A blog covering the health/care ecosystem and people.

What if you went to visit a Vermeer still life with fruit, vegetables, and flowers, and the only image you saw in the famous painting was the flower and an urn? What if you heard the sounds of a juicing machine whirring as you reflected on a Rembrandt? That’s exactly what happened to museum-goers visiting Amsterdam’s Rijksmuseum. These art patrons witnessed a museum guard literally pulling an apple out of a painting, to leave a barren portrait of an urn and little else. Roll over, Anthony Oberman, the artist of “Still Life with Fruit in a Terracotta Dish,” one of

            I greatly appreciated the opportunity today to attend a luncheon at the HX360 meeting which convened as part of the 2018 HIMSS Conference. The speaker at this event was Paul Krugman, who won the Nobel Prize for Economics 10 years ago and today is an iconic op-ed columnist at the New York Times And Distinguished Professor of Economics at the City University of New York (CUNY). I admit to being a bit of a groupie for Paul Krugman’s work. It tickles me to look at Rise Global’s list of the Top 100 Influential Economists:

“Spend more. Get less.” If a retailer advertised using these four words, how many consumers would buy that product or service? This is the American reality of healthcare spending in 2016, told in the OECD report, Health at a Glance 2017. I present five charts from the study in this post, which together take the current snapshot health-economic lesson for the U.S. First, look at health expenditures as a share of gross domestic product: the U.S. is number one above Switzerland, France, and the UK, and about two times the OECD average. Note, too, the proportion of out-of-pocket and so-called

Obesity, conflict, and mental illness contribute most to the ill health and mortality of the world’s population – especially in the U.S., according to the annual Global Burden of Disease study published this month in The Lancet and funded by The Bill & Melinda Gates Foundation. There’s good news and bad news in this research: on the upside, people are living longer. On the downside, there’s a lot of morbidity – that is, sub-optimal health – in those years. The study examines both YLLs (years of life lost) and YLDs (years lived with disability). “Death is a powerful motivator, both

The Netherlands, France and Germany are the best places to be a patient, based on the Global Access to Healthcare Index, developed by the Economist Intelligence Unit (EIU). Throughout the world, nations wrestle with how to provide healthcare to health citizens, in the context of stretched government budgets and demand for innovative and accessible services. The Global Access to Healthcare Index gauges countries’ healthcare systems in light of peoples’ ability to access services, detailed in Global Access to Healthcare: Building Sustainable Health Systems. The United States comes up 10th in line (tied with Spain) in this analysis. Countries that score the

CNN called it, “the ancient perfume store you never heard of,” but the Officina Profumo-Farmaceutica di Santa Maria Novella had its literal roots in medicinal herbs. With scents wafting onto a 13th century Florence piazza, the Farmacia now operates as a pharmacy storefront for homeopathic and herbal supplements, along with perfumes and home scents. A visit to the pharmacy today is a journey into medicinal time-travel, back to the year 1221. I spent time in the pharmacy today to learn about the literal roots of the shop in medicinal herbs cultivated in a monastery garden and reformulated by monks into

States that expanded Medicaid since the start of the Affordable Care Act made greater health system access improvements than those States that did not expand Medicaid, according to Aiming Higher: Results from the Commonwealth Fund Scorecard on State Health System Performance. There’s good news and bad news in this report: on the upside, nearly all states saw health improvements between 2013 and 2015, and in particular, for treatment quality and patient safety. Patient re-admissions to hospitals also fell in many states. But on the downside, premature deaths increased in nearly two-thirds of states, a reversal in the (improving) national mortality

Americans are more than five times more likely to skip medication doses or not fill prescriptions due to cost than peers in the United Kingdom or Switzerland. U.S. patients are twice as likely as Canadians to avoid medicines due to cost. And, compared with health citizens in France, U.S. consumers are ten-times more likely to be non-adherent to prescription medications due to cost. It’s very clear that more consumers tend to avoid filling and taking prescription drugs, due to cost barriers, when faced with higher direct charges for medicines. This evidence is presented in the research article, Cost-related non-adherence to prescribed

More U.S. patients are faced with spending more out-of-pocket for health care services, to meet high-deductible health plans and rationally spend their health savings account investments. As rational economic men and women, some are seeking care outside of the United States where many find transparently priced, high-value, lower-cost healthcare. Check out the table from the Medical Tourism Association, and you can empathize with cash-paying patients looking for, say, gastric bypass surgery or a heart valve replacement. My latest column in the Huffington Post discussed this trend, which points first to the Cleveland Clinic — a top-tier American healthcare brand that’s

“A full medical team via your mobile,” leads an article on clickdoctors.se, covering a Spanish mHealth start-up. This, in the February 2015 (Febrero 2015) issue of ling, the Vueling airlines magazine. I am flying from Florence, Italy, to London via Vueling airlines, heading from an art-and-Slow Food-filled holiday to a couple days of work in the UK. So imagine my surprise as I head to work on digital health and food projects in London reading this article enroute, in the lovely skies flying above the Alps. The story begins: “In 2050 Spain will be, along with Japan, one of the countries

People in the U.S. have lower life expectancy, a growing alcohol drinking problem, and relatively high hospital inpatient rates for chronic conditions compared with other OECD countries. And, the U.S. spends more on health care as a percent of GDP than any other country in the world. This isn’t new-news, but it confirms that U.S. health citizens aren’t getting a decent ROI on health spending compared with health citizens around the developed world. In the OECD’s latest global look at member countries’ health care performance, Health at a Glance 2015, released today, the U.S. comes out not-so-healthy in the context

On this day celebrating Martin Luther King, Jr., I post a photo of him in my hometown of Detroit in 1963, giving a preliminary version of the “I Have a Dream” speech he would give two months later in Washington, DC. As I meditate on MLK, I think about health equity. By now, most rational Americans know the score on the nation’s collective health status compared to other developed countries: suffice it to say, We’re Still Not #1. But underneath that statistic is a further sad state of health affairs: that people of color in the U.S. have lower quality of

It’s Independence Day week in America, and our British friends at The Lancet, the UK’s grand peer reviewed medical journal, dedicate this week’s issue to the Health of Americans – exploring life, death (mortality), health costs, chronic disease, and the Pursuit of Healthiness. This project is a joint venture between The Lancet and the U.S. Centers for Disease Control (CDC) which took 18 months to foster, called The Health of Americans Series. Americans mostly die from chronic diseases, aka non-communicable diseases, which are largely amenable to lifestyle changes like eating right, quitting smoking, drinking alcohol in moderation, and moving around more. 1 in

Women and binge drinking…job and financial stress…sleeplessness…caregiving challenges…sex…these were the topics covered in Health 2.0 Conference’s session aptly called “The Unmentionables.” The panel on October 1, 2013, was a rich, sobering and authentic conversation among 7 women and 1 man who kept it very real on the main stage of this mega-meeting that convenes health technology developers, marketers, health providers, insurers, investors, patient advocates, and public sector representatives (who, sadly, had to depart for Washington, DC, much earlier than intended due to the government shutdown). The Unmentionables is the brainchild of Alexandra Drane and her brilliant team at the Eliza

The American health infrastructure is not First World or First Rate, based on the outcomes. This, despite spending more on health care per-person than any country on the planet. Two seminal reports are out this week reminding Americans that our return-on-investment in health spending is poor. The first research comes from JAMA titled  The State of US Health, 1990-2010:  Burden of Diseases, Injuries, and Risk Factors. There is some good news in this report at the top line: that life expectancy for Americans increased in the two decades from 75.2 years to 78.2 years. But this positive quantitative outcome comes with

Comparing health care prices in the U.S. with those in other developed countries is an exercise in sticker shock. The cost of a hospital day in the U.S. was, on average, $4,287 in 2012. It was $853 in France, a nation often lauded for its excellent health system and patient outcomes but with a health system that’s financially strapped. A routine office visit to a doctor cost an average of $95 in the U.S. in 2012. The same visit was priced at $30 in Canada and $30 in France, as well. A hip replacement cost $40,364 on average in the

While 50% of Americans feel they have a sound financial position, the other half is living paycheck to paycheck. 8% say they can’t even pay for essentials. The second annual Allstate “Life Tracks” Poll finds American adults split between have’s and have not’s, with even the “have’s” feeling less than financially literate. There is an equal split between people who feel they’re in an “excellent” or “good” financial position compared with those who feel they’re in financially “fair” or “poor” shape. Men feel more financially secure than women; 3 in 4 single parents feel less well-off compared to the average

On a recent Whole Living segment on Martha Stewart’s Sirius XM radio channel, I learned of the artisan chocolatier, Gnosis. The company, whose name is Greek for “knowledge,” grew out of the kitchen of a holistic health counselor, Vanessa Berg, who began to make nutritionally-infused sweets for her private clientele. Word-of-mouth made its way to a buyer from Whole Foods, who subsequently did a deal with Berg to sell Gnosis goods in some of the company’s stores in New Jersey and New York. Here’s a link to the radio interview. Chocolate is a health food for this company, and for

On this day celebrating Martin Luther King, Jr., I post a photo of him in Detroit in 1963, giving a preliminary version of his “I Have a Dream” speech he would give two months later in Washington, DC. As I meditate on MLK, I think about health equity. By now, most rational Americans know the score on the nation’s collective health status compared to other developed countries: suffice it to say, We’re Not #1. But underneath that statistic is a further sad state of health affairs: that people of color in the U.S. have lower quality of health than white

  Consumers’ online access to electronic health records is growing in and outside of the U.S. — particularly evident in the U.K., where the National Health Service (NHS) patients are being given online access to their health records held by primary care providers (GPs). This program is termed “Record Access” and could morph into the larger concept of personal health records which, today, aren’t prevalent in the U.K. A new report analyzes U.K. consumers’ perceptions about online health record access called, Personal Health Records: Putting Patients in Control? The report was published in the UK by 2020health.org with support from Microsoft. The report is written

$132 won’t go far in a U.S. emergency room, but in Vietnam, it gets you first class treatment, a highly-trained and empathetic French doctor, and cheap prescriptions, as well. You could call it Presidential treatment, as a certificate from the White House was proudly displayed in the lobby waiting area sent in appreciation of great care received by President George W. Bush. After arriving in Hanoi two nights ago, following three airline flights over nearly 24 hours, our daughter developed a rough cough that gave her chest pains. We gave the condition one day to improve and then spoke with

Every patient carries her or his doctor inside, said the great Renaissance man, Albert Schweitzer. Based on Euro RSCG Worldwide’s Prosumer Report – My Body, Myself, Our Problem: Health and Wellness in Modern Times, health citizens globally have begun to take on Dr. Schweitzer’s vision. Clement Boisseau of Euro RSCG points out that people, globally, are fairly schizophrenic when it comes to thinking about empowerment over illness: check out the chart for perceptions by condition and disease state. Boisseau says that people perceive health today both in modern terms (such as feeling empowered to control some conditions), and archaic or “magically

This week’s mHealth Summit in Washington, DC, features scores of presentations, posters, and corporate announcements demonstrating the typical chaos of emerging technology markets: the Big Question at this stage on S-curves for new tech is always, “what’s the timing of the pace of change,” or for you mathematically-inclined readers, “what’s the slope of the mHealth adoption curve?” Before we address that question, let’s be transparent about the fact that there are several definitions of just what ‘mHealth’ is: purists may conceive it as covering only those health tools and applications that ‘go’ mobile–that is, that are deployed via mobile phones and

By 2050, the demand for long-term care (LTC) workers will more than double in the developed world, from Norway and New Zealand to Japan and the U.S. Aging populations with growing incidence of disabilities, looser family ties, and more women in the labor force are driving this reality. This is a multi-dimensional problem which requires looking beyond the issue of the simple aging demographic. Help Wanted? is an apt title for the report from The Organization of Economic Cooperation and Development (OECD), subtitled, “providing and paying for long-term care.” The report details the complex forces exacerbating the LTC carer shortage, focusing

Representatives from eight U.S. Federal government agencies, including the FDA and Veterans Administration, among others; health financiers (VCs, angels); health tech start-ups; providers, life science companies, and analysts, attended the Health Care Innovation Day DC sponsored by West Wireless Health Institute on April 28, 2011. The meeting had the tagline, A Discussion with the FDA, setting the stage for a day-long consideration of the role of regulation vis-a-vis health innovation. The $2.5+ trillion question (annual spending on health care in the U.S.) is: can innovation drive making health care “cheaper?” This was the underlying theme of the panel on which I sat

There’s cameraphone hacking that morphs the phone into a blood test device. Embrace Labs in India builds an incubator for $25. Micro- mobile payments are financing health care on the ground in emerging economies.   At SXSW in Austin, TX, on March 12, 2011, a globally experienced quartet of panelists shared their observations of working with highly constrained budgets in developing countries during the session, Mobile Health in Africa: What Can We Learn? The answer is: plenty. Doug Naegele of Infield Health moderated the panel, which included Patricia Mechael of the Center for Global Health and Economic Development at the Earth Institute, part of Columbia University; Josh

While innovation, writ large, is an engine for economic growth, it’s especially going to positively impact many aspects of health and health care, based on GE’s Global Innovation Barometer 2011. To prep for this week’s meeting of thought leaders at the World Economic Forum in Davos, Switzerland, GE surveyed 1,000 senior business executives in 12 countries in December 2010 and January 2011. Execs were surveyed from 12 countries including Australia, Brazil, China, Germany, India, Israel, Japan, S. Korea, Saudi Arabia, UAE, Sweden and the U.S. While execs agree that virtually all aspects of citizens’ lives will be positively improved by innovation over

1 in 2 people who use the internet to seek health information do so to self-diagnose; this is highest in China, US, UK, Russia, and Australia. Furthermore, health citizens in emerging economies including India, Russia, China, Brazil, and Mexico, may rely more on online health searches than people in developed countries. In these regions, health seekers face high costs of face-to-face visits with medical professionals. These global findings come out of the report, Online Health: Untangling the Web, from Bupa. Bupa is a health company based in the UK that serves 10 million members in 190 countries, and another 20 million

‘Tis the season for luxury goods spending, if you’re lucky: under the tree, you might find a Swiss watch from Baume & Mercier or Piaget; , chocolates boxed from Lindt & Sprüngli; or a Bally-branded handbag. If you have to stay in a hospital in Switzerland, the average cost of one inpatient night would be $617. That same overnight stay in a U.S. hospital would be $3,612 — a luxury good by any standard. The U.S. inpatient stay average cost ranges from a low of $1,595 (about 2.5 times greater than the Swiss rate) and a high of $14,306 (at the 95th percentile). These costs come from

Virtually every primary care doctor in Denmark uses an electronic medical record. Danish health citizens can access their laboratory results, medication profiles, waiting list information, and other information through a digital signature: over 1 million of 5.5 million Danes have done so.   This week, I had the honor of kicking off the online health track at the J. Boye 2010 conference in Aarhus, Denmark. I spent time with an HIT guru from a major Scandinavian university hospital; a member of the Danish public sector HIT organization; marketers from the pharmaceutical industry; an entrepreneur building a portal for the growing private health sector to bring transparency of quality,

The $N zillion question – whether translated into Euros, yen, pounds, lira, or pesos – is how to get more quality care and access in national health systems, while curbing health spending. Health costs have increased faster than economic development in nearly all OECD countries in the past 15 years. For the acronym-challenged, the OECD is the Organization of Economic Cooperation and Development – comprised of, generally, the most economically developed nations on Earth. This week, health maestros from OECD nations are meeting to wrestle this intractable challenge. Health costs consume about 9% of OECD countries’ budgets. This proportion of national GDPs

The U.S. has among the lowest tax-to-GDP ratios in the developed world, including state and local taxes. Only Mexico, Turkey and Korea have lower tax-to-GDP ratios among OECD members, at somewhere between 20 and 28%. The Organization for Economic Cooperation and Development (OECD) believes that U.S. tax rates are, in fact, too low and, even with modest tweaks upward, “would still keep the overall tax burden at a relatively moderate level and not impose excessive costs,” OECD states in its Economic Survey of the U.S., released today. “Tax breaks have grown significantly since the major tax reform of 1986,” the report notes, and

Welcome, HolaDoctor, to the growing roster of consumer-facing health portals. La differencia, this time, is that HolaDoctor is an entirely Spanish-speaking website of comprehensive health information. The site focuses on health content and tools highly targeted to Hispanics and health issues of most concern. Known previously as DrTango, founded in 1999, HolaDoctor has at least 1.3 million Hispanic consumers who have registered on its site, and operates over 500 multilingual health websites under its corporate umbrella. The morphing from DrTango to HolaDoctor has to do with the organization’s launch of its consumer-focused health and wellness portal reaching out to Spanish speakers in the

  Among seven developed countries – Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom and the United States of America — it’s the U.S. that ranks dead last in the effectiveness of the nation’s health system. In particular, the U.S. rates poorly on the issues of coordination of health care, cost-related problems causing access challenges for health citizens, efficiency, equity, and long/healthy/productive lives for citizens. Of course, it also figures in that the U.S. spends more per capita on health care than any other country on the planet: $7,290 per person compared with Health Nation #1, the Netherlands, which

I’m in a country this week where 66% of health providers have adopted 9 of 14 critical electronic health applications, according to a study from The Commonwealth Fund. According to the same study, only 26% of U.S. providers have opted into these functions.    As I amble across cobblestoned and craggy streets, looking up to frescoe’d facades on 500 year old palazzi, church domes and the bluest sky ever, the signs of the Italian Renaissance are everywhere in walkable Florence, Italy.     But it’s not all art and architecture, gelato and chianti for me this week. It’s also the techno-reality

In 2008, mass media coverage of vaccines seemed more focused on pop celebrity fights, pro- and con-, versus scientific revelations. Will 2009 yield more knowledge and less confusion? 2008 was something of an Amanda Peet-versus-Jenny McCarthy show, pro v. con, taking place on the covers of People magazine and in YouTube videos. But just in the past few weeks, there’s been a subtle shift in news about vaccines toward more solid information. The headline points are: Minnesota children came down with the Hib virus, with blame going first to the Hib vaccine shortage and possibly, too, to 3 in 5

In this season’s Health System Idol contest, the U.S. loses to most other developed countries. One in three Americans would like to “completely rebuild” the U.S. health system, according to The Harris Poll conducted in ten nations.   And another 50% believe that, “fundamental changes are needed to make it work better.”   Harris also measured ‘unpopularity’ with another metric: asking whether, “the system works pretty well and only minor changes are necessary.” Adding this yin to the other yang, the mash-up is still the same: the U.S. plays last fiddle to the rest of the world’s health system orchestra.

The UAW and GM have been debating health care as Friday’s deadline for their national contract approaches. This round of negotiation is about survival. Yesterday, I covered the rising costs of employer-sponsored health insurance. Today, let’s visit the intimately-related topic of retiree health benefits. These are eroding even faster than health benefits for employed workers. Many employers have significantly scaled back health benefits for retirees. Currently, one in three large employers offers retire benefits, compared with two in three in the late 1980s. Consider the predicament of the company ranked #3 on the 2006 Fortune 500 list, General Motors. Retirees