Minimising waste in the health system

AMA, media release 21 July 2016
“The AMA today released its new Position Statement on the Doctor’s Role in Stewardship of Health Care Resources.  Doctors are important stewards of health care resources and good stewardship is an important part of ethical, best practice care. The Position Statement explains that stewardship involves avoiding or eliminating wasteful expenditure, with the aim of maximising quality of care and protecting patients from harm, while ensuring affordable care in the future. Stewardship is not rationing, which involves limiting the amount of health care a person is allowed to have because of economic reasons or scarcity of resources…”
Find release and link to full statement here.

Doctors must have key role in health financing funding

AMA, media release 21 July 2016
“The AMA today released its new Position Statement on the Role of Doctors in Stewardship of Healthcare Financing and Funding Arrangements 2016. Stewardship of health financing and funding means ensuring health funding is directed to achieving health outcomes, does not have adverse impacts or involve wasteful expenditure, and is sustainable and able to meet future needs. AMA President, Dr Michael Gannon, said today that, without the clinical stewardship perspective, there is a significant risk that health policy decisions will be driven primarily by government financing and political perspectives ahead of positive public health outcomes.”
Find release and link to full statement here.

How shortcomings in the mental health system affect the use of involuntary community treatment orders

Aust Health Rev. 2016 Jul 15. doi: 10.1071/AH16074.
Authors: Light EM, Robertson MD, Boyce P, Carney T, Rosen A, Cleary M, Hunt GE, O’Connor N, Ryan CJ, Kerridge IH.
“Objective The aim of the present study was to examine stakeholder perspectives on how the operation of the mental health system affects the use of involuntary community treatment orders (CTOs). …The findings of the present study indicate that deficiencies in health service structures and resourcing are a significant factor in CTO use. This raises questions about policy accountability for mental health services (both voluntary and involuntary), as well as about the usefulness of CTOs, justifications for CTO use and the legal criteria regulating CTO implementation.”
Find abstract here.

For transgender people, better health care begins with basic human rights

The Globe and Mail, 20 July 2016
Author: Andre Picard
“Transgender issues have never had a higher profile. But visibility doesn’t necessarily translate into equality, human rights, improved health or better lives for transgender people. Beyond the distorting Hollywood spotlight and the infantile U.S. political disputes about who can pee where, very real issues remain for the 25 million transgender women and men (and those who identify as non-binary) worldwide. One of the biggest challenges is getting decent health care.”
Find article here.

Judge orders that teenager with narcolepsy be allowed to try sodium oxybate

BMJ 2016;353:i3413
Author: Clare Dyer
“A High Court judge has ordered a three month trial of sodium oxybate for a 17 year old girl with narcolepsy and cataplexy, after ruling that NHS England had incorrectly applied its policy on exceptional drug funding when it turned her down. “S,” whose identity is protected by an anonymity order, and her family had been trying for two years to obtain the drug after the drugs normally used in the NHS for narcolepsy failed to control the condition, which was severely affecting her life.”
Find extract here.

New Methodology To Examine Spending Patterns For End-Of-Life Care

Health Affairs, blog June 15, 2016
Author: Chris Fleming
“According to the Medicare Payment Advisory Commission, end-of-life care in the United States accounts for some 30 percent of Medicare spending. A new study, released as a Web First by Health Affairs, looked at 2012 Medicare administrative claims data and identified four unique spending trajectories. Nearly half (48.7 percent) of older Medicare beneficiaries were classified as “high persistent,” maintaining high spending throughout the year.”
Find article here.

TV comedian writes off $15m in US medical debt

BMJ 2016;353:i3228
Author: Michael McCarthy
“In a television show highlighting the practices of the US debt buying industry, the comedian John Oliver wrote off nearly $15m (£10.3m; €13.2m) in medical debt owed by nearly 9000 people.1  …Medical debt is common in the United States…”
Find extract here. See also The Guardian ‘John Oliver experienced the high of forgiving medical debt – you can too’, including link to program here.

France: a philosophy for health

The Lancet, Volume 387, No. 10034, p2174-2176
Authors: Richard Horton, Audrey Ceschia
“The dominance of English as the language of science and, increasingly, global health too often closes the door on the history and experiences of others. In France’s case, careful study of the nation’s struggle to achieve universal health coverage, together with its distinctive approach to global health, has much to offer those who seek to understand the diversity of paths to achieve better health at home and abroad. The two Lancet Series papers1,2 on France’s contribution to health, along with four comments from French or Francophone leaders,3–6 aim to correct this imbalance in the English-language literature on health.”
Find commentary and related series articles here.

Considering the Common Good — The View from Seven Miles Up

N Engl J Med 2016; 374:2006-2007
Author: Martin F. Shapiro, M.D., Ph.D.
“The dilemma on that airplane was unique in some respects, but one issue involved in our decision underlies many treatment decisions made in conventional medical settings, though it’s rarely acknowledged explicitly in U.S. medicine. We had to decide which patient would get the treatment that had the potential to improve his or her outcome. They could not both get what was best for them, because the “treatment” for my patient (landing at O’Hare and picking up more oxygen) would clearly endanger the other patient. U.S. health care prides itself on its great respect for “patient autonomy” — which we tend to translate as giving patients what they want. In many situations, such allocation decisions have implications for others.”
Find article here.

NHS refusal to fund HIV prevention treatment is shameful, say charities

The Guardian, 1 June 2016
Author: Nadia Khomami
“The UK’s leading HIV and sexual health charities have attacked as “shameful” a decision by NHS England not fund a treatment method that can drastically reduce transmission risks. If followed regularly, the pre-exposure prophylaxis (PrEP) prevention method, usually with a prescribed daily pill, can reduce the risk of HIV infection by up to 86%, according to a recent study. But on Tuesday, a meeting of NHS England’s specialised services committee confirmed an earlier decision that the treatment fell outside its remit because preventative services were the responsibility of local authorities.”
Find article here.