Webmedcentral - Economics of medicine ArticlesThe Economics of medicine articles published by Webmedcentral
http://www.webmedcentral.com
2024-03-29T11:57:52+01:00webmedcentral logo
http://www.webmedcentral.com/
http://www.webmedcentral.com/images/Header_Logo.giftext/html2010-09-14T22:36:40+01:00http://www.webmedcentral.com/Mr. Franz PorzsoltA Three-Step Strategy To Approach The Public Benefit Basket In The Health-Care Systems Of Industrialized Nations
http://www.webmedcentral.com/article_view/622
In all health-care systems of industrialized nations it is difficult to describe the appropriate volume of services to be provided to all members of society. In our article, we propose a three-step strategy to facilitate decision making about this volume. This concept is based on the distinction between health-care services that save lives and others which improve the quality of life. Services provided to avoid life-threatening conditions are summarized in the minimal benefit basket (MBB). The MBB is a virtual basket which describes the absolute minimum of health care essential for survival. This virtual basket can only be defined by scientific data. It cannot be expected that all members of a society will be content with this minimal package of health-care services. The public benefit basket (PBB) is, however, a real basket which describes the health-care services a society could actually provide its members.Four evidence-based criteria were selected for inclusion of a particular service in the MBB. These criteria include the definition of the final goal of a particular service, the effectiveness with which this goal is attained, the validity of the report describing the goal attainment and, finally, the costs of the service. These criteria should represent a specific set of acceptable instructions guiding health-care policy. Once services which are essential for survival have been defined and included in the MBB, it may be easier to select and add optional services that improve the quality of life. Adding optional services to the predefined MBB will result in the package of health-care services, the PBB, which should be offered to all members of society. This procedure facilitates defining a PBB which is needed to make policy decisions in any society.text/html2010-09-26T07:11:04+01:00http://www.webmedcentral.com/Prof. Nastu P SharmaHealth Inequities and Investing in the Early Life Years: Lessons to reach to Poor and Vulnerable in Nepal
http://www.webmedcentral.com/article_view/711
It has clearly been proven in various studies that the poor suffer more than the rich in the matters of mortality, fertility, malnutrition, and morbidity, but it is the size of the gap between the rich and poor, which has caught the attention of policy makers and development agencies. Every year more than half a million maternal deaths and around four million prenatal deaths occur in low –and middle- income countries, mostly among the poorest groups within these countries. This review article high lights about need for robust health system performance in developing countries to reduce health inequalities particularly to reach to poor and vulnerables.text/html2010-10-01T08:28:54+01:00http://www.webmedcentral.com/Dr. Stephen J MacdonaldThe Role of Patient Involvement in Practice Based Commissioning within the UK\'s National Health Service
http://www.webmedcentral.com/article_view/853
Over the past decade there has been mounting debate about the desirability of public and patient involvement in the commissioning of health services in the UK. This issue has arisen partially due to the National Health Service management moving from a system control by health practitioners to that of a devolved managerial approach with tight central financial control and an agenda for efficiency. Yet, it is often unclear within this debate about what constitutes as public and patient involvement. The aim of this study is to investigate what is meant by public and patient involvement, and to assess the effectiveness of public involvement initiatives associated with Practice Based Commissioning. In order to achieve this, the study has utilised quantitative and qualitative methods to analyse health inequalities and public involvement within the North-east of England. In order to measure patient and public involvement qualitative interviews were conducted with patients and health professionals in the Easington area of East-Durham. The conclusion of the research was that the public had little interest in the process of commissioning, but volunteers were keen to be involved in practical projects such as fitness promotion programmes, long term care initiatives and projects to encourage healthy activities in the community. The authors construct a model of involvement ranging from ‘passive’ involvement where volunteers simply discuss issues at meetings to ‘active’ involvement where they actually help organise activities. The study suggests that active involvement schemes could promote health and reduce health inequalities.text/html2010-10-13T10:01:38+01:00http://www.webmedcentral.com/Dr. Manuel,PhD HensCost-effectiveness Evaluation Of Therapy With Naratriptan And Rizatriptan For Migraine In Spain
http://www.webmedcentral.com/article_view/958
The purpose of this study is to investigate the cost-effectiveness of naratriptan and rizatriptan therapy for migraine attacks. Methods: cost-effectiveness analysis from the healthcare financer perspective in Spain, using a model based on a decision tree, which incorporates the direct healthcare costs and the probabilities associated with each of the possible outcomes. The average cost-effectiveness ratio and incremental cost-effectiveness ratio were obtained. Results: theaverage cost-effectiveness ratio of rizatriptan was 91.99 Euro per unit of effectiveness, in contrast to 139.27 for naratriptan. When comparing the cheapest therapy (naratriptan) with the most effective one (rizatriptan), the incremental cost-effectiveness ratio was 7.93 Euro per unit of effectiveness gained. Conclusion: Rizatriptan proved to be more efficient than naratriptan for the treatment of acute migraine in terms of cost-effectiveness, from the healthcare-provider perspective in Spain.text/html2011-05-18T10:22:24+01:00http://www.webmedcentral.com/Ms. Minerva Garcia-fuentes PharmdInter-Country Cost-Effectiveness Differences Between Naratriptan and Rizatriptan for the Acute Migraine in the Netherlands and Spain
http://www.webmedcentral.com/article_view/1933
The purpose of this study was to investigate the differences in cost-effectiveness results of naratriptan and rizatriptan therapy for acute migraine attacks between two Western European countries, The Netherlands and Spain. Methods: cost-effectiveness analysis from the healthcare financer perspective, in the context or primary care, in The Netherlands and Spain, using a model based on a decision tree, which incorporates the direct healthcare costs and the probabilities associated with each of the possible outcomes. The average cost-effectiveness ratio (ACER) and incremental cost-effectiveness ratio (ICER) were obtained. Results: rizatriptan resulted to be more efficient than naratriptan in terms of cost-effectiveness in both countries. Close ACER results for both drugs in both countries were found, specially regarding naratriptan, but their ICER results show wider variations. Our results suggest that inter-country variations in cost-effectiveness could require a detailed analysis for each drug or groups of them. text/html2010-07-23T10:22:33+01:00http://www.webmedcentral.com/Mr. Mohammad S WalidThe Impact Of Depression And Opioid-antidepressant-anxiolytic Use On Length Of Stay And Hospital Cost Of Spine Surgery
http://www.webmedcentral.com/article_view/448
Background: The purpose of this study is to investigate the economic impact of opioid-antidepressant-anxiolytic use in spine surgery patients.Methods: The charts of 816 spine surgery inpatients of the Medical Center of Central Georgia were retrospectively reviewed and data on preoperative use of opioids, antidepressants and anxiolytics as well as history of depression were collected and analyzed for any impact on length of stay and hospital charges. Surgery was either lumbar microdiskectomy (LMD), anterior cervical decompression and fusion (ACDF), or lumbar decompression and fusion (LDF).Results: LDF patients with history of depression had higher prevalence of combined opioid, antidepressant and anxiolytic use compared with the rest of the patients (20%). However, graphing opioid-antidepressant-anxiolytic use in each type of spine surgery against the average length of stay and hospital charges showed an increase in stay and charges in the LDF group without a history of depression (or possibly undiagnosed depression).Conclusion: LDF patients without history of depression who are on all three medications (opioids, antidepressants and anxiolytics) are more likely to stay longer in hospital and seem to consume more hospital resources than others.text/html2011-03-01T21:41:49+01:00http://www.webmedcentral.com/Dr. Antoni Sicras-MainarAdaptation of the Categories Johns-Hopkins ACG Case-Mix System in Primary Healthcare: a Longitudinal, Retrospective Claim Database Study.
http://www.webmedcentral.com/article_view/1657
In representation ACG Study Group:Catalonia(Milagrosa Blanca-Tamayo,Esperanza Escribano-Herranz,Ferran Flor-Serra,Josep Ramon Llopart-Lopez, Daniel Rodriguez-Lopez, Encarna Sanchez-Fontcuberta,Josep Maria Vilaseca-Llobet); Mallorca (Jose Estelrich-Bennasar,Vicente Juan Verger, Maria Antonia Mir-Pons,Maria Vega Martin-Martin,Juan Antonio Perez-Artigues); and Aragon (Jose Maria Abad-Diez,Maria Mercedes Aza Pascual-Salcedo, Daniel Bordonaba-Bosque, Amaya Calderon-Larranaga, Francisca Gonzalez-Rubio, Anselmo Lopez-Cabanas,jesus Magdalena-Belio,Beatriz Poblador-Plou,Antonio Poncel-Falco).
text/html2011-04-01T17:33:10+01:00http://www.webmedcentral.com/Prof. Jan NorumInduced Abortion on Demand (IAD) in Norway 1979-2009 and a Pre IAD Comparator. A Markov Model Based Cost-Effectiveness Analysis (CEA)
http://www.webmedcentral.com/article_view/1830
Objective: In the western world, there is a growing concern about an aging population. The number of births per women has been low for decades. The objective was to clarify the cost-effectiveness with regard to induced abortion on demand (IAD) and a comparator.Methods: A Markov model was established, time perspective was 31 years (1979-2009) and two alternatives compared. A) The induced abortion on demand (IAD) as performed. B) A comparator where 2/3rds of the IAD were avoided to obtain pre IAD figures. Health care (C1), patient/family (C2) and other sectors (C3) costs together with production losses (C4) were calculated in both arms. Savings (S) in terms of life years gained (LYG), health care (S1), patient/family (S2) and other sectors (S3) savings together with production gains (PG) (S4) were included and based on data from Statistics Norway. A 4% discount rate (d.r.) was used.Results: Between 1979 and 2009, a total of 452,112 pregnancies were terminated. In the comparator arm, 301,408 additional births were obtained and further 5,772 births were added as the children grew up. LYG was indicated 2,372,699 (4% d.r.). Based on the model, the cost/LYG (4% d.r., all resource use) was a saving of Euro 74. Excluding family costs/savings, the figure was Euro 5,187 saved/LYG. The major cost factors were family related costs (66%) and costs in other sectors (23%). Health related costs were negligible (2.5 %). The major saving was due to PG.Conclusion: From a societal perspective, an intervention avoiding induced abortions is very cost effective and welfare services counteracting family costs are important.text/html2011-12-14T08:50:41+01:00http://www.webmedcentral.com/Dr. Ana A IglesiasCost Effectiveness Estimate of Bazedoxifene
http://www.webmedcentral.com/article_view/2547
Background: A three-year clinical trial of bazedoxifene 20 or 40mg/day compared with raloxifene 60mg/day or placebo in postmenopausal women with osteoporosis showed that treatment with bazedoxifene significantly reduced the risk of new vertebral fracture (NVF) in this population; all subjects received oral daily calcium and vitamin D supplements. Based on this clinical trial, the aim of the present study was to assess the cost effectiveness of bazedoxifene compared with placebo or raloxifene, for the treatment of osteoporosis in postmenopausal women. Methods: The cost effectiveness was only estimated from a healthcare perspective in the 50 to 64 age group. Only drug acquisition costs and direct costs were considered. Incremental cost effectiveness ratio was calculated as cost per event avoided. Because the incidence of deep vein thrombosis events was higher with bazedoxifene and raloxifene compared with placebo, this incidence was taken in account in the decision tree. A sensitivity analysis was performed. Results: We applied a cost minimization analysis between treatment groups without differences in the primary endpoint (bazedoxifene 20mg versus 40mg and bazedoxifene 20mg versus raloxifene 60mg): the most efficient drugs were bazedoxifene 20mg and generic raloxifene 60 mg, respectively. The cost of avoiding additional NVF versus placebo (i.e. in the case of no treatment with bazedoxifene 20mg) would be 436.054,39 annual euros (256.552,60 euros per year in the case of generic raloxifene). Conclusion: Considering the defined conditions, treatment with bazedoxifene versus a placebo group would not be efficient.text/html2013-02-13T12:37:47+01:00http://www.webmedcentral.com/Dr. Esther Una CidonCost-Effectiveness Studies Applied to the Screening Of Colorectal Cancer
http://www.webmedcentral.com/article_view/4014
Screening for colorectal cancer (CRC) is an effective strategy to reduce its mortality and even its incidence. But due to the existence of multiple screening tests with their differences in costs, acceptability and effectiveness in terms of life years gained (LYG) well-designed studies are needed to assist the Health Authorities in the decision-making process. At this point a new technique of radiology, virtual colonoscopy, has emerged as part of CRC screening in the general population. When both types of colonoscopy were compared with the strategy of "no screening", the incremental cost-effectiveness ratio for colonoscopy and CV were respectively 20,000 and 30,000 euros per LYG, proving that both strategies are cost-effective according to most international acceptability thresholds. However, when both are compared to each other, traditional colonoscopy seems to be the most cost-effective. Since most of the studies are based on assumptions and estimates based on data from clinical trials and mathematical modeling, there is still much to be done to draw firm conclusions.Keywords: virtual colonoscopy, screening, colorectal cancer, cost effectiveness.text/html2016-09-14T11:44:01+01:00http://www.webmedcentral.com/Dr. Deepak Gupta\"Paid\" Medical Research For Students: Time For Minimum-Wage Medical Research Internships
http://www.webmedcentral.com/article_view/5183
As a researcher myself, I have always wondered about what drives the pursuit of research. There is data to suggest the positive impact of medical student research for future evolution as academic physicians or physician-scientists. The data from undergraduate student research, however, suggests that pre-medical students prefer to focus more on clinical care than on research pursuits when compared with non-pre-medical students. The reasons for students showing non-primary interests in medical research can be that (a) the undergraduate research achieves more fulfillment for self with multi-year involvement that may not be feasible for students while on the medical school pathway; (b) the project ownership that drives the aptitude and zeal for research pursuits may not be possible with short-term involvements in medical research; and (c) the absence of well-defined and mandatory course-based undergraduate research experiences and/or abundant medical research internships may preclude the popularity of medical research among student researchers. The medical students have opportunities (a) to apply for extremely limited research positions that pay stipend (long term jobs or summer jobs), (b) to choose elective rotations for learning and experience in medical research as part of their educational curriculum, and (c) to volunteer as "researchers" for ongoing medical research projects at financially-constrained departments. Overall, the major avenue that society needs to ponder is that when "only zilch comes free", it should not expect medical research to drive itself into a promising future in the absence of research dollars' abundance. Therefore, it is high time that research teams should plan minimum wage medical research internships to "give" stipends to their student researchers before asking to "take" their time for teams' planned and ongoing medical research projects. This is long overdue because for umpteen times, student researchers have demonstrated their readiness to "give" their dedication for research while making their legitimate case to "take" positions among highly competitive graduate medical education programs in the United States and tread their future into practicing and/or innovating medicine.text/html2016-12-21T16:06:55+01:00http://www.webmedcentral.com/Dr. Deepak GuptaHonorariums: How can they be so difficult to devise?
http://www.webmedcentral.com/article_view/5244
Honorariums (for organizing conferences and for managing journals): How can they be so difficult to devise? As only zilch comes free and nobody wants their conferences or their journals to be zilches, the society should decide and conclude to invariably pay their organizers and their editors unless the society keeps coming up short in the education/research funds wherein the society can decide to cut down the number of conferences and journals (to manageably numbered which can be comfortably paid) instead of expecting the organizers and the editors (of innumerable conferences and journals) to do the work for free.text/html2018-03-19T05:26:41+01:00http://www.webmedcentral.com/Dr. Deepak GuptaSelf-Pay All Along
http://www.webmedcentral.com/article_view/5443
Being an avid reader, I stumbled onto the health insurance practice of ASO [1]. As a healthcare consumer, it is important to know what ASO is. The acronym ASO stands for "Administrative Services Only" [2], a practice that has figuratively evolved the majority of our employers into becoming our health insurance carriers. How (and why) did the evolution of ASO happen? Historically, we all used to pay directly for our healthcare on an as-needed basis. At some point of time, this as-needed self-pay practice became too personally burdensome and subsequently insurance carriers started paying for our healthcare while we (along with our employers) began paying recurring health insurance premiums as our contributions. In time this practice also became too burdensome and currently, instead of contributing their parts towards the employees' premiums, the employers have begun withholding the corresponding funds from the health insurance carriers, supposedly as "cash-in-hand", while their employees continue to pay their parts of premiums [3]. Essentially, majority of our employers have evolved into covert insurance carriers [4] by directly paying for our healthcare bills and our overt insurance carriers' not-so-large ASO fees [5]. The ASO fees primarily serve as compensation for larger insurance carriers' superior negotiating power over healthcare providers that determines healthcare bills' actual/final reimbursable values. Negotiating power is heavily dependent on the number of clients that an entity can bring to the table. For example, our government-owned Medicare & Medicaid, as the largest third-party payer for our healthcare, literally dictates the terms of healthcare payments and fees. Ironically, even the government-owned Medicare & Medicaid cannot currently "negotiate" [6] drug prices with the drug manufacturers although there may be "negotiations" in the future [7].
To identify the ultimate payer of our healthcare system, we can illuminate ASO practices by using two scenarios unrelated to healthcare.
The gratuities [8], that are expected from us as customers being served in restaurants (or for that matter in any server-based industry), are actually the owners' excuse to maintain underpaying jobs for their servers as per the legal subminimum wages [9]. However, if the owners were to start paying their servers appropriately, there would be correspondingly inflated bills which would again be footed by us as customers dining in their restaurants.
A lifetime total of car insurance premiums [10] paid by an average driver as mandatory fees to drive a car is usually higher in total than what the car insurance carrier would pay out for actual injury claims based on the average driver having three-four car accidents over entire driving-lifetime [11].
With the abovementioned analogies, it appears contrasting that the total Medicare/Medicaid/social security (lifetime) benefits that we recoup, are more than the total Medicare/Medicaid/social security (lifetime) taxes that we pay [12]. However, our government is forced to draw from our lifetime taxes (the non Medicare/Medicaid/social security taxes) to balance its healthcare budget. The lifetime tax bill paid by the average person runs into millions pounds in United Kingdom [13], and the lifetime tax bill of the average person in the United States [14] is probably not far behind. A valid question would be whether our total lifetime healthcare benefits [15] averaging hundreds of thousands dollars (our healthcare costs [16] paid by our third-party payers) are more or less than the total lifetime amount of healthcare insurance premiums [17] paid completely by us or shared between us and our employers over our lifetimes. One thing for certain is that premiums paid by the insured for individual health insurance [18], are considerably less than the total premiums paid when shared by employee-employer, enrolled in group health insurance [19]. Herein, the buffering power of numbers comes into play again. People covered under individual health insurance by the largest insurance carriers with membership in the multimillions [20-22] may expect more stable premiums as compared to the coverage under group health insurance with the largest employers employing couple of millions at best [23] unless the employer's number of employees is larger than the population insured by the regionally available insurance carrier.
We have been long mistaken that employers paying their shares of premiums on our behalves are utilizing somebody else's money, not ours. Hypothetically, how many of us would prefer being insured with individual health insurance over group health insurance [24] if the total (potentially subsidized and/or tax-free) premiums paid under individual health insurance would become a component of our correspondingly improved compensation packages, say on the terms within the legally allowable Health Reimbursement Arrangement (HRA) [25]? Ironically, the HRA-model may be catastrophically difficult-to-impossible to implement for large employers who are evolving their ASO-model by withholding their shares of employees' healthcare premiums. How (and why) would employers be able to channel their withheld "cash-in-hand" funds into the HRA-model based adjustments in the compensation packages for their large number of salaried employees? Essentially, our employers' lifetime contributions to our healthcare insurance premiums have always been our personal funds hidden as salary-benefits-perks [26], irrespective of whether being paid to our overt insurance carriers or being withheld by our covert insurance carriers. Herein, we could wonder whether the legally allowable variable-graded-tiered compensation packages [27-29] as corresponding to the work responsibilities and productivities can percolate into the healthcare coverage policies within the work environments.
Alternatively, we must NOT wonder about which procedures or prescriptions are covered and what claims or costs will be denied [30]. We will encounter these issues when we directly require medical services. However, when these issues arise, the responsibility lies neither with our insurance carriers who are managing our healthcare costs for minimal administrative fees nor with our employers who have to constantly sustain cash flow and cash in hand for our-and-our peers' soaring healthcare needs. We should realize that everything boils down to our own lifetime healthcare salary-benefits-perks [26], that are overtly visible in the form of premiums paid to insure our healthcare and covertly invisible in the form of the cash-in-hand withheld for the sake of our healthcare.
Summarily, our incomplete understanding of our personal healthcare plans in the constantly evolving healthcare markets may NOT matter as long as we (a) always pay our recurring premiums on-time, (b) never forget that our healthcare system has been and will continue to be a self-pay system, and (c) always try to NOT fall sick. Hopefully, in the due course of time, we as a society will begin to forgive ourselves for our volatile healthcare premiums (similar to our mortgages) that are essentially cloaked ownership of our own health status (similar to our mortgaged homes). An appropriate analogy of this evolution of our healthcare could be an antiquated multi-thousand dollar home (our 20th century healthcare) evolving into a modern multimillion dollar villa (our 21st century healthcare). Embracing the abovementioned understanding, we are welcoming our ushering into a futuristic healthcare consumerism era [31], even though it may NOT be that futuristic after all. text/html2021-01-31T05:35:41+01:00http://www.webmedcentral.com/Dr. Deepak Gupta\"It\'s poverty, Covid\"
http://www.webmedcentral.com/article_view/5690
In 1990s, James Carville said that it is all about economy whichever way one looks at it [1]. Essentially, economy has evolved as a guise for food energy because food energy for individual’s survival requires individual’s society’s economic growth. Now the question arises whether food energy availability is modifiable and if it is modifiable whether it can be equitable [2]. Domestication of plants and animals followed by agricultural and technological revolution may have ensured that food energy availability can be modified by humans. However, this acquired human control over increasing the food energy availability may have led to acquired human control over inequitably distributing the abundantly generated and abundantly available food energy. Herein, the guise of modern economy comes to represent current and future food energy availability and current and future food energy distribution among modern human populations. Summarily, it is all about control of economy among humans to exercise control over food energy for humans.
This lays the ground for understanding why appropriate understanding and appropriate interpretation of demographics is most important when humans are dealing with pandemic/epidemic/endemic diseases. For example, while pondering on obesity epidemic, opioid epidemic or COVID-19 pandemic, the stark highlighter is often racial/ethnic differences among the prevalence of these diseases. However, this highlighted truth leaves a hole in the hearts of those disproportionately affected by these diseases when they assume this to be the fact of life with race/ethnicity being a non-modifiable factor. Herein lies the paradox because this presumed fact blinds not only those who feel frustration at being comparatively higher risk due to their race/ethnicity but also those who feel security at being comparatively lower risk due to their race/ethnicity. Moreover, while suffering due to race/ethnicity may strengthen bonds within the racial/ethnic groups, this shared experience over a non-modifiable factor like race/ethnicity may tend to overlook the shared experience over a modifiable factor like poverty [3-4].
The message can be simplified. It is true that socioeconomic differences lead to different prevalence of poverty among various racial/ethnic groups [5-7]. However, race/ethnicity itself being non-modifiable, poverty itself may be the primary target for modifications and corrections after overcoming the socioeconomic limitations induced by perceptions around race/ethnicity. It is important to remember that obesity, opioids and viruses may not be biologically targeting racial/ethnic/minority groups but these modern-day menaces may be socioeconomically targeting poor and underprivileged individuals irrespective of their racial/ethnic/minority status despite poverty having evolved over years to be differentially concentrated among individuals depending on their racial/ethnic/minority status.
Summarily, fighting with pandemic/epidemic/endemic diseases is primarily about overcoming poverty and secondarily about overcoming the underlying racial/ethnic/minority prejudices hindering eradication of poverty from the world. The call out should be about unifying the poor to collectively ask the rich for survivable and livable opportunities for themselves rather than getting divided over their racial/ethnic differences because it may appear self-serving to the rich and privileged to let the poor and underprivileged believe and blame it on their non-modifiable race/ethnicity rather than creating and allowing opportunities for the poor and underprivileged to evolve as the rich and privileged just like their own selves. text/html2021-04-06T03:21:31+01:00http://www.webmedcentral.com/Dr. Deepak GuptaHealth Care Infinity: Prohibit Regulate Normalize
http://www.webmedcentral.com/article_view/5697
Humanity should look much further beyond short-term vision for Health Care 2030 [1] because existential questions are so many and answers to them are so few, if any, when some do everything and some do nothing while few, if any, relish the endgame to exist in matrix.
What have been the primary gains to the humanity due to exponential progress in healthcare delivery over the last century [2]?
What is the primary endgame [3-5] for the humanity with unstoppable though unsustainable progress in healthcare delivery when longevity of life has been a moving target socioeconomically and quality of life is way too personal to get defined in universal terms?
Has humanity forgotten to learn how to limit their healthcare goals and targets on the lines of non-humans [6] who try sustaining their healthcare in the wild naturally without disrupting their ecosystems in the wild?
Will humanity surrender to artificial intelligence while misguidedly hoping that artificial intelligence will always serve humanity and its ever-growing healthcare needs because these insatiable needs are paradoxically going to make humanity existentially impossible without artificial intelligence thus allowing artificial intelligence to begin pulling the strings and eventually run and own the show in the matrix?
How will the future humanity repay their ever-growing debts [7-9] until they are hoping to get their debts completely forgiven when artificial intelligence owns the show because the future humanity may comparatively be smaller in size with inability to repay those impossibly overwhelming debts incurred by their ancestors especially when those ancestors might have already tapped into scantily available resources with none left for the future humanity to tap into?
How has humanity evolved to turn global society overtly dependent on the essentiality of healthcare jobs because downsizing and appropriating the unsustainable healthcare jobs will make the economic health of global society unsustainable?
How has humanity evolved to invent healthcare products for overconsumption which intentionally or inadvertently incentivize healthcare professionals to oversell themselves and these products thus creating a constant need to expand healthcare consumer base that in turn further prompts future healthcare innovations [10] for managing the metastatic overconsumption which in turn induces eternal shortage of healthcare professionals thus setting them up to fail in meeting the insatiable needs of unmanageably expanding healthcare consumer base?
Why does modern humanity have to complicate all the simple things?
Why is there no consensus that modern invention of humane birth control may be the best peacekeeping force deployed by global healthcare in modern times?
Why is there no cost-containment strategy for end-of-life care and after-death care because it may no longer be possible to die without passing unforgivable and non-repayable debts onto the heirs or onto the society in the absence of heirs?
Why is there no readiness in population to learn staying healthy and healing naturally while avoiding the trappings of modern healthcare delivery systems which ironically survive and expand socioeconomically with overabundance of oversold unnecessary healthcare services, more often than not?
Why is there no check on human quest that is driving to catch on the impossible race to fulfill humanity’s insatiable healthcare needs, especially the invented, cost-prohibitive and disappointingly unmet ones?
Why is there no understanding among modern humanity about a basic tenet to limit the expansion of needs to avoid the disappointment of ever-growing unmet needs because the unrealistic goals and targets will always keep moving to create naïve jobs for unsustainably expanding global population which will continue to irreparably consume the scantily available resources on the earth forcing the goals and targets to keep moving further and further towards unassailable and unsustainable heights?
Health Care Infinity should be about (a) humanely controlling human population, (b) banning unnecessary healthcare interventions, (c) cost-efficient and realistically goaled palliative/symptomatic/supportive/end-of-life care, (d) timely aborting gross world product’s unsustainable dependence on healthcare industry, (e) natural, home and kin supported healing once again overtaking artificial, institutional and third-party supported healthcare, (f) curtailing overconsumption of healthcare products, (g) downsizing unnecessary healthcare specialties and their workforces, and (h) ethically responsible professionals making frightening litigious world irrelevant. As inspired from the paradox of prohibition [11], Shakespearean dilemma persists: (a) “to prohibit, or not to prohibit” or (b) “to regulate, or not to regulate” or (c) “to normalize, or not to normalize”. This dilemma is universally present with applicability to everything within the matrix.
A story was one once told to me that we never sit in a vehicle which does not have functioning brakes to apply on an as-needed basis. However, brakes are needed only in a moving vehicle so as to avoid it turning into a speeding vehicle. As our matrix is never static (or dead) and always dynamic (or alive), we are banished to moving parts within the matrix thus requiring regulators to control our survival within the matrix. Thus, the bottom line is this that we can neither live with prohibition of natural deeds nor survive after normalization of natural deeds because we can only go on with our lives once our natural deeds are well regulated. The only remaining difficulty is how to gauge whether our natural deeds are getting overregulated to appear almost like prohibition or whether our natural deeds are getting under-regulated to appear almost like normalization. Herein the perception within the society comes to play a role. Whenever we feel our deeds are being prohibited, our deeds are being prohibited even if prohibition has not been formalized. Whenever we feel our deeds are being normalized, our deeds are being normalized even if normalization has not been formalized.
Although any human deed can be gaged on this spectrum in nature, few medicolegal examples can be used to self-explain the warranted balance by discipline.
Population control: Before the advent of modern “Pill”, the only humane population control method known to and perfected by humankind was abstinence-celibacy. Thus, the question arises whether contraception should be prohibited which can lead to overpopulation inducing inhumane violence of wars and pandemics as similar to what happens in the animal kingdom [12] or whether contraception should be normalized which can lead to contraction or even extinction of humanity. Herein, the answer may always be regulating the contraception with population dynamics changing accordingly to adapt to evolving times in the unknown future.
Gun control: Before the advent of external “Tool”, humans like other animals and plants used to primarily depend on their internal armamentarium to resist and overcome those which may attempt to trespass their homeostatic environments. However, with the passage of millenniums, the self-coronation of superiority among earthly species became possible for humanity with tools coming handy to maintain and sustain human safety in human-centered ecosystems. Thus, the question remains whether guns should be prohibited which may expose any tool-less human to potentially fall prey to human and non-human predators or whether guns should be normalized which may provide any human the opportunity to acquire the tool without knowing how appropriately to use the tool. Herein, the answer may always be regulating the guns to appreciate the invention’s role in human superiority as a species while keeping a check on its self-destructive potential [13].
Drug control: Before the advent of overuse “Epidemic”, tobacco, alcohol, cocaine, cannabis, opioids, caffeine and many other substances might have been accidentally discovered by the animals as medicinal or nutritional plants for medicinal or nutritional purposes which inspired the humans to explore and refine them to the dizzying heights of overabundance and thus overuse whereafter humans controlling their environments but lacking self-control might be at blame for humans’ downfall due to drugs [6]. Thus, the question remains whether drugs should be prohibited which can strangulate the humanity by depriving itself the experienced usage of medicinal and nutritional plants for medicinal and nutritional purposes as learned over the millions of years of life’s existence on the earth or whether drugs should be normalized which can bring upon the humanity the carnage of overuse and overdose of pandemic proportions. Herein, the answer may always be regulating the drugs to contain the self-destructive proportions of drug overabundance and overuse of synthetically manufactured drugs without losing the medicinal and nutritional benefits of their plant-based origins and the naturally-derived drugs therein.
Diet control: Before the advent of food “Epidemic”, food was an essentiality and death from starvation was the only reality. However, we started producing too much food and as we decided to sell food only to those who have the capacity to buy, we started over-feeding the already full stomachs while leaving those starving to keep on starving if they cannot buy at the market-stabilizing prices being asked for the foods because we do not have food production problem in modern economy but food distribution problem therein [14-15]. Thus, the question remains whether dieting should be prohibited which can further balloon our adiposity-based chronically diseased humanity or whether dieting should be normalized which can skin modern humanity down to bones thus negating the human labor over millenniums to finally achieve global abundance in food production. Herein, the answer may always be regulating the diet so that every human has just enough to feed on for surviving even if every human does not have enough to pay the price for the food being fed upon.
Pain control: Before the advent of opioid “Epidemic”, humanity was more likely to suffer from the unrelenting pain and even die while suffering. However, we learnt to ease our pain just like our non-human ancestors learnt to ease their pain by retiring temporarily or permanently to secluded healing environments or using plant-based wild-nutrition as self-medication under evolved experimentations until we dawned upon ourselves the industrialized production of our analgesics and thereafter began ingesting the overabundant analgesics being produced to sustain our jobs created within our free markets. Thus, the question remains whether analgesia should be prohibited which can revert us back to the times of immense suffering which modern humanity may find it extremely hard to endure as similar to domesticated animals’ doomed plight in the wild [6] or whether analgesia should be normalized which may potentially hasten our modern humanity to die faster death although that death may most likely be painless at least for the dead after their death until and unless modern humanity discovers and accepts painful afterlife. Herein, the answer may always be regulating the analgesia to allow pain to play its role in survivable and adaptable suffering, only to be countered when survivors need the irreplaceable alternative to overcome insufferable happenings.
Essentially, even though prohibition feels like strangulation of natural instincts and normalization feels like drowning in natural instincts with regulation feeling like we can finally breathe despite apparently self-destructive natural instincts until we cannot breathe anymore due to overregulation seeming like prohibition and under-regulation seeming like normalization, balance by discipline needs the regulations as equalizers between prohibitions and normalizations of whatever happening within matrix’s multiverse’s nature that always exists over a spectrum. Therefore, “Saving Normal” [16] should actually be about regulating the nature rather than prohibiting the nature or normalizing the nature because in the terms of philosophical utilitarianism, statistics’ normal curve on the paper may analogously be inverted upside down as prohibition’s paradox’s regulation curve [11] for balanced existence within the matrix.text/html2021-12-20T05:03:55+01:00http://www.webmedcentral.com/Dr. Deepak GuptaCan Adverse Correctional Experiences Lead To Third Victim Syndrome?
http://www.webmedcentral.com/article_view/5749
We talk about the first victim and the second victim syndrome [1-5]. However, we must also look into the third victim. The third victim may be fictional entities like corporations, towns, communities, societies and nations. However, much before the final step taken by these fictional entities to dissolve themselves under the relentless pressures of being the third victims [6], real people depending on them to survive variably suffer when the third victims are suffering. Yuval Harari may say that fictional entities cannot suffer [7-8], and he may be right that these fictional entities may not suffer per se except that they can just cease to exist after dissolution. However, their victimization as the third victims may leave real people suffering in its wake much before the actual dissolution of these fictional entities.
The immediately victimized third victims may be the corporations but the victimization effects do not cease to exist just at them where-after the victimization percolates into towns of people they serve and to nations of people they belong. Eventually, societies and environments become the far-removed third victim called humanity trotting globally and matrix forcing existence [9].
Therefore, whenever over-litigating, over-regulating and over-charging, the first victim, the second victim and the third victim eventually encompass the litigators who over-litigate, the regulators who over-regulate, and the chargers who over-charge because over-litigating, over-regulating and over-charging eventually lead to evolution of ghosts out of unsustainable vibrant and alive towns, communities, societies and nations [10-12] to which these litigators, regulators and chargers themselves belong. Each victimization that leads to new litigation, each litigation that leads to new regulation, and each regulation that leads to new charge eventually leads to new improvement per se that helps some things while harming other things. Thereafter, the cycle starts again [13], and it goes on and on because existence in problematic matrix is and remains unresolvable without nothingness.
The bottom-line is that, just like positive stress to tolerable stress becoming toxic stress to evolve adverse childhood experiences [14-15], there is a thin blurred timeline when positive litigation, positive regulation and positive charging cross over tolerable litigation, tolerable regulation and tolerable charging to become toxic litigation, toxic regulation and toxic charging inducing adverse correctional experiences for the third victims secondary to global humanity's maladapted responses to the first victims and the second victims.text/html2022-06-01T04:57:54+01:00http://www.webmedcentral.com/Dr. Deepak GuptaPentagonization of Healthcare
http://www.webmedcentral.com/article_view/5781
Healthcare used to be about physician-patient relationship. But then healthcare grew. Whether it grew because physicians might have wanted more or because patients might have needed more is another chicken or egg dilemma or paradox. Anyhow healthcare grew. With its growth came the conundrum how to manage it from going out of control. Thereafter, the circle of physician-patient relationship got pentagonized wherein physicians began becoming workers for non-physician owners (fictional/legal entities' shareholders) and patients began evolving as products [1-5] under third-party payers while everybody began getting regulated by the overseeing litigators and legislators. Why did physician-patient relationship evolve into regulator-owner-worker-product-payer pentagon? This may be because physicians could possibly neither self-regulate anymore nor provide insurmountably expansive and expensive healthcare on their own for which patients could not even imagine paying on their own when even difficult-to-pay premiums, deductibles, coinsurance, copays were weighing their medical debt-ridden lives down to their graves [6-7]. It was not clear anymore who controlled and cared for whom but one thing for sure was that healthcare got fissured [8]. Then the pandemic happened and the fissured healthcare cracked wide open with disengaged workers resigning [9] and helpless products perishing leaving hapless regulators-owners-payers clueless. What actually happened? The reach of healthcare on society got overblown and then this bubbled healthcare could not safely blow over anymore without blowing up society's economy [10-11]. Too much unnecessary healthcare got discovered and invented [12-13] which became too necessary to sustain society or at least its healthcare-dependent economy. Fissuring widened with expanding wants of regulators-owners-payers while needs of workers-products taking the heat in the backseat [14]. "Beat the Heat, Check the Backseat" became the slogan for something else [15]. What could have been done to prevent this? Healthcare costs could have been controlled well before they went out of control proving irreparably costly to the society. Overblown expansion of healthcare could have been un-necessitated well before unnecessary healthcare became economically necessary for society's survival. What's done is done. It can no longer be undone. The only thing that can happen or is already happening is that society may be suffering the payback by non-unionized workers who may be resigning en masse to either not work at all under disengaging conditions or get hired again after renegotiating the terms for bettered work-engagement. Ironically, the pentagonized healthcare has evolved workers to measure their engagement only in terms of appropriately quantified wages with appropriate quality of wage-rates because providing healthcare just for the sake of innate calling to caregiving may have inadvertently steamrolled the expectations of regulators-owners-payers that caregiving workers can feel fulfillment and remain engaged despite provisions of unpaid unequal unsatisfactory wages. Concurrently, after having evolved to helplessly and fruitlessly expect affordable healthcare costs in their own countries, patients may be choosing on a whim to explore medical tourism and even reverse emigration [16-17] to underexplored developing countries which themselves may be expecting to reap riches by providing healthcare at so-called affordable rates for those touring and/or emigrating from unaffordable developed countries until the currently welcoming countries themselves become too developed and thus unaffordable for accommodating the needs of touring and/or emigrating patients. The bottom-line is that resources may always remain limited and redistribution may always remain unequal where-after pentagonized healthcare may have to constantly juggle between needs and wants of regulators-owners-payers-workers-products because fissured healthcare may never travel back in time to revive mutual physician-patient relationship that may have been long gone and done under the pentagonized connections among regulator-owner-worker-product-payer.text/html2022-10-23T02:05:28+01:00http://www.webmedcentral.com/Dr. Deepak GuptaOverlooked Intentions Are To Unintended Consequences As Unnecessary Care Is To Caregiver Shortage
http://www.webmedcentral.com/article_view/5802
Just like naïve “Wildhood” [1] akin to adolescence as described in “Behave” [2], the developing nations are naïvely expanding and emulating healthcare coverage on the lines of developed nations like the United States (U.S.) and their Centers for Medicare & Medicaid Services. But they may have to be ready for few things:
There is a need for legal professionals. There is a need for healthcare professionals. However, is there an upper limit to how far and how much society can bear legal costs and healthcare costs [3-4]? This question may have not arisen yet in some places while this question may have been overlooked in other places. These are sensitive questions with no answers remaining right for all the time. The logic may state that when lawyers are too many, they drive society’s economy which becomes dependent on them exploring legal avenues in every human transaction and when doctors are too many, they drive society’s economy which becomes dependent on them exploring healthcare avenues in every human body. This is nobody’s fault because society needs legal and healthcare professionals but it can never know how many it truly needs or its resources can economically support. Therefore, its needs’ projections may always get overshot especially when payers for these services are well-endowed pillars of society who can bear the costs of these services at least for the time being before passing it on to the unsuspecting, ignorant and impoverished within society [5]. Thus, the question remains whether the unsuspecting, ignorant and impoverished within society will ever be ready to bear the costs of growing number of lawyers and doctors either in-training or in-practice.
The number of medical college seats thus the number of applicants appearing in eligibility determining examinations in developing nations thus the number of applicants representing 40th-50th to be eligible for admissions to medical colleges may keep on increasing but the scores representing 40th-50th percentile may keep on decreasing thus lowering the bar for eligibility to get admissions in medical colleges [6-7]. Although this bar may seem to be dwindling when compared to Medical College Admission Test® (MCAT®) conducted by Association of American Medical Colleges scoring eligibility of applicants for admissions into U.S. medical schools, MCAT® always scales the score to 472-528 with ~500 at its 50th percentile [8] so that applicants across the years successfully getting admitted into medical schools may not feel or recognize that they have scored differently compared to other successful applicants over the years. For appearances’ sake, eligibility determining examinations in developing nations too can consider scaling applicants’ scores to avoid this obvious dwindling of cut-off scores because in MCAT® even when theoretically all questions may have been answered incorrectly, still the score may be 472 or within 1st percentile considering that negative marks for incorrect answers are not there and lowest score can never be below 472 even when it may even be theoretically representing zero correctly answered question. However, U.S. medical schools give weightage to applicants’ life-stories, reference letters, grade point average (GPA), and performance in interviews which allow better triaging of applicants despite all applicants scoring 472-528 in MCAT®. Comparatively, eligibility determining examinations in developing nations may not get scaled because applicants are getting admitted to medical colleges in developing nations solely based on their numerical scores in eligibility determining examinations plus their capacity to bear the costs of medical college education although same may be somewhat true for MCAT® applicants who may consider to apply for MCAT® to score 472-528 only after readying themselves for time and money needed to be invested in their medical education. Some may even wonder whether holistic approach entrusted with administrators overseeing admissions at U.S. medical schools can ever be emulated during admissions in medical colleges in developing nations. Some may even wonder whether, to equalize all foreign as well as indigenous medical graduates’ assessment prior to their provisional or permanent medical registration to practice medicine in developing nations, eligibility determining examinations for postgraduate medical specialty programs themselves can evolve on the lines of United State Medical Licensing Examination® (USMLE®) with its scaled scoring finally designating pass/fail [9] unlike MCAT® scaled scoring without pass/fail as final outcome unless assessment tests prior to provisional or permanent medical registration to practice medicine in developing nations are feared to have extremely poor pass percentage. Interestingly, as contrasting to just common percentage (< 10%) of applicants appearing and qualifying in eligibility determining examinations to finally fill medical college seats in developing nations and as compared to only 41% of MCAT® applicants finally accepted in at least one U.S. medical school during 2019-2021 (n=164,428), it appears that only 2-3 percent of applicants failed in three-step USMLE® during 2019-2021 period while 91%-93% U.S. medical school seniors (final year students) matched into residency training programs via National Resident Matching Program® (NRMP®) in the 2022 Main Residency Match® [10] irrespective of applicants’ personal statements, letters of recommendation, Medical Student Performance Evaluations (MSPEs), medical school transcripts and performance in interviews unlike very common percentage (≥10% but much lower than those observed during USMLE® and NRMP®) of applicants appearing in eligibility determining examinations and thence succeeding in securing their admission to postgraduate medical specialty programs in developing nations. On top of all this, the number of lifetime attempts are limited to seven in MCAT® and four per step in three-step USMLE® while lifetime limits to attempts may have been erased for eligibility determining examinations in developing nations. The bottom-line is that scores documented in eligibility determining examinations in developing nations, or MCAT®, or USMLE® are only a glimpse but not the complete picture into the caliber of prospective doctors applying for these programs because many high scoring doctors may fail to practice medicine as much successfully and safely as some other doctors who may have scored very low in mandatory examinations/tests like eligibility determining examinations in developing nations, or MCAT®, or USMLE®.
The number of doctors in-training and in-practice will increase with increasing population’s unrecognized and unmet healthcare needs which would have remained unrecognized and unmet in the absence of large shockproof public and private payers to bear the costs of recognizing and meeting unrecognized and unmet needs. Now the chicken-egg paradox will prevail to ignore and overlook whether these unrecognized and unmet healthcare needs will have rather remained undiscovered in the absence of large shockproof public and private payers or will rather get invented in the presence of large shockproof public and private payers. Consequently, there will be eternal shortage of doctors [11] to fulfill readily discovered and constantly invented old and new healthcare needs of growing population supported by large shockproof public and private payers because rapidly evolving healthcare needs being paid by large shockproof public and private payers will always lead way ahead of the numbers of doctors in-training and in-practice whose numbers may never catch up to sufficiently fulfill the readily discovered and constantly invented old and new healthcare needs of growing population. The question for doctors will evolve whether the unresolvable shortage of doctors will necessitate the shortage of unnecessary and invented healthcare or the shortage of necessary and discovered healthcare. The question for payers will evolve whether the cost of screening diseases among all those who are at-risk will turn out to be more than the cost of treating diseases among all those who become sick [12]. The question for developers will evolve whether healthcare needs will evolve on the lines of Apple Inc. products wherein the needs may have to invented to be needed. The final question for system will evolve whether the always-lagging unresolvable doctor shortage will drive always-leading impossibly expanding healthcare to evolve artificial intelligence as robotic doctors thus maybe turning even the available doctors in-training as well as doctors in-practice redundant in due course of time.
The simplest thing to wonder and ponder is that it is unimaginable what the unsuspecting, ignorant and impoverished within society can and will ever achieve by detesting well-endowed pillars of society who will eventually pass healthcare costs on to them after having overlooked intentions leading to unintended consequences with unnecessary care leading to caregiver shortage.