This document discusses several studies that estimate the effect of obesity on US healthcare costs. It first replicates the two-part model used in Cawley and Meyerhoefer (2012) on data from 2000-2005, finding similar results. It then modifies the model to use data from 2000-2012, adds further controls, and investigates time heterogeneity. The document also critiques the strengths and improvements needed in Kuo et al. (2015), which uses machine learning approaches and lifetime medical expenditures.
Expositor: Juan Ponce -Director FLACSO Ecuador
Seminario Internacional sobre Experiencia exitosas en Nutrición, organizado por el Programa Mundial de Alimentos de las Naciones Unidas (PMA) en Colombia y DSM.
14 y el 15 de mayo de 2015.
Bogotá, Colombia.
Mathematical Model for Drug Therapy in Patients With Diabetes MellitusIJESM JOURNAL
This study presents a new mathematical model for Drug Therapy in Patients with Diabetes
Mellitus which includes external rate at which blood glucose, insulin and epinephrine is being
increased in the form, ( , , ) ( )
.
Y f g h e r t i i . The system has been analyzed and solved to provide
the systems natural frequency, ω0, which is the basic descriptor of saturation level of the drug.
We establish that the resonance period for the final model, that is, T0=3.76912 hrs, agrees well
with the data for the existing insulin therapy, showing that the peak, which is the time period for
insulin to be most effective in lowering blood sugar, is in the acceptable therapeutic range.
Mathematics Subject Classification: Primary 93A30; Secondary 91B74, 93C15, 92C50, 92C42
Modelling the effects of decreasing the inter–competition coefficients on bio...IJAEMSJORNAL
The notion of a biodiversity loss has been identified as a major devastating biological phenomenon which needs to be mitigated against. In the short term, we have utilised a Matlab numerical scheme to quantify the effects of decreasing and increasing the inter – competition coefficients on biodiversity loss and biodiversity gain. On the simplifying assumption of a fixed initial condition(4,10), two enhancing factors of intrinsic growth rates, two inhibiting growth rates of intra – competition coefficients and two inhibiting growth rates of inter – competition coefficients. The novel results that we have obtained; which we have not seen elsewhere complement our recent contribution to knowledge in the context of applying a numerical scheme to predict both biodiversity loss and biodiversity gain.
Expositor: Juan Ponce -Director FLACSO Ecuador
Seminario Internacional sobre Experiencia exitosas en Nutrición, organizado por el Programa Mundial de Alimentos de las Naciones Unidas (PMA) en Colombia y DSM.
14 y el 15 de mayo de 2015.
Bogotá, Colombia.
Mathematical Model for Drug Therapy in Patients With Diabetes MellitusIJESM JOURNAL
This study presents a new mathematical model for Drug Therapy in Patients with Diabetes
Mellitus which includes external rate at which blood glucose, insulin and epinephrine is being
increased in the form, ( , , ) ( )
.
Y f g h e r t i i . The system has been analyzed and solved to provide
the systems natural frequency, ω0, which is the basic descriptor of saturation level of the drug.
We establish that the resonance period for the final model, that is, T0=3.76912 hrs, agrees well
with the data for the existing insulin therapy, showing that the peak, which is the time period for
insulin to be most effective in lowering blood sugar, is in the acceptable therapeutic range.
Mathematics Subject Classification: Primary 93A30; Secondary 91B74, 93C15, 92C50, 92C42
Modelling the effects of decreasing the inter–competition coefficients on bio...IJAEMSJORNAL
The notion of a biodiversity loss has been identified as a major devastating biological phenomenon which needs to be mitigated against. In the short term, we have utilised a Matlab numerical scheme to quantify the effects of decreasing and increasing the inter – competition coefficients on biodiversity loss and biodiversity gain. On the simplifying assumption of a fixed initial condition(4,10), two enhancing factors of intrinsic growth rates, two inhibiting growth rates of intra – competition coefficients and two inhibiting growth rates of inter – competition coefficients. The novel results that we have obtained; which we have not seen elsewhere complement our recent contribution to knowledge in the context of applying a numerical scheme to predict both biodiversity loss and biodiversity gain.
The tribal dances represent the rich cultures of Chhattisgarh. Dances are the chief means of the celebration of the tribals. These folk dances also represent the community affairs, characterized by robustness and earthiness. These dance groups are mainly the group dances which involve complex footwork.It is always wonderful to watch the dancers moving are in a line, gyrating in a circle, always in the anti-clock direction.
The drivers of public health spending: integrating policies and institutionsOECD Governance
This presentation was made by Joaquim Oliveira Martins at the 5th Meeting of the joint OECD DELSA/GOV Network on Fiscal Sustainability of Health Systems, held on 4-5 February 2016 at the OECD Conference Centre in Paris.
The Mis-measure of Health Care: Can Measurement, Improvement, and Cost Reduct...The Commonwealth Fund
Slides from the lecture "The Mis-measure of Health Care: Can Measurement, Improvement, and Cost Reduction be Reunited?" which was delivered by Eric Schneider MD on Wednesday, May 1, 2019 at The MacLean Center for Clinical Medical Ethics at The University of Chicago.
Healthcare Costs And Performance In The OECDguest112d32
The 'Healthcare Costs And Performance In The OECD' presentation was given by Alex Rascanu to University of Toronto class on Economics for Public Management - Expenses in June 2009. More information on the author:
http://www.rascanu.com
Healthcare Costs And Performance in the OECDAlex Rascanu
The 'Healthcare Costs And Performance in the OECD' presentation was initially given to the University of Toronto class of Economics for Public Management – Expenses, in June 2009. For more information on the author:
http://www.rascanu.com
http://www.twitter.com/alexrascanu
The tribal dances represent the rich cultures of Chhattisgarh. Dances are the chief means of the celebration of the tribals. These folk dances also represent the community affairs, characterized by robustness and earthiness. These dance groups are mainly the group dances which involve complex footwork.It is always wonderful to watch the dancers moving are in a line, gyrating in a circle, always in the anti-clock direction.
The drivers of public health spending: integrating policies and institutionsOECD Governance
This presentation was made by Joaquim Oliveira Martins at the 5th Meeting of the joint OECD DELSA/GOV Network on Fiscal Sustainability of Health Systems, held on 4-5 February 2016 at the OECD Conference Centre in Paris.
The Mis-measure of Health Care: Can Measurement, Improvement, and Cost Reduct...The Commonwealth Fund
Slides from the lecture "The Mis-measure of Health Care: Can Measurement, Improvement, and Cost Reduction be Reunited?" which was delivered by Eric Schneider MD on Wednesday, May 1, 2019 at The MacLean Center for Clinical Medical Ethics at The University of Chicago.
Healthcare Costs And Performance In The OECDguest112d32
The 'Healthcare Costs And Performance In The OECD' presentation was given by Alex Rascanu to University of Toronto class on Economics for Public Management - Expenses in June 2009. More information on the author:
http://www.rascanu.com
Healthcare Costs And Performance in the OECDAlex Rascanu
The 'Healthcare Costs And Performance in the OECD' presentation was initially given to the University of Toronto class of Economics for Public Management – Expenses, in June 2009. For more information on the author:
http://www.rascanu.com
http://www.twitter.com/alexrascanu
This second edition of the health system review of Philippines shows the major changes that have occurred over the 7 years since the last review. Channelling of funds from sin tax to Health has shown unprecedented levels of finances are now available for UHC. PhilHealth has dramatically increased coverage of people as well as service providers that it works with from both government and non-government sectors. However major challenges remain; regional and socioeconomic disparities in the availability and accessibility of resources are prominent and there is a need to improve regulation of service providers. Philippines HiT reports on the current health system reforms undertaken including challenges of incorporating primary health care as in the overall health architecture of the country.
Chapter 2Factors influencing the application and diffusion of .docxcravennichole326
Chapter 2
Factors influencing the application and diffusion of CQI in health care
Contents
Introduction
The dynamic character of CQI
A CQI case study
The current state of CQI in healthcare
CQI and the science of innovation
The business case for CQI
Factors affecting successful CQI application
Introduction
CQI is utilized across health care sectors (including primary and preventative care) as well as across geographic and economic boundaries
The need for CQI is increasing
One reason: the safety and quality of care has shown little improvement over the last decade despite best efforts of clinicians, managers, researchers, and involvement of public
This lecture will review a number of factors and processes have been shown to facilitate or impede the implementation of CQI in health care
The Dynamic Character of CQI
CQI methodology is constantly being refined and tested: it is an evolutionary quality improvement mechanism
This is because in response to new challenges, CQI applications develop via continuous, ongoing learning and sharing among disciplines about ways to use CQI philosophies, processes and tools in a variety of settings
The Surgical Safety Checklist:
a CQI Success Story
Checklist CQI methodology orginated in aviation
2001 utilised by Pronovost (2006) in Intensive Care Units as a way of reducing central line infections
Surgical Safety Checklist (SSC) developed by Gawande (2009) is disseminated by WHO across the world
The Surgical Safety Checklist:
a CQI Success Story
Development of SSC depended upon:
Effective leadership
Interdisciplinary teamwork
Use of a PDSA improvement cycle to test, learn and improve
Engagement of a broad range of expertise to improve safety on a global scale
The Surgical Safety Checklist:
a CQI success story
Results vary but after the introduction of the SSC:
Haynes et al. (2009) demonstrated a reduction in complication rates from 11.0% at baseline to 7.0% plus, and a reduction in death rates from 1.5% to 0.8% in eight hospitals in eight cities
The SURPASS group study of six hospitals in the Netherlands, showed a statistically significant decrease in the proportion of patients with one or more complications, from 15.4% to 10.6% (de Vries et al. 2010).
So if Checklists are Successful …
Why aren’t more healthcare providers using CQI tools and processes?
Why is the gap between knowledge and practice so large?
Why don’t clinical systems incorporate the findings of clinical science or copy the “best known” practices reliably, quickly, and even gratefully into their daily work simply as a matter of course?
Limitations of Checklists
May be too simple a tool and what is required is more complex system solutions to quality and safety issues (Bosk et al. 2009).
Problems with checklists are indicative of broader CQI and quality improvement issues in healthcare including:
Process vs. outcome;
Cost vs. benefit vs. value;
Minimum standards required to define evidence for change;
How to balanc ...
Unit 5Instructions Enter total points possible in cell C12, under.docxmarilucorr
Unit 5Instructions: Enter total points possible in cell C12, under the rubric. Next enter scores (between 0 and 4) into yellow cells only in column F.Evidence-Based Clinical Question SearchUnsatisfacotrySatisfactoryAverageExcellentScoreWeightFinal Score1234Identify your refined PICOT question.IncompleteN/AN/AComplete05%0.00Using PubMed and the Cochrane collaboration database, do a systematic review of your clinical question.IncompleteN/AN/AComplete010%0.00Describe your systematic review and include an errors analysis.IncompleteN/AN/AComplete010%0.00Determine an evidence-based quantitative article from the search that contains an evidence-based randomized control trial.IncompleteN/AN/AComplete010%0.00Summarize the case study selected.IncompleteN/AN/AComplete05%0.00Describe the study approach, sample size, and population studied.IncompleteN/AN/AComplete05%0.00Apply the evidence from this review to your practice specifically in your overview.IncompleteN/AN/AComplete010%0.00Evaluate the outcomes, identifying the validity and reliability.IncompleteN/AN/AComplete010%0.00Discuss if the study contained any bias.IncompleteN/AN/AComplete010%0.00Determine the level of evidence identified in the review.IncompleteN/AN/AComplete010%0.00LengthLess than 7 pages8 pages9 pages10 pages 05%0.00Format/StyleDid not follow APA formatMajor errors with APA formattingText, title page, and references page follow APA guidelines . Minor references and grammar errorsText, title page and references page follow APA guidelines. No grammar, word usage or punctuation errors. Overall style is consistent with professional work.010%0.00100%0.00Final Score0Percentage0.00%Total available points =2504Rubric ScoreGrade pointsPercentageLowHighLowHighLowHigh3.54.022525090%100%2.53.4920022580%89.99%1.72.4917520070%79.99%1.01.6915017560%69.99%0.01.000150059.99%Comments:
Running head: EFFECTIVE OBESITY MANAGEMENT 1
EFFECTIVE OBESITY MANAGEMENT 2
Effective Obesity Management
Kaplan University
Topic Selection 42/42
EBP Overview 48/48
Length 6/6
Format/Style 20/24
Total 116/120 Outstanding paper with APA errors.
Introduction
With this paper, I will share my research topic question, after much consideration, I came across the best way to address the question and yield evidence based practice results. My question is: is bariatric surgery effective in yielding long term success when compared to lifestyle changes, in the obese population? I will also include the use of reputable reliable search resources such as Cochrane Database. There are significant healthcare issues that can be addressed within my area of specialty, and the focus in healthcare should be to create a better environment where best healthcare decisions can be made. The understanding of these healthcare issues provides a better environment where better pr ...
DELSA/GOV 3rd Health meeting - Gijs VAN DER VLUGT, Camila VAMMALLE, Claudia H...OECD Governance
This presentation by Gijs VAN DER VLUGT, Camila VAMMALLE and Claudia HULBERT was made at the 3rd Joint DELSA/GOV Health Meeting, Paris 24-25 April 2014. Find out more at www.oecd.org/gov/budgeting/3rdmeetingdelsagovnetworkfiscalsustainabilityofhealthsystems2014.htm
1. The Effect of Obesity on US Healthcare Costs
Enoch Chan
Neil Cho
Yuan Fei
Jessica Koh
May 15, 2015
Enoch Chan Neil Cho Yuan Fei Jessica Koh The Effect of Obesity on US Healthcare Costs May 15, 2015 1 / 12
2. Outline
Outline
1 Model Replication (Cawley and Meyerhoefer (2012))
Two-Part Model
Instrumental Variables
Replications Results
Limitations
2 Modifications
Final Results
3 Critique of Kuo, et al. (2015)
Strengths
Improvements
4 References
Enoch Chan Neil Cho Yuan Fei Jessica Koh The Effect of Obesity on US Healthcare Costs May 15, 2015 2 / 12
3. Model Replication (Cawley and Meyerhoefer (2012)) Two-Part Model
Two-Part Model (2PM)
Part 1: Logit
ln
pit
1 − pit
= β1BMIit + αt + Xitβc + it (1)
We obtain Pr(MedEx > 0)
Part 2: Gamma GLM with Log Link
ln(µYit
) = β1BMIit + αt + Xitβc + uit Yit ∼ Γ(α, β) (2)
Run on the subset of data where MedEx > 0
We obtain E[MedEx|MedEx > 0]
We obtain
E[MedEx|BMI, αt, Xc] = Pr(MedEx > 0) × E[MedEx|MedEx > 0] (3)
Enoch Chan Neil Cho Yuan Fei Jessica Koh The Effect of Obesity on US Healthcare Costs May 15, 2015 3 / 12
4. Model Replication (Cawley and Meyerhoefer (2012)) Instrumental Variables
Instrumental Variables
Motivation
Obesity may be endogenous
Possible mismeasurement error
Implementation
BMIit = β1BMIeld,it + β2BMI2
eld,it + αt + Xitβc + it (4)
Use two-degree polynomial of BMI of eldest biological child to
instrument for BMI
Use Obesity indicator of eldest biological child to instrument for
Obesity
We obtain ˆBMIit. Substitute ˆBMIit for BMIit in the two-part model.
Enoch Chan Neil Cho Yuan Fei Jessica Koh The Effect of Obesity on US Healthcare Costs May 15, 2015 4 / 12
5. Model Replication (Cawley and Meyerhoefer (2012)) Replications Results
Replication Results
Cawley and Meyerhoefer’s results:
IV: BMI: 149 (35), Obesity: 2741 (745)
Non-IV: BMI: 49 (9), Obesity: 656 (113)
Table: Marginal Effect Estimates from Two-Part Model (2000 to 2005 data)
IV (total expenditure) Non-IV (total expenditure)
VARIABLES (1) (2) (3) (4)
BMI 125.696** 68.848***
(40.306) (9.540)
Obesity 2062.187* 647.113***
(732.5577) (116.860)
Observations 40,421 40,421 40,421 40,421
Robust standard errors in parentheses
*** p<0.01, ** p<0.05, * p<0.1
We cluster standard errors at the household level
Enoch Chan Neil Cho Yuan Fei Jessica Koh The Effect of Obesity on US Healthcare Costs May 15, 2015 5 / 12
6. Model Replication (Cawley and Meyerhoefer (2012)) Limitations
Limitations
Instrumental variable validity
Genes that influence weight may also affect other unknown factors that
could affect residual medical costs
Non-longitudinal data
Unable to track respondents over time and estimate long-term effects
Mismeasurement in data
Generalizability of results
Limited to adults with biological children between ages of 11-20
Possible underestimation of results
Enoch Chan Neil Cho Yuan Fei Jessica Koh The Effect of Obesity on US Healthcare Costs May 15, 2015 6 / 12
7. Modifications
Modifications
1 Validity of the two-part model
Health expenditures are actual outcomes
The zeros in our data are “true zeros”
Frondel and Vance (2012): two-part model is most appropriate
2 Baseline model: expand time horizon to 2000-2012
Table: Marginal Effect Estimates from Two-Part Model (2000 to 2012 data)
IV (total expenditure) Non-IV (total expenditure)
VARIABLES (1) (2) (3) (4)
BMI 169.425*** 85.616***
(30.313) (7.234)
Obesity 3297.591*** 982.399***
(558.406) (97.053)
Observations 88,880 88,880 88,880 88,880
Robust standard errors in parentheses
*** p<0.01, ** p<0.05, * p<0.1
Enoch Chan Neil Cho Yuan Fei Jessica Koh The Effect of Obesity on US Healthcare Costs May 15, 2015 7 / 12
8. Modifications
Modifications
3 Further controls
Motivation: control for the effect of diseases with genetic causes that
are unrelated to obesity
Additional controls: health perception, insurance coverage
4 Investigating time heterogeneity
Motivation: increase in marginal effect of obesity when comparing the
2000-2012 sample with the 2000-2005 sample
Interaction terms between BMI/obesity and year fixed effects
Only 2012 showed a significant effect - topic for further research
Enoch Chan Neil Cho Yuan Fei Jessica Koh The Effect of Obesity on US Healthcare Costs May 15, 2015 8 / 12
9. Modifications Final Results
Final Results
Table: Marginal Effect Estimates from Two-Part Model with Further Controls
(2000 to 2012 data)
IV (total expenditure) Non-IV (total expenditure)
VARIABLES (1) (2) (3) (4)
BMI 93.136*** 35.979***
(29.527) (6.676)
Obesity 1956.029*** 293.408***
(552.047) (90.678)
Observations 88,880 88,880 88,880 88,880
Robust standard errors in parentheses
*** p<0.01, ** p<0.05, * p<0.1
Enoch Chan Neil Cho Yuan Fei Jessica Koh The Effect of Obesity on US Healthcare Costs May 15, 2015 9 / 12
10. Critique of Kuo, et al. (2015) Strengths
Strengths of Kuo, et al. (2015)
Use Machine Learning approaches to determine optimal model and
instrument
Box-Cox transformation, Markov Field
Refines definition of obesity into finer categories
Innovative use of Lifetime Medical Expenditures (LME)
Enoch Chan Neil Cho Yuan Fei Jessica Koh The Effect of Obesity on US Healthcare Costs May 15, 2015 10 / 12
11. Critique of Kuo, et al. (2015) Improvements
Improvements for Kuo, et al. (2015)
Instrumental variables
Validity: using average family weight as the instrument does not solve
the endogeneity problem
Implementation: unclear where and how IV is implemented
Implementation of LME
Calculation of LME per age group is a linear approximation of a
nonlinear relationship
Major difference between predicted marginal effect of obesity on LME
for men and women
Enoch Chan Neil Cho Yuan Fei Jessica Koh The Effect of Obesity on US Healthcare Costs May 15, 2015 11 / 12
12. References
References
Cawley, John and Meyerhoefer, Chad. “The medical care costs of
obesity: An instrumental variables approach.” Journal of Health
Economics, 2012, 31(1), pp.219-230.
Frondel, Manuel and Vance, Colin. “On Interaction Effects: The
Case of Heckit and Two-Part Models.” Ruhr Economic Papers, 2012,
309(1), pp.1-21.
Enoch Chan Neil Cho Yuan Fei Jessica Koh The Effect of Obesity on US Healthcare Costs May 15, 2015 12 / 12