Difference Between Skeletal Smooth and Cardiac Muscles
Quality of Health Care
1. Quality of Health Care: health
economics versus health politics
Dr. Gediminas Černiauskas
Vilnius Mykolas Romeris University
Zurich 08.09.2010
2. Objectives
• To examine why politicians and economists are getting “stronger”
in health care quality related debates
• To indicate what value added economists may provide in quality
related issues
• To provide insights assuring that “political animals” would remain
useful for modern societies
• To provide an example of a political project with marginal political
input but quite outstanding health and economic results
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3. Politics is the oldest profession of
human kind
Hypothesis: politics is the oldest profession of human kind
Proof of the hypothesis: The ape who initiated ‘’Let’s go down from
the tree!” was not a doctor, nor an economist. He or she was a
leader - a politician
Falsification of the proof: what if apes had fallen from the tree by
accident
Counter argument: Someone (politician of course) had said – “Let’s
not go back to the tree, guys!”
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4. Professions dealing with quality of
health care
• Quality of health care and quality related issues have for a long time been
almost exclusively in the domain of medical professionals
• Starting from the fall of the nineteenth century politicians stepped in for
reasons of social stability (Bismarck), grip on power (Semasho), equity and
solidarity (Beveridge)
• In parallel to the health sector becoming the major sector of the
economy, economist followed politicians bringing their concepts of
marginal costs and utility as well as the principles such as Pareto
optimality
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5. Development of health sector
*According to ILO 18,2 mil. have been employed in health and social services
in US (year 2008). At the same year manufacturing accounted for 15.9 mil.,
construction – 11.0 mil., transport – 6.5mil., agriculture – 2.2mil. 5
9. Quality of health care
Quality of health care has multiple dimensions. Let’s take some
dimensions indicated in „Assuring the quality of health care in the
European Union. A case for action“, WHO 2008
• Acces
• Safety
• Equity
• Appropriateness
• Health improvement
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10. Optimal quality
For economists overall quality of health care or consumer equilibrium is
about achieving highest possible utility. Marginal utility per Euro or Swiss
Franc spend has to be the same for all products (dimensions of quality of
health care). Overall, quality for society will grow if all dimensions of quality
will grow (for example, because of GDP growth). Let’s take 3 time periods (t-
10, t, t+10) with economic growth and corresponding optimal values (3, 5, 7)
for each health care quality dimension
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11. Why politics is a show?
Politicians have tools to cope with long term problems by using recourses
pooled by tax offices to support fundamental science, medical
universities, help the poor and the elderly. But....
• they have to face the political cycle
• to withstand pressures put forth by the medical profession, the industry,
and patients on the topic of temptation to use public recourses above the
sustainable levels
• to resolve “emergencies” created by mass media
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12. Optimal quality for health politicians
Short time optimum quality for politicians at the time period t will be not 5,
5, 5, 5, 5 but (if unnoticed you are able to misappropriate some resources
from other sectors) 6,6, 5,5,5
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13. Suboptimal quality for health
politicians
The suboptimal scenario for health politician is 5, 6, 4, 6, 4 (if you are not able
to misappropriate some resources from other sectors but able to shift some
resources from priorities of less vocal consumers of health care for the good
of groups speaking loudly)
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14. Checks and balances
• Medical professionals are against this show (at least because of the
principal “you should not harm the patient”)
• Economists are also against such short-term policies (they prefer “boring”
equilibrium and incremental changes to “bright” new ideas about radical
reforms or “miracles” created by the welfare state)
• Both groups of professionals are critical about politicians and this sceptical
approach creates a rational framework for political show
• Civil society with free press, NGO’s, elections are instrumental in limiting
scope of “dirty“ political games
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15. An example how to expose
inefficiency of political trics
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16. Doctors and economists need each
other (MTA)
Doctors and economists, while usually suspicions of each other, sometimes
(e.g. medical technology assessment or evidence based medicine) need
mutual exchange of professional expertise
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17. Good politician: a puppet of professionals, humble
servant of sovereign citizens, the leader of national
state or local community?
Politicians and civil servants sometimes are eager to show that they
are not just for “dirty games” and “stupid restrictions”. How to proceed
to be “good”?
•To look for advice. Efficient political interventions may come on the
basis of sound analysis undertaken by professionals but sometimes
this analysis is limited and academic recommendations tailored for the
particular country or period missing
•Get public‘s opinion. Sustainable (in long term) political decisions
have to be supported by the voters. The Swiss referendum system has
not been introduced in majority of the world and opinion pools are far
from providing clear picture on population needs or how to meet
them
•To undertake related risks and rise as a leader...
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18. Ending road wars: Lithuanian
experience. The background
• For many years Lithuania was one of the regional “leaders” with regards
casualties to on the roads
• Talks were talked, billions invested in to quality of roads, policemen
equipped with speed meters but there was no change
SDR, Transport accidents, per 100000
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19. Ending road wars.
The trigger for the decisive action
• On 7th November 2007 a drunken policeman driving a car
managed to kill 3 school children age 10 and escaped from the
scene
• The first reaction of the public was to lynch the bastard on the spot.
Politicians managed to calm the public, proposed measures to
tackle the problem and managed to implement the foreseen
activities
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20. Ending road wars.
Implenented measures
• More training for future drivers and 2 year probation period for
young drivers
• Intensive public awareness campaign
• Shifting some of investments from construction of highways
towards ”low priority” investments such as roundabouts on
crossroads, speed bumps. Around 20 million Euros had been spent
in 2008
• Increase of fines for speeding and non-sober driving
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22. Ending road wars.
Political results
Percentage of population trusting govermental institutions
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23. Ending road wars.
Economic assessment I
Assumptions:
• One life year saved -5000 Euro
• Number of years saved per one avoided death – 30
• Costs of treatment per 1 injured – 1000 Euro
• Discount rate – 10 percent
• Outcomes and expenditures are constant since 2009 (during first 7
months of year 2010 aditional 30% decrese of car accidents related
deaths compared to corresponding period of 2009 have been recorded)
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25. Conclussions
• Economists and politicians are legitimite
decission makers what regards Health care
quality
• Politics is a “tricky” bussines but... “Political
animals” had been instrumental not just at
the down of humanity but may be useful in
the modern age of liberalism and
professionalism
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