In conjunction with National Public Health Week 2009, the American Public Health Association has initiated a campaign to build a foundation for healthier nation.
http://www.generationpublichealth.org/
This video is short and well done. It hits a lot of the points we've been talking about all year.
Monday, April 6, 2009
Friday, February 20, 2009
Case Mixing and Hospitals
We had a discussion recently in our course Strategy and Financial Management of Health Care about how various insurers (state, private, self-pay) pay for medical care and how hospitals charge different rates for each of them. This has less to do with desire on the hospital's part to treat customers differently, and more to do with the fact that the government can set what they will pay for a given service at pretty much any level they want. As a result, Medicare and Medicaid payments usually do not even meet the break even point for the care that is given. Therefore, hospitals are forced to pass of this deficit to private insurers and self-paying patients.
We then discussed two ways in which this effects health care. The first is that branches of medicine that cater primarily to lower-income or older individuals (Psychiatry for instance) are far less profitable than other areas of medicine. This results in many hospitals avoiding providing this service or having to pursue more lucrative fields in order to subsidize the losses they suffer by offering those services. The second area has to do with public policy. When states make cuts to Medicaid (like what may happen in NH) they often due so by reducing their reimbursement rates for procedures. Since the volume of care being given does not change, hospitals have larger deficits from Medicaid procedures. This results in them increasing their charges to private insurers (who are happy to pass the charge onto their customers) and self-payers. As a result, attempts to balance budgets by cutting Medicaid can be essentially the same as raising taxes, as the costs are passed back to the consumers and taxpayers.
We then discussed two ways in which this effects health care. The first is that branches of medicine that cater primarily to lower-income or older individuals (Psychiatry for instance) are far less profitable than other areas of medicine. This results in many hospitals avoiding providing this service or having to pursue more lucrative fields in order to subsidize the losses they suffer by offering those services. The second area has to do with public policy. When states make cuts to Medicaid (like what may happen in NH) they often due so by reducing their reimbursement rates for procedures. Since the volume of care being given does not change, hospitals have larger deficits from Medicaid procedures. This results in them increasing their charges to private insurers (who are happy to pass the charge onto their customers) and self-payers. As a result, attempts to balance budgets by cutting Medicaid can be essentially the same as raising taxes, as the costs are passed back to the consumers and taxpayers.
Friday, February 6, 2009
A week in the life . . .
A week in the life . . .
TDI is a very busy place with new things happening all the time. I thought it would be good to share an average week for a student here at TDI. . .
A class dealing with the strategic and financial management is required for the MPH degree and optional for the MS students. This class allows us to work in small groups and get inside various health care organizations and study their financials and management techniques. This past week began with a conference call to the CEO of Concord Hospital in Concord, NH. On this particular call, the CEO was very open about the hospital current financial growth as well as goals for the near future. That evening I went to co-ed intramural basketball game at the Alumni Gym. TDI is known for dominating all intramural sports and several opportunities to participate arise during the year.
Tuesday morning I attend The Economics of Health Care with a great instructor. We watched the movie “SiCKO” and tried to identify themes discussed in the movie relating to the U.S. economy as well as other countries. After class I began work on a white paper, much like the white paper submitted by our faculty for the Obama administration. However, we are allowed to choose a topic of interest- I went with the release of dimethylmercury during from coal and oil-fired power plants. This includes the laws, regulations, key stakeholders, and recommendations that I would give to policy makers.
The middle of my week consisted of a trip to Montpelier, VT for my internship at the Vermont Attorney Generals Office. I get to watch policy making happen and watch public policy proposals move through the legislature. Currently, I am helping to formulate the Vermont Pharmaceutical Disclosure Act for public use.
I had class all day on both Thursday in Friday. Class discussions revolved around strategies hospitals use in health care to stay competitive, the States Childrens’ Health Plan (SCHIP), and mercury poisoning from fish- great timing for my white paper.
Overall, it was a very productive week. TDI allows for incredible opportunities and variety while keeping life busy.
Betsy B.
TDI is a very busy place with new things happening all the time. I thought it would be good to share an average week for a student here at TDI. . .
A class dealing with the strategic and financial management is required for the MPH degree and optional for the MS students. This class allows us to work in small groups and get inside various health care organizations and study their financials and management techniques. This past week began with a conference call to the CEO of Concord Hospital in Concord, NH. On this particular call, the CEO was very open about the hospital current financial growth as well as goals for the near future. That evening I went to co-ed intramural basketball game at the Alumni Gym. TDI is known for dominating all intramural sports and several opportunities to participate arise during the year.
Tuesday morning I attend The Economics of Health Care with a great instructor. We watched the movie “SiCKO” and tried to identify themes discussed in the movie relating to the U.S. economy as well as other countries. After class I began work on a white paper, much like the white paper submitted by our faculty for the Obama administration. However, we are allowed to choose a topic of interest- I went with the release of dimethylmercury during from coal and oil-fired power plants. This includes the laws, regulations, key stakeholders, and recommendations that I would give to policy makers.
The middle of my week consisted of a trip to Montpelier, VT for my internship at the Vermont Attorney Generals Office. I get to watch policy making happen and watch public policy proposals move through the legislature. Currently, I am helping to formulate the Vermont Pharmaceutical Disclosure Act for public use.
I had class all day on both Thursday in Friday. Class discussions revolved around strategies hospitals use in health care to stay competitive, the States Childrens’ Health Plan (SCHIP), and mercury poisoning from fish- great timing for my white paper.
Overall, it was a very productive week. TDI allows for incredible opportunities and variety while keeping life busy.
Betsy B.
Wednesday, January 21, 2009
New President, New Health Policies?
Here at TDI we focus a lot of energy on trying to improve access to and quality of health care services and exploring ways to make health care more affordable. Although many people recognize this, it was great to hear President Obama say in his inaugural address that “we will restore science to its rightful place, and wield technology's wonders to raise health care's quality and lower its cost.” We know from The Dartmouth Atlas that the cost of care has little to nothing to do with the quality of care that patients receive and we are glad the administration seems to be asking questions about what options there are to improve the quality of care while cutting the costs. We were all excited about the white paper submitted by several of our faculty members to the new administration (which is featured on the TDI homepage now http://tdi.dartmouth.edu/) and are excited to have that as a wonderful example as we begin to find topics to write white papers of our own for our Environmental and Occupational Health class this term. Hopefully some of the issues raised in the TDI white paper will be addressed, as for now we have a new president, and now we’ll just have to wait…and study.
-Shannon
-Shannon
Thursday, January 15, 2009
Happy New Year
It's an exciting time to be learning about health and health care in America and TDI is on the cutting edge of U.S. reform efforts. The Institute's cognoscenti just published a white paper outlining some of the issues that should be high on the new president's list of priorities.
Not only do we study the data that informs these policy leaders' opinions, but Elliott Fisher, James Weinstein, and others come to our classes and fill in all the details. It's really inspiring to hear their thoughts and then later see their comments and opinions appear in the Wall Street Journal, NEJM, or the NYTimes. We look forward to posting updates during the next few months about what we learn and how it will prepare us for leading change in health care.
As we at TDI speed headlong into a new term, I also thought it might be worthwhile to post the mission, vision and values of the Institute in the first blog post of 2009:
An Ambitious Mission: The Dartmouth Institute aspires to be the preeminent research and educational institution devoted to the ongoing reform of the U.S. health care system.
An Altruistic Vision: To achieve a patient-centered, high-quality, cost-effective health care system with access and excellence for all.
A Core of Values: We believe in commitment, education, excellence, dignity, integrity, diversity, trust and respect for all.
Happy New Year.
-Sam W.
Not only do we study the data that informs these policy leaders' opinions, but Elliott Fisher, James Weinstein, and others come to our classes and fill in all the details. It's really inspiring to hear their thoughts and then later see their comments and opinions appear in the Wall Street Journal, NEJM, or the NYTimes. We look forward to posting updates during the next few months about what we learn and how it will prepare us for leading change in health care.
As we at TDI speed headlong into a new term, I also thought it might be worthwhile to post the mission, vision and values of the Institute in the first blog post of 2009:
An Ambitious Mission: The Dartmouth Institute aspires to be the preeminent research and educational institution devoted to the ongoing reform of the U.S. health care system.
An Altruistic Vision: To achieve a patient-centered, high-quality, cost-effective health care system with access and excellence for all.
A Core of Values: We believe in commitment, education, excellence, dignity, integrity, diversity, trust and respect for all.
Happy New Year.
-Sam W.
Monday, December 15, 2008
Mini-Sessions
During this past week or two, TDI has hosted a couple voluntary mini-sessions on special topics of interest for students to broaden their understanding and skill. The first one was on media relations and Dr. Bruce Dan (former ABC News Health Editor, former Senior Editor of JAMA, and founder of WebMD) came up from D.C. for a couple days to teach us skills that would help us best communicate health information with journalists, broadcasters, and other media outlets. One of the highlights of the session was watching all of his video clips on what to do and what not to do while on camera! He was very engaging and we all came away with increased confidence to project our message to the media and ultimately the general public.
The other mini-session was on clinical trials and was hosted by Dr. Jon Lurie, a faculty member of TDI and Dartmouth Medical School. He and several other local experts lectured on various aspects of clinical trials over the course of four days, including drug and medical device development, the placebo effect, consent forms, challenges in attaining validity, etc. One of the most interesting takeaways of this session was learning about the intricacies of developing and running a randomized, controlled clinical trial. Dr. Lurie and Judi Forman had gained great expertise from assisting with the design and management of SPORT, and offered excellent insight for those of us who might want to get involved in future clinical trials research. Overall, it was a great week of relaxed learning with no grades and lots of knowledge building!
--Jared Conley
Tuesday, December 2, 2008
Finals behind me
With finals behind me, I realize just how much we've learned over the past two terms: a lot of weighty, important, and novel concepts relating to health problems facing the U.S., ideas for better policy, approaches to improving health services, and upstream determinants of public health. We've been given the skills to measure the supporting information and communicate this new-found knowledge.
What we have gained is nothing short of impressive, and it's a good thing, because the road ahead is daunting. There are more problems than can be discussed over Thanksgiving dinner (I tried), and the solutions are more complex than a turkey and pie-sated public can wrap their heads around (I tried that, too...). Fortunately, there is more learning ahead so that we can further equip ourselves for the change-making down the road.
-Matthew H. Davis
What we have gained is nothing short of impressive, and it's a good thing, because the road ahead is daunting. There are more problems than can be discussed over Thanksgiving dinner (I tried), and the solutions are more complex than a turkey and pie-sated public can wrap their heads around (I tried that, too...). Fortunately, there is more learning ahead so that we can further equip ourselves for the change-making down the road.
-Matthew H. Davis
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