctoral training in evaluation methodology in 1986, it is safe ... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=1837449 Sun, 28 Sep 2008 04:00:00 +0100 1837449 http://www.medworm.com/index.php?rid=1791713&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2008%2F09%2Fwellness-programs-why-other-human.html First, our beliefs:Prevention is powerful and important. Vaccinations and good hygiene protect us from much illness and disease. A person who exercises regularly, maintains a healthy weight, avoids tobacco, and stays mindful of safety (seatbelts, not drinking and driving, etc.) will likely be rewarded with extra years of active, healthy, independent living (1, 2, 3). We own our own health, and our everyday habits and simple preventive measures go a long way in determining our daily and long-term wellbeing.Here at the Foundation, we are not fatalistic, nor do we ignore overwhelming evidence supporting the power of healthy lifestyles. However, we have started to wonder about the best way to encourage those lifestyles. And, in today's business environment it seems important to provide some re... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=1791713 Sun, 14 Sep 2008 04:00:00 +0100 1791713 http://www.medworm.com/index.php?rid=1750363&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2008%2F08%2Fill-designed-consumer-directed-health.html Since their arrival, we have watched as consumer-directed health plans (CDHPs) have been set up to fail. They have been overpriced, underfunded, highly-restricted, unfavorably positioned, tentatively introduced and fraught with administrative barriers. Then, surprise, we hear reports (1) that they seem unpopular. Here at the Health as Human Capital Foundation, we write often about the importance of consumers taking an active role in health decisions. Without consumers asking informed questions, understanding options, and—most importantly—holding the purse strings, there will not be an affordable, high-quality healthcare solution.Those of us who have ventured into the health system as true consumers, asking about price and trying to pay directly, know that consumer-friendly transactions... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=1750363 Sun, 31 Aug 2008 04:00:00 +0100 1750363 http://www.medworm.com/index.php?rid=1711830&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2008%2F08%2Ftethering-unhappy-workers-with-health.html One of my neighbors is in her early sixties. She works part time for a large company, taking calls from customers making travel reservations. She admits that she a) doesn’t really like the work, b) doesn’t respect the company, and c) doesn’t really need the extra income. So why work? “Because I can get health insurance until Medicare kicks in.” She’s counting down: “Only nineteen more months to go!”From my interactions with her, I assume she performs her job politely and capably. However, I can’t help but think that her real feelings about her job and her employer come through in one way or another. Motivation is the charge in a person’s batteries; when low, it’s harder to get started, hard to move fast, hard to keep going. As customers, we sense when a cashier or rec... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=1711830 Sun, 17 Aug 2008 04:00:00 +0100 1711830 http://www.medworm.com/index.php?rid=1677328&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2008%2F08%2Fhow-did-high-priced-questionable.html Not long ago, I attended a charity auction raising money for a small-town hospital. The event included a high-priced charity golf tournament, several social gatherings and an auction. The event was well-attended and quite fun; everyone was excited to rally around a “good cause.”I admit I didn’t really think about the specifics of the charity. I presumed it would provide services for people unable to pay for prenatal care or perhaps screening programs for the community at large. So, I bid happily on some smaller items in the silent auction and watched the fun as wealthy, wine-drinking bidders waged in friendly competition to buy fancy vacations and trips on private jets. Their donations—many thousands of dollars—were helping make the town a better place.Well into the final evening... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=1677328 Sun, 03 Aug 2008 04:00:00 +0100 1677328 http://www.medworm.com/index.php?rid=1640352&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2008%2F07%2Fhow-labels-get-in-way-of-trusting.html One day in 2000 I became overweight. No, the reading on my scale didn’t change, but the definition used by the World Health Organization did (1). Instead of being in the “normal” category (Body Mass Index up to 25.8), I slid just over the boundary (2). Or, more correctly, the boundary slid just below me. In the language of epidemiology, I instantly became “at risk” for several diseases and health events. I wasn’t any different--I already knew I should lose a few pounds--but the label said I was.Of course, it is natural in science (and life) to classify things as good or bad, problematic or not. Plus, defining criteria for “at risk” helps us allocate our resources and attention; it helps us know who to worry about, and when we should pay attention ourselves. But it seems our... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=1640352 Sun, 20 Jul 2008 04:00:00 +0100 1640352 http://www.medworm.com/index.php?rid=1583013&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2008%2F07%2Fcars-medicine-and-businesses-crash.html As regular readers of this blog already know, here at HHCF we examine the interconnectedness among an array of workforce characteristics, corporate policies and practices, and outcomes. These factors all affect each other—absence policies affect health care costs, compensation policies affect prevention rates, management practices affect turnover, and so on. Whether we are talking about the “whole patient” or the “whole workforce,” it is literally impossible to optimize wellbeing one system at a time without considering its context within other systems.In medicine, almost everyone has heard of examples like the following:My friend’s grandmother has multiple health conditions and receives advice and treatment from a variety of providers; the list includes a psychologist (minor d... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=1583013 Sun, 06 Jul 2008 04:00:00 +0100 1583013 http://www.medworm.com/index.php?rid=1536731&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2008%2F06%2Fplacebo-effect-high-prices-and-someone.html Whenever I hear people (especially those who do not work in healthcare industry) exclaim that "America has the best healthcare in the world," I wonder how they formed this opinion. Certainly we have many wonderful medical capabilities, but we also have tremendous challenges.The challenge most people are aware of is cost. But that problem either gets blamed on government—for not providing better access to insurance, or corporations—for being greedy. So, the next comment is often something like: “Medicine is so great, what a shame the costs are so out of control.”In casual conversation, I rarely question a person's generalization, but it is hard not to wonder if most Americans understand their own role in making healthcare expensive.A few specific aspects of our individual roles come... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=1536731 Sun, 22 Jun 2008 04:00:00 +0100 1536731 http://www.medworm.com/index.php?rid=1501497&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2008%2F06%2Fpaying-workers-for-time-spent-not.html I have a friend who holds a director-level position for a government agency. Recently, she reached her maximum limit for time off that can be rolled over; so in order to avoid losing days she “must” take two days per month, plus her usual vacation time. While admitting that she neither needs nor wants that many days away, and knowing her department runs better when she is there, she is hesitant to forfeit this portion of her total compensation. And with no option available to convert time off to money, foregoing time off is forfeiting pay. Is this the choice workers should be forced to make?Most organizations buy into the idea that policies should reward good workers, and that corporate success should align with employee success. But is this idea reflected in the time-off policies of m... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=1501497 Sun, 08 Jun 2008 04:00:00 +0100 1501497 http://www.medworm.com/index.php?rid=1469989&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2008%2F05%2Fmoney-matters-what-do-skinny-people-in.html Discussion Paper no. 1287-04, 2004,2. Drewnowski, A., C. D. Rehm, and D. Solet. "Disparities in Obesity Rates: Analysis by ZIP Code Area." Soc Sci Med 65, no. 12 (2007): 2458-63.3. Flint, A. J., and T. E. Novotny. "Poverty Status and Cigarette Smoking Prevalence and Cessation in the United States, 1983-1993: the Independent Risk of Being Poor." Tob Control 6, no. 1 (1997): 14-8.Footnote*A technique called CHAID (Chi squared Automated Interaction Detector)not only examines what factors are significant, but which ones account for the greatest difference in likelihood. (Source: Health as Human Capital - Illustrated Research Summaries) Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=1469989 Mon, 26 May 2008 04:00:00 +0100 1469989 http://www.medworm.com/index.php?rid=1434587&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2008%2F05%2Fno-we-havent-given-market-solutions-in.html In this political season, we each have our positions. When it comes to choosing a candidate, or even a political party, for better or worse, all issues get combined into one big package (foreign policy+ science+ religion+ education+ healthcare+ sound bites+ everything). Voters align with a person or party who supports their most important issues, and accept (or tolerate) the rest.While we like to think of one party (ours!) as right and one as wrong, if we were honest, we would probably admit that the “other guy” can have some ideas worth considering. Too often we simply nod in passive agreement with our general package, and reject all components of the other.It is in this context that I watched the evening news, where the topic was presidential positions about the healthcare problem. O... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=1434587 Sun, 11 May 2008 04:00:00 +0100 1434587 http://www.medworm.com/index.php?rid=1402379&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2008%2F04%2Fin-end-we-all-have-costly-choices-to.html “America is the only country where people don’t believe that the death rate is one per-person.”A former colleague of mine used this line to get a laugh, and make a point (1). We do seem to characterize death as something we can avoid, delay and overcome, rather than as our inevitable, natural fate. Whether we say it or not, our society considers death an adversary against which we must never stop fighting. To stop fighting means death wins and we fail.Recently, several of us discussed the often difficult choices that accompany treatments for late-stage cancer. I mentioned that—if ever faced with that choice—I might choose not to undergo the very difficult procedure known as auto-bone marrow transplant. My reasoning? The procedure is extremely difficult, not as effective as once t... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=1402379 Sun, 27 Apr 2008 04:00:00 +0100 1402379 http://www.medworm.com/index.php?rid=1369742&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2008%2F04%2Fcost-problem-why-other-high-tech.html Technologies advance. Products and services improve. When they do, consumer expectations also change to demand more for a better price. These days if our phones do not include thousands of wireless minutes AND a camera, a calendar, email, media players, an alarm clock, instant messaging, blue tooth connectivity, speaker phone, games, a calculator, maps of the entire globe, and an internet browser, we think it is an inferior product. Oh, and all those features come in a smaller size and a lower price than any of the phones or calculators or CD players we bought just five years ago. Like technologies, services also change in value. Not more than a decade ago most people still went to a travel agent to book airline tickets. When it became convenient, feasible, and less costly to book tickets ... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=1369742 Sun, 13 Apr 2008 04:00:00 +0100 1369742 http://www.medworm.com/index.php?rid=1337079&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2008%2F03%2Fcage-cliff-and-letting-healthcare.html This study demonstrates consumers’ ability to make sound personal decisions regarding health and necessary care. The result was more efficient use of healthcare, lower personal cost, and none of the often-feared dire consequences.Economic incentives are a powerful tool in helping consumers make value-based decisions. When someone else pays the bill, consumers have little incentive to distinguish among providers or to use the healthcare system efficiently.References1. Wharam, J. F., B. E. Landon, A. A. Galbraith, K. P. Kleinman, S. B. Soumerai, and D. Ross-Degnan. "Emergency Department Use and Subsequent Hospitalizations Among Members of a High-Deductible Health Plan." JAMA 297, no. 10 (2007): 1093-102. (Source: Health as Human Capital - Illustrated Research Summaries) Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=1337079 Sun, 30 Mar 2008 04:00:00 +0100 1337079 http://www.medworm.com/index.php?rid=1306086&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2008%2F03%2Fwhen-did-anything-abnormal-become.html When I was a child, my family often told a funny story about my grandfather. In the 1920s he was screened by an eye doctor and found to have better than 20:10 vision. Instead of celebrating, the doctor prescribed glasses to “correct” his vision to a normal 20:20 level, which would be “easier on his eyes.” Apparently, it was believed that seeing too well might he harmful in the long run. As the story goes, he got the glasses, but chose not to wear them. We all laughed at how unsophisticated medicine was in the “old days” when doctors didn’t know better. Certainly, with all the technology and medical advancements of today, we wouldn’t treat something just because it wasn’t normal, would we?A disease classification for everyday life.Oddly enough, last month psychologists pub... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=1306086 Sun, 16 Mar 2008 04:00:00 +0100 1306086 http://www.medworm.com/index.php?rid=1271889&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2008%2F03%2Fif-we-only-consider-one-possible-cause.html Here is a comparison of medical costs for two different companies. Company #2 workers are 84% more costly. Can you guess why? Does Company #2 have older workers? Do they have more chronic illness? Do they live in a geographic region with higher rates of obesity or smoking?No, no, and no.In fact, these two groups are as identical as we could make them in our modeling: same type of workers, same age, same gender, same job, same salary. So, why is there a difference in costs? (We give you the answer later.)Costs and HealthMore than once per week I discuss medical or disability costs with someone who works in health promotion or human resources. Invariably, I’m told that the explanation for medical costs is health status. If we are discussing a group with low costs, they credit health improv... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=1271889 Sun, 02 Mar 2008 05:00:00 +0100 1271889 http://www.medworm.com/index.php?rid=1237788&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2008%2F02%2Fits-not-more-medical-tests-we-should-be.html At least once a month, I hear about or receive a pass-along email regarding a medical test someone is “fighting for.” An advocacy group may be demanding a legislative mandate to have insurance cover their issue, or a patient fighting to have his insurance company approve payment for a specific procedure in a unique situation. Almost always, the story tells of a vulnerable individual in the clutches of a profit-hungry business, and uses strong emotional appeal to incite fear in readers who wouldn’t want such a thing to happen to them. But we rarely hear the other side of the argument. Adding more tests adds to the total cost of insurance, which has become increasingly more cost-prohibitive in recent years. So, it would be wise to add things that add clear value and minimal risk. The p... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=1237788 Sun, 17 Feb 2008 05:00:00 +0100 1237788 http://www.medworm.com/index.php?rid=1198062&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2008%2F02%2Ftaking-mother-may-i-out-of-employment.html Can I get surgery? What about more time off? Can I have dental work? What about better life insurance? Can I?How often do we think that payment rules govern our permission to do what we want? “I can’t X, because my Y won’t pay for it.”For X, substitute “get a procedure,” “take time off,” “use a specific vendor,” or “buy a particular product.”For Y, substitute “my company”, “my health insurance,” “my employer,” or “my pharmacy plan.”More than we realize, employment and health insurance arrangements are just business agreements about payments. Too often, our society mistakes payment rules for permission to make personal decisions. Here are a few common scenarios: 1) My friend had a pharmacy benefit as a part of his company’s health insurance plan. ... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=1198062 Sun, 03 Feb 2008 05:00:00 +0100 1198062 http://www.medworm.com/index.php?rid=1165385&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2008%2F01%2Faligning-incentives-what-do-bonuses.html Five years ago, if a benefits manager told me he had a low rate of short-term disability at his company, I would have responded: “Great! What sorts of health improvement programs do you have?”Today, that’s definitely not the question I would ask. What have I learned in the last few years?Regular readers of this blog know we are great believers in the power of incentives. Other things being equal, a person will choose options that produce the greatest personal benefit.Often, when we mention “incentives,” readers from human resources and health industries think we are referring to specific rewards for specific behaviors (e.g., being paid $100 for completing a health assessment). While this is certainly one type of economic incentive, our definition is much broader. Incentives can i... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=1165385 Sun, 20 Jan 2008 05:00:00 +0100 1165385 http://www.medworm.com/index.php?rid=1132214&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2008%2F01%2Fmotorcycle-riding-sky-diving-and.html I met someone last week who was quitting his job after 15 years. The company he worked for was acquired by another firm that had very different rules of conduct for its employees. The new company instituted very detailed guidelines about attire (all shoes must have laces), workspace (no food or drink at the desk), and behavior (no leaning on the side of desks—yes, an actual rule). Further, their health insurance policy had exclusions for items that the executives considered unwise: no coverage for treatments resulting from motorcycle accidents, sky-diving, or sexually-transmitted diseases.Can companies do that? Certainly, when they’re paying. Whoever pays for insurance can decide what type of treatments will and won’t be covered by their insurance policy. Whenever we allow a third pa... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=1132214 Sun, 06 Jan 2008 05:00:00 +0100 1132214 http://www.medworm.com/index.php?rid=1097757&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2007%2F12%2Fhospital-infection-rates-secret-that.html The Centers For Disease Control (CDC) estimates that in 2002, 1.7 million patients acquired an infection in U.S. hospitals and about 100,000 died as a result.(1) On average, one in every 22 hospital admissions will result in an infection, which means in facilities with the highest rates the incidence is even higher (1). More worrisome, the rate of a “superbug” called methicillin-resistant Staphylococcus aureus (MRSA)*, is increasing in hospitals (2), where over 75% of equipment (such as blood pressure cuffs) in inpatient rooms tested have the resistant bacteria (3). In all, the Committee to Reduce Infection Deaths (RID) estimates that infections add an additional $30.5 billion to the cost of healthcare in our country (3).Almost all healthcare-associated infections are avoidable with ap... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=1097757 Sun, 16 Dec 2007 05:00:00 +0100 1097757 http://www.medworm.com/index.php?rid=1064931&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2007%2F12%2Fpto-banks-and-health-savings-accounts.html Our Health as Human Capital philosophy focuses on aligning economic incentives in ways that reward employees for high performance, good health and attendance at work.By implementing a balance of shared economic rewards and responsibilities, companies and employees have the same goals: be productive and stay healthy. This means an ideal work environment that offers meaningful, performance-based bonuses, as well as benefits that share economic responsibility for the positive and negative consequences of personal health.What do we mean by SHARE rewards and responsibilities? It means that a person GAINS something by NOT using the benefit and GIVES UP something when they use the benefit.It is not surprising that employers report that the two most effective absence management strategies are: pai... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=1064931 Sun, 02 Dec 2007 05:00:00 +0100 1064931 http://www.medworm.com/index.php?rid=1034891&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2007%2F11%2Fwhich-conditions-do-we-spend-most-money.html In a recent meeting among human resources professionals from large companies, the discussion turned to the types of health conditions that contribute to total spending. Several in the group assumed that severe conditions account for the majority of costs in a population of employees and their families. Actually, no. While it is a common assumption that serious illnesses (the “outliers”) contribute the most to costs, in fact spending has more to do with the prevalence of an illness than its severityThis surprising fact has implications when policy-makers think about solutions to our health care problems. If common issues contribute most to costs, perhaps there are signifcant opportunities in the ways we prevent and manage those issues.So which conditions really drive cost by virtue of b... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=1034891 Sun, 18 Nov 2007 05:00:00 +0100 1034891 http://www.medworm.com/index.php?rid=1002852&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2007%2F11%2Fusing-stockbrokers-or-healthcare.html A quick quiz: Look at the graph to the right and guess what characteristic results in Group 2 getting three to seven times more MRI and Ultrasound tests than Group 1. Are those people older, sicker, poorer, more rural, or higher risk?To get the answer, read on. Hint: none of the mentioned factors is the reasonSometime we need supportAs consumers, when we have assets to protect, we often want advice from experts. We seek someone who will be on our side, someone whose goals are aligned with ours. In a practical sense, we can tell if their goals align with our goals by how much we both gain from the transaction.Financial AssetsThe first couple of times I invested money in stocks and mutual funds, I didn’t understand how the brokers made their living. I went to brokers recommended by friends... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=1002852 Sun, 04 Nov 2007 04:00:00 +0100 1002852 http://www.medworm.com/index.php?rid=966977&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2007%2F10%2Fplease-dont-complicate-things-with-new.html Sometimes we would rather not hear that our usual way of thinking is insufficient or incorrect. It is easier and more comfortable to stay put than to change.A medical exampleIt is now known that most ulcers are caused by a type of bacteria called Heliobacter Pylori, the discovery of which won the 2005 Nobel Prize (1). Before the 1980s, it was well-accepted that a) ulcers were the result of lifestyle factors – such as stress, alcohol, and spicy food, and b) bacteria could not live in the acidic environment of the stomach. With that understanding of cause, the standard way to treat an ulcer was to control the level of acid produced by the body. When word came of a bacterial cause, it forced a difficult change in thinking for doctors and patients alike.Believe it or not, patients and doctor... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=966977 Sun, 21 Oct 2007 04:00:00 +0100 966977 http://www.medworm.com/index.php?rid=933223&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2007%2F10%2Fwhile-everyone-argues-whether.html Our rational alternative to current healthcare proposals. We would propose that if the focus of healthcare reform first acknowledged some basic truths currently not heard in the healthcare debate, it may be possible for true reform:· It’s your money.· Having health insurance is not the same as having healthcare.· Our healthcare options are not limited to “red” or “blue.”· You can do more to protect your health than anyone else can.First, we will explain why these matter, and then we will propose a rational alternative.1. It’s your money.Whether Uncle Sam or corporate execs pay the bill, it’s still your money.Corporations pay with workers’ wages, and government pays with citizens’ taxes. In either case, we pay. Think of it this way: from each pay check, we take some ha... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=933223 Sun, 07 Oct 2007 04:00:00 +0100 933223 http://www.medworm.com/index.php?rid=896821&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2007%2F09%2Fin-case-you-hadnt-noticed-pandora-went.html Question: Is it irresponsible to encourage consumers to jump into the ocean of health information?Answer: Too late, consumers started swimming years ago.While some would like to debate whether consumers should be encouraged to investigate and make their own health decisions, we contend that the discussion is moot; consumers navigate oceans of information everyday. Even for those who fear it’s a Pandora’s Box with potential for more harm than good, it’s too late to take it back.Let’s consider the size of the information ocean today:Over seven million new pages of information appear on the World Wide Web each day (1).There are over 61,000 scholarly/academic journals in print in the U.S. alone (2).We broadcast 132 million hours of television and 320 million hours of radio programming ... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=896821 Mon, 24 Sep 2007 04:00:00 +0100 896821 http://www.medworm.com/index.php?rid=853741&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2007%2F09%2Fmedical-service-coding-and-billing.html Corporations often use health claims data to describe and understand the important health issues faced by their workforce. But medical services coding and billing have a business purpose: how doctors and hospitals get paid. We also recognize that claims data are powerful indicators of how reimbursement policies affect consumer and provider behavior. Depending on who pays, and what is paid for, the behavior of both consumers and providers changes, regardless of the actual health issues being treated.My first lesson on this subject came during a review of health claims data for a large company in the early 1990s. Our analysis revealed that the most expensive service (in total cost) for the entire population was an obscure code labeled “other ill-defined dislocations of the cervical vertebr... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=853741 Sun, 09 Sep 2007 04:00:00 +0100 853741 http://www.medworm.com/index.php?rid=823061&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2007%2F08%2Fgetting-value-from-health-benefits-use.html Sometimes people object to our position that when a third party pays for health benefits, individuals tend to consume more. But it’s true: misaligned economic incentives increase the cost and reduce the quality of care. Because of this, we believe consumers should be more aware of the cost of health care, and pay more (and directly for) their health benefits. As true consumers (who pay rather than having a third-party pay), people become more engaged in purchase decisions – with incentive to improve both the quality and cost-effectiveness of those decisions.Protestations we hear usually involve such statements as: “no one would choose to be sick (have surgery/be injured) if they do not have to” or “making health issues about money is blaming the victim,” or “you imply that an... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=823061 Sun, 26 Aug 2007 04:00:00 +0100 823061 http://www.medworm.com/index.php?rid=794252&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2007%2F08%2Fstatistics-help-but-only-you-can-decide.html There’s been much in the news this summer confirming that virtually no medical treatment or drug comes without risk. A few that caught our attention:1) A study reports that children who take Ritalin for Attention Deficit Hyperactivity Disorder (ADHD) will not grow as quickly as other children, averaging a height one inch shorter than similar children not taking the medication (1).2) Amid controversy, a review panel recommended to the Food and Drug Administration (FDA) to keep a diabetes drug on the market even though it increases the rate of heart disease. Their reviewers believed that in some cases the benefits may outweigh the risk (2). 3) Reviewers for the FDA recommended against U.S. release of a new medication to target obesity and cardiometabolic syndrome because of increased risk ... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=794252 Sun, 12 Aug 2007 04:00:00 +0100 794252 http://www.medworm.com/index.php?rid=767677&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2007%2F07%2Fgood-intentions-curse-of-3.html Joke:Q: How many (Chicago School) economists does it take to change a light bulb? A: None. If the light bulb needed changing the market would have already done it.Here at the Health as Human Capital Foundation, we believe that market forces are powerful and useful. Perhaps market forces can’t actually replace a light bulb, but they do provide an essential rationality to consumption of goods and services. Consumers vote with their pocketbooks. If price increases, consumers purchase less. If a lower-cost alternative appears, some consumers switch brands. Markets, without external constraints, find a dynamic equilibrium that responds to changes in supply and demand.In “efficient” markets (ones where prices and supply are not artificially too high or too low) consumer and suppliers engag... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=767677 Mon, 30 Jul 2007 04:00:00 +0100 767677 http://www.medworm.com/index.php?rid=735576&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2007%2F07%2Fgetting-paid-more-for-doing-worseonly.html Imagine paying your lawyer more for losing a case than winning it. Imagine paying your realtor a higher commission for not selling your house than he or she might earn when it sells. Imagine returning a new bicycle that doesn’t work and being charged extra for its flaws. Such a system would seem objectionable, unfair, and perhaps even criminal.Yet, that is essentially how the medical payment system works.If you enter a hospital to have a procedure, the hospital charges one fee. But if you experience complications, need to stay longer, or need to return to repair a problem, the hospital will receive higher fees. The “fee-for-service” (FFS) system is pay-as-you-go, offers no refunds, and allows no discounts for poor quality (although health plans do get discounts based on quantity). Ho... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=735576 Sun, 15 Jul 2007 04:00:00 +0100 735576 http://www.medworm.com/index.php?rid=707691&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2007%2F07%2Fwhat-would-goldilocks-say-about-health.html Rarely are we “just right.”Many discussions about our nation’s health care crisis focus on substantial numbers of uninsured people and their lack of access to health services. We worry about those who do not receive sufficient care. Rarely do we hear about services that happen too much.Some might claim that there is no such thing as “too much” care. Or that a bit too much would be hard to find objectionable—like being too clean, or too careful. Isn’t more care always better? Or, like Goldilocks, should we all be seeking an amount of healthcare that is just right for us?According to many statistics, Goldilocks was on to something. There are convincing indications that Americans often get too many health care services. Perhaps the most convincing data come from the Dartmouth At... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=707691 Sun, 01 Jul 2007 04:00:00 +0100 707691 http://www.medworm.com/index.php?rid=688753&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2007%2F06%2Fthere-are-wellness-incentives-and-then.html Anyone who has implemented wellness programs knows that offering cash and prizes can increase participation. It has become commonplace to offer money or premium discounts to employees to encourage participation in questionnaires and behavior change programs. While we wish everyone would WANT to participate without a financial carrot, most employees seem to need a little extra encouragement.Interestingly, the presence or absence of a wellness incentive is not universally predictive of participation. Some companies can achieve a 63% response rate with NO incentive (1), while others might only achieve a 5%-10% participation rate with a modest incentive. These differences must be explained by something other than offering a specific carrot for a specific action.In the Health as Human Capital P... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=688753 Sun, 17 Jun 2007 04:00:00 +0100 688753 http://www.medworm.com/index.php?rid=688754&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2007%2F06%2Fonline-rx-shopping-trip-shows-that.html How much of a difference in price would you find if you were to actually shop for health care?People with insurance and a low deductible have little incentive to compare prices for health care services. Take medications as an example. If there is a relatively small co-payment on medications, or a differential of $10 to $25 on brand-name versus generic medication, why spend much time comparing? Even if we do find an inexpensive alternative, some health plans limit their coverage to “approved” pharmacies—further discouraging efforts to save money. Because most of us do not think of shopping, we may assume that the price difference would be minimal. Think again.Because of controversy about the legality and authenticity of medications obtained from sources outside the U.S., we limit comp... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=688754 Sun, 03 Jun 2007 04:00:00 +0100 688754 http://www.medworm.com/index.php?rid=688755&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2007%2F05%2Femployee-health-problems-are-not.html At a recent talk, I asked the audience a question. “True or false, employee health problems are the number one cause of lost productivity?” The vast majority answered “true.” Where did they get this impression? And is it correct?The past six years of productivity research have emphasized the impact of health problems (1-10). Numerous studies have quantified the effects of health issues on worker productivity. Across most workforces, health problems produce significant decreases in productivity. Comparing the effects of different diseases, researchers find that chronic conditions—especially those that produce noticeable discomfort (pain, fatigue, trouble concentrating) and affect a significant number of people—tend to generate a significant amount of lost work time. We all know ... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=688755 Sun, 20 May 2007 04:00:00 +0100 688755 http://www.medworm.com/index.php?rid=688756&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2007%2F05%2Ffor-bodies-or-dream-houses-inhabitants.html Suppose you’re ready to build a dream house, and you hire some highly skilled craftsmen to direct the different parts of the project. Each expert has a plan—one for plumbing, one for electricity, one for windows—and a credit card you provide to buy supplies. Then imagine that there is no master plan, no complete blue print, no work coordination, and no central account in which you can check the spending balance. Perhaps you find that things aren’t going well, and you need different expertise. So you invite new independent workers (roofers, cabinet-makers and carpenters) to the project and add their costs. But still there is no comprehensive view of overall progress, quality or cost.Of course, no one would build a house this way. At the very least, the process would be inefficient. ... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=688756 Sun, 06 May 2007 04:00:00 +0100 688756 http://www.medworm.com/index.php?rid=688757&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2007%2F04%2Fpatient-costs-should-and-do-matter-in.html This article suggests that BECAUSE doctors ignore cost to the patient the system should not ask patients to share costs. However, economic theory would suggest the reverse: by asking patients to have active control of healthcare spending, they would, in turn, ask doctors to consider costs more often.Thus, we would suggest a completely opposite course of action—put more economic responsibility on patients, so that they become active participants in care decisions. Patients are the true purchasers, who deserve transparency in the quality and price of their options. Perpetuating a belief system that implies that doctors have sole responsibility for choosing “90% of all services” that patients receive moves us further away from, rather than closer to, the levels of transparency and parti... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=688757 Sun, 22 Apr 2007 04:00:00 +0100 688757 http://www.medworm.com/index.php?rid=688758&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2007%2F04%2Fbig-screen-tvs-crack-cocaine-and-wolves.html In the last blog entry we discussed an alternative for how health care could be purchased in the U.S.—provide funds directly to individuals (rather than government or employer-sponsored insurance) and let them create a competitive market with their individual healthcare choices. These funds could come in the form of higher wages or accounts designated specifically for healthcare expenses.This suggestion often provokes some doubt. Despite our acceptance of individual participation in choices for virtually every market of life-necessities—housing, food, clothing, transportation, financial investing, etc.—the same does not apply to health care.Negative reactions usually reflect a preference for providing health services to individuals rather than money. Statements also reflect a judgmen... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=688758 Sun, 08 Apr 2007 04:00:00 +0100 688758 http://www.medworm.com/index.php?rid=688759&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2007%2F03%2Foption-rarely-mentioned-in-current.html Recent pre-election political discussions have featured significant debate about who should pay for healthcare. Imbedded in these debates are strong beliefs about who should bear responsibility for the cost of health services. First, it is important to differentiate healthcare from health insurance. While the terms are used interchangeably, one refers to services, and the other refers to a system that defines and pays for a set of specified services. The usual debate focuses on insurance (who will pay for what we deliver now), rather than how to alter care delivery to improve its value. As such, this blog discusses arguments about who pays.Recently, proposals in politics and the media focus on one of two options: universal health insurance provided by government, or private insurance cover... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=688759 Sun, 25 Mar 2007 04:00:00 +0100 688759 http://www.medworm.com/index.php?rid=688760&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2007%2F03%2Fimportance-of-human-capital-as-national.html We have all heard it: Social Security and Medicare are in big trouble. Perhaps huge trouble.The latest projections* by the U.S. treasury department indicate that ten years from now, in 2017, we will be taking more money OUT of the fund that pays Social Security than we put in—for the first time since it was created in 1935. The yearly deficit for Social Security will increase steadily, and by 2041 the fund will be empty. Medicare funds will run out sooner, in 2020.Our current financial commitments to these two programs are immense. With no changes, costs are estimated to grow to almost 20% of GDP, with a projected shortfall of over $35 trillion between now and 2080. Unless things change significantly, the country in which our next generation lives and works could collapse under the weigh... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=688760 Sun, 11 Mar 2007 05:00:00 +0100 688760 http://www.medworm.com/index.php?rid=688761&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2007%2F02%2Fhow-does-compliance-affect-costs-well.html Regular readers of this blog know that we have discussed how:· Most people have low medical costs in a given year;· Averages can be misleading;· Illnesses are episodic; and· People with high costs this year are likely NOT to be as expensive next year.All these findings have implications about medical treatments or interventions. One often hears a general statement that high rates of medical compliance with recommended medications result in lower future health costs.* As a generalization, this is probably correct to state that, on average, people of similar characteristics and severity of illness will have lower costs when their illness is better controlled than when it is not. Many chronic diseases can be managed well with adherence to medication and a healthy lifestyle. Thus, we hear ... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=688761 Sun, 25 Feb 2007 05:00:00 +0100 688761 http://www.medworm.com/index.php?rid=688763&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2007%2F02%2Fcant-buy-me-health-entry-4-2007.html “The reality is: you can’t buy your health. You already own it. It’s yours, not someone else’s to sell to you.”My colleague, Hank Gardner, M.D., made this statement a few weeks ago. The conversation stuck with me because it expressed some complex issues quite succinctly. Health is one form of human capital, and like all forms of human capital, it is not traded in the marketplace. Just as you cannot increase your knowledge without a commitment of your own time and effort, you cannot increase your health without being personally involved in that effort. While simple, the concept that good health cannot be purchased has profound and important implications. I will list a few that have occurred to me.1. We have the greatest influence on our own healthOver a lifetime, our own behaviors... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=688763 Sun, 11 Feb 2007 05:00:00 +0100 688763 http://www.medworm.com/index.php?rid=688762&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2007%2F01%2Fwhen-most-expensive-option-isnt-best.html We often hear people express how the health care Americans receive is the “best” in the world. For those who have health insurance, the level of technology and types of intervention available is amazing.Today we can detect and “fix” problems that were a mystery a generation ago. Surgeons can operate from thousands of miles away using robotics, women in their sixties can bear children, genetic abnormalities can be detected before birth, devices can be implanted to do everything from medication delivery, to heart rhythm regulation, to diagnostic photography. Evening news programs frequently feature new technologies and treatments that have saved lives using recent scientific advancements. In short, we are proud of our medical miracles.Perhaps it is this pride, or our desire to have e... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=688762 Sun, 28 Jan 2007 05:00:00 +0100 688762 http://www.medworm.com/index.php?rid=688764&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2007%2F01%2Freminder-that-everything-is-tradeoff.html According to the Bureau of Labor Statistics (1) average total compensation for workers in private industry in the 3rd quarter of 2006 was $25.52 per hour. If we apply this to full-time workers (and assume 40 hour weeks and 48 weeks of work = 1920 hours), this is a total package of almost $49,000 per year. Of this, $34,640 was salary and $14,361 was benefits ($3,380 of which is for health care). These numbers are not truly averages, because they represent all workers (including part time) and many workers who are not eligible for or do not select certain types of benefits. But, in aggregate, this is the picture of employer spending in the U.S.Over the past two years, total compensation in private industry has increased from $23.29 to $25.52 per hour. But employer costs for benefits have inc... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=688764 Mon, 15 Jan 2007 05:00:00 +0100 688764 http://www.medworm.com/index.php?rid=688765&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2007%2F01%2Fillness-is-about-likelihood-not.html Recently, some accomplished health researchers challenged our findings regarding how much individuals’ health care costs change from year to year. We were showing that the vast majority of expensive people become less expensive the following year. (For a similar graph, see our earlier blog on episodic illness.) The researchers insisted that our findings must be incorrect—everyone knows that chronically ill people get progressively sicker and more expensive over time. Many studies comparing average costs for groups of people prove their case.Although paradoxical, both perspectives are correct.Most health issues make a person more likely, but not certain, to have a serious (i.e. expensive) event. I learned this lesson early in my career from a set of studies published in 1991 and 1992 (1... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=688765 Mon, 01 Jan 2007 05:00:00 +0100 688765 http://www.medworm.com/index.php?rid=688766&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2006%2F12%2Four-people-are-our-greatest-assetbut-no_17.html A key element in the Health as Human Capital paradigm is a clear employment contract. In this contract, an employer and an employee agree that a day’s pay will be provided in return for a day’s work. In a perfectly efficient employment market, each worker would be paid the value of his work, and would contribute work effort equivalent to his pay. However, in most organizations, employers pay people based generally on time at work—not based on productivity or output—with a set salary or an hourly rate.The practice of paying people to “be there,” rather than paying people by the amount of work they do, began in the industrial era. Factories needed a steady shift of workers on the assembly line and it became important to fill positions at all times. Also, in this new, complex, tea... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=688766 Sun, 17 Dec 2006 05:00:00 +0100 688766 http://www.medworm.com/index.php?rid=688771&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2006%2F12%2Fit-would-be-so-much-easier-if-there.html In a recent conversation about health care, it became clear that the person I was speaking with, “Bob”, (who does not work in a health-related field) was asking me to name “the villain.” He wanted a clear enemy to blame for the health care mess. Surely, he implied, one entity is MOST at fault for high prices, less-than-ideal quality, and lack of access. Bob wanted someone held responsible, someone at which he could direct his frustration.My realization that Bob (and probably most of us) wanted our problem to be someone’s fault got me thinking about all of our blame-assigning options. If we look for the culpable party, there are many to choose from. For starters, it would be easy to point fingers (and many do) at greedy capitalists. Many of the largest U.S. health plans and pharma... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=688771 Mon, 04 Dec 2006 05:00:00 +0100 688771 http://www.medworm.com/index.php?rid=688772&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2006%2F11%2Fwhy-dont-high-deductible-health-plans.html We saw in the last entry that high-deductible health plans (HDHPs) are priced at a level that is neither attractive to the consumer, nor encourages significant deposits by employers into health savings accounts.This may seem illogical.Why can’t we just shift the money from the premium to the deductible and call it even? Well, that’s not how insurance works.The REAL risk in health care is the possibility of something very expensive happening.If we rank order a group of employees from lowest to highest health care spending and divide them into ten equal groups of people, we see how uneven the spending really is. The top 10% of a sample group of employees account for about 70% of costs. The top 5% spend almost half of all the health care dollars.* Thus, for about 90% of the consumers in t... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=688772 Sun, 19 Nov 2006 05:00:00 +0100 688772 http://www.medworm.com/index.php?rid=688773&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2006%2F11%2Fproof-that-consumers-can-and-do-make.html We find irony in some recent suggestions that “consumer” plans are not gaining traction. Some argue that consumers are not capable of making wise choices based on financial parameters. In truth, consumers have been doing exactly that. We have witnessed several large employers offer a high-deductible health plan (HDHP) in combination with savings accounts (either HSAs or HRAs). When this HDHP-savings combination is offered as one option among more traditional plans, very few employees have signed up. Skeptics might conclude that these plans are too complicated or risky to be desirable. Or, perhaps they would think HDHPs are just a bad idea. Another explanation—ironically—demonstrates consumers are making a logical choice. In examples from HCMS datasets, HDHP premium contributions f... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=688773 Sun, 12 Nov 2006 05:00:00 +0100 688773 http://www.medworm.com/index.php?rid=688768&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2006%2F10%2Fhealth-as-human-capital-how-is-this.html The Health as Human Capital paradigm (1) is not just another label on the same-old solutions. Some people assume that it a re-packaging of “total cost management” or “health and productivity management.” Not so.It begins with this simple concept: health is one of three important assets that a person brings to his or her job (as well as to family and community). Health, like skills and motivation, belongs to the individual and is influenced by individual choices. Better health allows us to earn a better living. Having the capacity to function well, mentally and physically, with high energy and few limitations, improves the quality of life, the productivity of work, and the pleasure of leisure. Health is one of our most precious personal resources.Because it is inherently ours, no on... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=688768 Sun, 29 Oct 2006 04:00:00 +0100 688768 http://www.medworm.com/index.php?rid=688775&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2006%2F10%2Fits-more-important-to-understand.html We saw in entry 20 that, among a group of people, having a specific health condition is not a strong predictor of who will be expensive in the future. Instead, having many different health issues predicts future high medical expense costs better than any specific health condition. Hence, our position is that outside the treatment a patient receives directly from his or her provider, add-on disease-focused programs are an inefficient, and perhaps counterproductive, method of managing health care expenditures.In this entry we extend this topic to include broader human capital concepts. We don’t question whether medical care for specific diseases can and should improve.** However, the broader view—beyond the narrow, clinical realm of medicine—recognizes that illness always occurs within... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=688775 Mon, 16 Oct 2006 04:00:00 +0100 688775 http://www.medworm.com/index.php?rid=688774&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2006%2F10%2Fshould-we-really-be-focusing-on.html Recently I was asked, “so if you were to advise a group of employers about what disease to pick next as a focus for disease management, what disease would you tell us to pick?” My answer: I would tell you not to pick one, because single diseases are not the most useful way for employers to address the cost problem. In a future entry we’ll address other factors surrounding a person with an illness. Today’s entry will focus on the mathematics of cost for single and multiple diseases. We will explain health care utilization using the Agency for Healthcare Research and Quality (AHRQ) disease classification system, which categorizes medical claims data into 261 different disease categories. While there are thousands of diseases, this standardized classification system makes them more ma... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=688774 Mon, 02 Oct 2006 04:00:00 +0100 688774 http://www.medworm.com/index.php?rid=688776&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2006%2F09%2Fnew-white-paper.html We often post detailed research findings in this blog, illustrating a narrow concept within the Health as Human Capital approach. However, the blog format is not conducive to longer discussions, so readers (and writers) may lose sight of the bigger picture.To remind ourselves we have posted a new white paper on the front page of the foundation website. In it, we present our philosophy about aligning incentives in the workplace. Our belief is that when workers believe that their human capital is valued and that good performance will be rewarded, they will also value their own health more. As such, lower health costs may be a side effect of aligned compensation and time-off policies, as much as an indicator of good health status.The paper is called: A Hierarchy of Aligned Incentives: Health... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=688776 Mon, 25 Sep 2006 04:00:00 +0100 688776 http://www.medworm.com/index.php?rid=688777&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2006%2F09%2Fhoping-for-absolutes-in-subjective.html In a perfectly objective world, one would be able to define diagnoses, health status and functionality in absolute terms: afflicted or not, ill or well, able or unable. But in many instances, neither medical science nor human experience allows such straightforward classifications. We may not know what is wrong or what our prognosis might be. Plus, recovery from illness or injury usually includes diversions and setbacks rather than smooth, linear improvement. Thus, there is often no single, clear, identifiable point along the line between ill and well, or able and unable, that we can point to with certainty and say “now, I am better enough” to return to my usual activities.It is within this realm of uncertainty that companies apply health benefits policies. Disability insurance covers s... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=688777 Sun, 17 Sep 2006 04:00:00 +0100 688777 http://www.medworm.com/index.php?rid=688767&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2006%2F04%2Fhealth-care-price-and-quality.html One goal of consumer-centric health strategies is to engage users in a true health care marketplace. Instead of simply using care, consumers would investigate, shop, compare, and choose their care based on information—the same way consumers choose most goods and services.A shift toward true consumerism will require two behavioral drivers. First, and most important, consumers must spend their own money on care. Meaning that what is NOT spent is, and remains, their money. [For a reminder about spending my money versus someone else’s money, see Blog Entry 4 from 2005.] Second, consumers must have sufficient information about price and quality to make sound decisions. Even without information, early results suggest that consumers try to find less expensive treatment alternatives. However, ... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=688767 Mon, 03 Apr 2006 04:00:00 +0100 688767 http://www.medworm.com/index.php?rid=688769&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2005%2F11%2Fwhat-mean-does-and-doesnt-meanwhen.html According to the Kaiser Family Foundation Annual Survey the average cost of employer-sponsored health care in 2005 was $4,024 per individual employee. The average for family coverage was $10,880 – leading to an overall average of about $7,000 for each employed person. These are daunting numbers, but what do they really represent? For things like health care costs, the average is not really a helpful description of the true pattern of spending across a population.From an accounting perspective, an employer uses the average to understand total spending on benefits, by converting total spending to one per-employee amount. For some things, the average is a reasonable indication of what is typical in most cases. For example, things like weather (daily temperature) or human characteristics (he... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=688769 Mon, 21 Nov 2005 05:00:00 +0100 688769 http://www.medworm.com/index.php?rid=688770&cid=s_35748_51_f&fid=35748&url=http%3A%2F%2Fhhcf.blogspot.com%2F2005%2F10%2Fdo-anticipated-health-events-affect.html When consumers know ahead of time that they will need significant medical care, do they behave differently than when the need for care is less certain? It would make sense that in times when care is highly probable, families may choose insurance coverage that minimizes out-of-pocket expenditure.We decided to look in our own dataset to find evidence of this phenomenon. A few of my research colleagues in the Health as Human Capital Research Group ran an analysis. They identified employees from a large corporation who were employed continuously over a two year period. More than 4,100 of these employees were in PPO plans that included either a $200 or a $400 deductible. Controlling for a variety of other variables (including age, gender, salary, ethnicity, and region) we tested to see if those... Health as Human Capital - Illustrated Research Summaries blogs http://www.medworm.com/rss/comments.php?id=688770 Sun, 23 Oct 2005 04:00:00 +0100 688770