[EQ] Effective Dissemination of Findings from Research - a compilation of essays

Effective Dissemination of Findings from Research – a compilation of essays

 

Foreword, Egon Jonsson

Contributors

David Hailey, Jeremy Grimshaw, Martin Eccles, Craig Mitton, Carol E. Adair, Emily McKenzie, Scott Patten, Brenda Waye-Perry, Leif Rentzhog, Paul Taenzer, Christa Harstall, Saifee Rashiq, Pamela Barton, Don Schopflocher, Lynda Jobin

The Institute of Health Economics (IHE) 2008 - University of Alberta

 

Available online PDF [88p.] at: http://www.ihe.ca/documents/Dissemination_0.pdf

 

“….While the notion of the value of and need for Knowledge Transfer and Exchange KTE has received wide support, it has also been acknowledged that both researchers and decision makers are driven by demands that may not be conducive to successful Knowledge Transfer and Exchange KTE. For researchers, these demands include challenges such as adapting the research cycle to fit real-world timelines, establishing relationships with decision makers, and justifying activities which fit poorly with traditional academic performance expectations (Canadian Health Services Research Foundation 1999). For decision makers, a perceived lack of knowledge of the research process, the traditional academic format of communication, and a lack of timely results are frequently cited barriers to using research findings (Canadian Health Services Research Foundation 1999). Both parties also frequently lament the lack of time and resources to participate in Knowledge Transfer and Exchange KTE.

 

Noting these challenges, a variety of mechanisms to facilitate Knowledge Transfer and Exchange KTE have been proposed including joint researcher-decision maker workshops, inclusion of decision makers in the research process as inter-disciplinary research teams, collaborative definition of research questions, and the use of intermediaries that understand both roles known as “knowledge brokers” (CHSRF 1999).

Inter-personal contact between researchers and decision makers is an often cited fundamental ingredient in successful Knowledge Transfer and Exchange KTE initiatives (Thompson et al. 2006). However, to date, “gold standard” approaches to KTE seem to be more based on experience and even rhetoric than rigorous evidence. Our primary aim for the literature review and key informant interviews described herein was to examine and summarize the current evidence base for Knowledge Transfer and Exchange KTE strategies…’

 

Content

Chapter 1. Overview

Chapter 2. Knowledge translation of research findings

What should be transferred? .

To whom should knowledge be transferred and with what effect?.

With what effect should knowledge be transferred?.

How should research knowledge be transferred?.

Effectiveness of professional behaviour change strategies.

Effectiveness of knowledge translation strategies focusing on patients

Effectiveness of knowledge translation strategies focusing on policy makers and senior health service managers

Chapter 3. Knowledge Transfer and Exchange (KTE): a systematic review, key informant interviews and design of a KTE strategy.

Chapter 4. SBU’s Ambassador Program in Northern Sweden

Chapter 5. The Alberta HTA Chronic Pain Ambassador Program: an Alberta adaptation of the SBU clinical Ambassador Program

Chapter 6. CADTH’s Liaison Program

References.

 

Figure 1: Stakeholders for different types of research

 

 

 

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[EQ] Managing chronic conditions: Experience in eight countries

Managing chronic conditions: Experience in eight countries

             

The editors

Ellen Nolte, Senior Lecturer at the London School of Hygiene & Tropical Medicine, United Kingdom.

Cécile Knai, Research Fellow at the London School of Hygiene & Tropical Medicine, United Kingdom.

Martin McKee, Professor of European Public Health at the London School of Hygiene & Tropical Medicine, and Head of Research Policy of the European Observatory on Health Systems and Policies.

World Health Organization 2008, on behalf of the European Observatory on Health Systems and Policies

WHO Regional Office for Europe, Copenhagen, Denmark

 

Full text of the book [PDF 1MB -202p.] at:http://www.euro.who.int/Document/E92058.pdf

 

 “…..One of the greatest challenges facing health systems in the 21st century is the need to develop effective approaches to address the growing burden of chronic disease. Chronic diseases are complex and require a long-term, multifaceted response that coordinates inputs from a wide range of health professionals, essential medicines and – where appropriate – monitoring equipment, all of which is optimally embedded within a system that promotes patient empowerment.

With many health systems still largely built around an acute, episodic model of care, health professionals, policy-makers and patient organizations struggle to respond in ways that meet the needs of people with complex chronic health problems.

 

This book examines the health system response to the rising burden of chronic disease in eight countries:
Denmark, England, France, Germany, the Netherlands, Sweden, Australia and Canada

It provides a detailed assessment of the current situation, a description of the policy framework and future scenarios, as well as evaluation and lessons learned.

It shows that many different strategies are being implemented, with different models of care at varying degrees of development, and with differing comprehensiveness. Perhaps not surprisingly, the approaches adopted often reflect the characteristics of each health system, each with its own governance mechanisms and relationships between, and responsibilities of, different stakeholders. Nonetheless, there are many lessons for those seeking to develop effective responses to this common challenge. …”

 

Contributors include: Carl-Ardy Dubois, Isabelle Durand-Zaleski, Daragh K Fahey, Anne Frølich, Nicholas Glasgow, Mark Harris, Iqbal Hasan, Izzat Jiwani, Tanisha Jowsey, Ingvar Karlberg, Eveline Klein Lankhorst, Cécile Knai, Allan Krasnik, Martin McKee, Ellen Nolte, Olivier Obrecht, Michaela L. Schiøtz, Ulrich Siering, Debra de Silva, Cor Spreeuwenberg and Nicholas Zwar.

 

 

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[EQ] Season's greetings from EQUITY & Health listserv Team!

 

	Season's greetings from EQUITY & Health listserv Team! We’d like to express our appreciation for your input and participation in      Equity, Health and Human Development Listserver during the year 2008. Our current operations will be suspended for the holidays and will begin again on the 12th January, 2009. Wishing you every joy and prosperity in the coming year. Knowledge Management and Communications Area – DD/KMC Pan American Health Organization / World Health Organization - PAHO/WHO
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[EQ] The U.S. Commitment to Global Health

The U.S. Commitment to Global Health  - 2008 Report

 

Available online at: http://www.nap.edu/catalog.php?record_id=12506

The Institute of Medicine-with the support of four U.S. government agencies and five private foundations-formed an independent committee to examine the United States' commitment to global health and to articulate a vision for future U.S. investments and activities in this area.

the committee considered the following key areas of U.S. government engagement in global health:
- the financial and technical resources provided to countries to expand public health infrastructure and improve access to health interventions;
- the governance structures across U.S. agencies responsible for delivering these benefits;
- the research effort that focuses on health problems endemic to poor countries; and
- the relationship of the United States with the World Health Organization (WHO), the leading global agency in the field of health policy.

While the scope of this report was limited to U.S. government efforts in the realm of global health, this topic is inevitably linked to broader discussions on U.S. commitments to global economic development and the environment.2 This report does not, however, cover the related areas of food security, water and sanitation, climate change, educational and economic opportunity, and gender equity. Similarly, the committee was not tasked with evaluating or recommending action on broader international development reforms..."

Contents

Summary
Charge to the committee
A prominent role for health in U.S. foreign policy
Progress in global health can be achieved now
Urgent opportunity for action
Restructure the U.S. global health enterprise
Mobilize financial resources for health
Focus U.S. government efforts on health outcomes
Advance U.S. strengths in global health knowledge
Support and collaborate with the WHO
Call to action

Harold Varmus to present Barmes lecture Dec. 16, 2008

Dr. Harold Varmus

The National Institute of Dental and Craniofacial Research and the Fogarty International Center, together with the Foundation for NIH, present the 2008 David E. Barmes Global Health Lecture:

"The U.S. Commitment to Global Health"

 videocast. (http://videocast.nih.gov/)

Harold Varmus, former Director of the National Institutes of Health and co-recipient of a Nobel Prize for studies of the genetic basis of cancer, is President of Memorial Sloan-Kettering Cancer Center in New York City.

Dr. Varmus chairs the Scientific Board of the Bill & Melinda Gates Foundation's Grand Challenges in Global Health program and leads the Advisory Committee for the Global Health Division. He was a member of the World Health Organization (WHO) Commission on Macroeconomics and Health, and is a co-founder of the Public Library of Science, a leading publisher of open access journals. In addition, he serves as co-chair of the Institute of Medicine's committee on The U.S. Commitment to Global Health. The committee has issued its interim report on the day preceding the lecture.

NIDCR and Fogarty jointly host the annual Barmes Lecture, which honors the late David E. Barmes. Dr. Barmes was a special expert for international health at the NIDCR. Prior to joining NIDCR, he served in senior management positions related to oral health, health promotion, and non-communicable diseases at the World Health Organization in Geneva.

The reception is sponsored by the Foundation for the National Institutes of Health, with generous support from Lilly, Abbott Fund, Bristol-Myers Squibb Foundation, ExxonMobil, PepsiCo, Aeras Global TB Vaccine Foundation, Burroughs Wellcome Fund, Merck, Pfizer, Tibotec, and the United Nations Foundation.

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[EQ] The Effect Of Regulation On Pharmaceutical Revenues: Experience In Nineteen Countries

D R U G  S P E N D I N G - 16 December 2008  - Health Affairs 
 

Drug Spending In The U.S. And Abroad

"...In two papers published today on the Health Affairs Web site, researchers from the RAND Corporation warn that introducing European-style price controls on prescription drugs into the United States could have large negative effects on the revenues of pharmaceutical manufacturers and the welfare of consumers. The papers are part of a five-paper package on prescription drugs released today by Health Affairs.

In a third article, Murray Aitken of IMS Health and coauthors argue that spending on prescription drugs has reached a turning point and that U.S. drug spending will grow more slowly in coming years than in the recent past. In a fourth paper, Arjun Jayadev of the University of Massachusetts and Nobel economics laureate Joseph Stiglitz of Columbia University make the case for value-based pricing of pharmaceuticals and public financing of clinical trials. Finally, Harvard's F.M. Scherer questions the way that one of the RAND papers estimates the extent to which declines in profits for drugmakers are likely to translate into declines in pharmaceutical innovation.

Access the package here: http://content.healthaffairs.org/cgi/content/full/hlthaff.28.1.w125/DC3

Health Affairs is pleased to make this 5-paper package freely accessible to listserv recipients for two weeks.....'  [From: "Ford, Kathleen]

The Effect Of Regulation On Pharmaceutical Revenues: Experience In Nineteen Countries
Neeraj Sood, Han de Vries, Italo Gutierrez, Darius N. Lakdawalla, and Dana P. Goldman

"......We describe pharmaceutical regulations in nineteen developed countries from 1992 to 2004 and analyze how different regulations affect pharmaceutical revenues.
First, there has been a trend toward increased regulation.
Second, most regulations reduce pharmaceutical revenues significantly.
Third, since 1994, most countries adopting new regulations already had some regulation in place. We find that incremental regulation of this kind had a smaller impact on costs.
However, introducing new regulations in a largely unregulated market, such as the United States, could greatly reduce pharmaceutical revenues.
Finally, we show that the cost-reducing effects of price controls increase the longer they remain in place. ...'

[Health Affairs 28, no. 1 (2009): w125-w137 (published online 16 December 2008; 10.1377/hlthaff.28.1.w125)]

U.S. Pharmaceutical Policy In A Global Marketplace
Darius N. Lakdawalla, Dana P. Goldman, Pierre-Carl Michaud, Neeraj Sood, Robert Lempert,
Ze Cong, Han de Vries, and Italo Gutierrez

".....U.S. consumers generate more pharmaceutical revenue per person than Europeans do.
This has led some U.S. policymakers to call for limits on U.S. pharmaceutical spending and prices.
Using a microsimulation approach, we analyze the welfare impacts of lowering U.S. prices toward European levels,
and how these impacts vary with key modeling assumptions. Under the assumptions most favorable to them,
price controls generate modest benefits (a few thousand dollars per person). However, for the remainder of plausible
assumptions, price controls generate costs that are an order of magnitude higher.
In contrast, publicly financing reductions in consumer prices, without affecting manufacturer prices, delivers benefits in virtually all plausible cases

Prescription Drug Spending Trends In The United States: Looking Beyond The Turning Point
Murray Aitken, Ernst R. Berndt, and David M. Cutler

'....Annual growth in real prescription drug spending averaged 9.9 percent during 1997-2007 but has slowed since 2003,
falling to 1.6 percent in 2007. More patent expirations, increased generic penetration, and reduced new product innovations
have contributed to this turning point. We document trends and identify underlying components: declines in the role of
blockbuster drugs, increased importance of biologics and vaccines relative to traditional pharmaceuticals, and a changing
medication mix away from those prescribed principally by primary care physicians toward those mostly prescribed by specialists.
We conclude with policy implications...."

Price Controls And Global Pharmaceutical Progress
F. M. Scherer

"....An alternative explanation for the sizable access effects is that blockbusters are heavily promoted, both directly to consumers and
through detailing (promotion to medical professionals), and the hoopla surrounding their marketing causes physicians to confront
and deal with symptoms of which they were previously unaware or unresponsive. To the extent that this explanation has validity,
better, more objective, continuing education of physicians seems warranted. The paper by Murray Aitken and colleagues suggests
that changes, including greater use of generics and perhaps an ebbing of the access effect, have been emerging in recent years,
more through the incentives generated by insurers' tiered reimbursement systems than through any change in physicians' behavior..."

Two Ideas To Increase Innovation And Reduce Pharmaceutical Costs And Prices
Arjun Jayadev and Joseph Stiglitz

"....The pharmaceutical industry is undergoing a period of uncertainty. Profits are being squeezed by increasing costs and
competitive pressures, and new drug production is slowing down. This Perspective reviews two policies that could
assist in realigning incentives toward genuine innovation while also keeping drug spending growth under check.
Value-based pricing can incentivize genuinely new discoveries and align research and development with social welfare.
Public funding of clinical trials likewise can reduce both pharmaceutical costs and prices and direct research effort
in a manner that is more socially productive than the current state of affairs..."

 

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[EQ] Tracking progress towards universal childhood immunisation and the impact of global initiatives

Tracking progress towards universal childhood immunisation and the impact of global initiatives:

a systematic analysis of three-dose diphtheria, tetanus, and pertussis immunisation coverage

 

Stephen S Lim PhD a, David B Stein BA a, Alexandra Charrow BA a, Prof Christopher JL Murray MD a  

 

The Lancet, Volume 372, Issue 9655, Pages 2031 - 2046, 13 December 2008

doi:10.1016/S0140-6736(08)61869-3

 

Website: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61869-3/abstract  [Subscription required]

 

Background: Substantial resources have been invested in increasing childhood immunisation coverage through global initiatives such as the Universal Childhood Immunisation (UCI) campaign and the Global Alliance on Vaccines and Immunisations (GAVI). There are longstanding concerns that target-oriented and performance-oriented initiatives such as UCI and GAVI's immunisation services support (ISS) might encourage over-reporting. We estimated the coverage of three doses of diphtheria, tetanus, and pertussis vaccine (DTP3) based on surveys using all available data.

 

Methods: We estimated DTP3 coverage by analysing unit record data from surveys and supplemented this with reported coverage from other surveys and administrative data. We used bidirectional distance-dependent regression to estimate trends in survey-based coverage in 193 countries during 1986—2006. We used standard time-series cross-sectional analysis to investigate any association in the difference between countries' official reports and survey-based coverage as the dependent variable and the presence of GAVI ISS as the independent variable, controlling for country and time effects.

 

Findings: Crude coverage of DTP3 based on surveys increased from 59% (95% uncertainty interval 51—65) in 1986 to 65% (60—68) in 1990, 70% (65—74) in 2000, and 74% (70—77) in 2006. There were substantial differences between officially reported and survey-based coverage during UCI. GAVI ISS significantly increased the difference between officially reported coverage and survey coverage. Up to 2006, in 51 countries receiving GAVI ISS payments, 7•4 million (5•7 million to 9•2 million) additional children were immunised with DTP3 based on surveys compared with officially reported estimates of 13•9 million. On the basis of the number of additional children immunised from surveys at a rate of US$20 each, GAVI ISS payments are estimated at $150 million (115 million to 184 million) compared with actual disbursements of $290 million.

Interpretation

 

Survey-based DTP3 immunisation coverage has improved more gradually and not to the level suggested by countries' official reports or WHO and UNICEF estimates. There is an urgent need for independent and contestable monitoring of health indicators in an era of global initiatives that are target-oriented and disburse funds based on performance….”

 

Prof Christopher J L Murray, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA

 

Funding Bill & Melinda Gates Foundation.

 

Comments by:

David M Bishai, Johns Hopkins Bloomberg School of Public Health, Baltimore
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61853-X/fulltext

“…With close to 600 surveys from 193 countries, this definitive study confirms that the correlation between mothers’ reports and official reports is not good. Sometimes survey data indicate higher, sometimes lower, coverage than official reports. This news is a cause for concern because there might be an upward trend in officially reported rates of vaccine coverage that has occurred in the years since the GAVI Alliance (previously the Global Alliance on Vaccines and Immunizations) began to pay countries proportionally to the number of DTP3-vaccinated children.2 An upward trend would be good news, except that sometimes the upward trend is only in the official reports and not in the survey data. To put it bluntly, the authors are worried that financial incentives to report DTP3 coverage are biasing some of the official reports…”

 

 

 

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[EQ] Integrating mental health into primary care

Integrating mental health into primary care

A global perspective

 

Michelle Funk, Department of Mental Health and Substance Abuse, World Health Organization

Gabriel Ivbijaro, Wonca Working Party on Mental Health, London UK

World Health Organization and World Organization of Family Doctors (Wonca) 2008

 

Available online PDF file [224p] at:
http://www.who.int/mental_health/policy/Mental%20health%20+%20primary%20care-%20final%20low-res%20140908.pdf

 

“….This report presents the justification and advantages of providing mental health services in primary care. At the same time, it provides advice on how to implement and scale-up primary care for mental health, and describes how a range of health systems have successfully undertaken this transformation.

Mental disorders affect hundreds of millions of people and, if left untreated, create an enormous toll of suffering, disability and economic loss. Yet despite the potential to successfully treat mental disorders, only a small minority of those in need receive even the most basic treatment.

 

Integrating mental health services into primary care is the most viable way of closing the treatment gap and ensuring that people get the mental health care they need. Primary care for mental health is affordable, and investments can bring important benefits.

 

Key Messages:
1. Mental disorders affect hundreds of millions of people and, if left untreated, create an enormous toll of suffering, disability and economic loss.

2. Despite the potential to successfully treat mental disorders, only a small minority of those in need receive even the most basic treatment.

3. Integrating mental health services into primary care is the most viable way of closing the treatment gap and ensuring that people get the mental health care they need.

4. Primary care for mental health is affordable, and investments can bring important benefits.

5. Certain skills and competencies are required to effectively assess, diagnose, treat, support and refer people with mental disorders; it is essential that primary care workers are adequately prepared and supported in their mental health work.

6. There is no single best practice model that can be followed by all countries. Rather, successes have been achieved through sensible local application of broad principles.

7. Integration is most successful when mental health is incorporated into health policy and legislative frameworks and supported by senior leadership, adequate resources, and ongoing governance.

8. To be fully effective and efficient, primary care for mental health must be coordinated with a network of services at different levels of care and complemented by broader health system development.

9. Numerous low- and middle-income countries have successfully made the transition to integrated primary care for mental health.

10. Mental health is central to the values and principles of the Alma Ata Declaration; holistic care will never be achieved until mental health is integrated into primary care….”

 

 

Content:

 

Executive summary

Introduction

PART 1: Primary care for mental health in context

Chapter 1: Primary care for mental health withina pyramid of health care

Chapter 2: Seven good reasons for integrating mental health into primary care

PART 2: Primary care for mental health in practice

10 principles for integrating mental health into primary care

Argentina: Physician-led primary care for mental health in Neuquén province, Patagonia region

Australia: Integrated mental health care for older people in general practices of inner-city Sydney

Belize: Nationwide district-based mental health care.

Brazil: Integrated primary care for mental health in the city of Sobral

Chile: Integrated primary care for mental health in the Macul district of Santiago.

India: Integrated primary care for mental health in the Thiruvananthapuram District, Kerala State.

Islamic Republic of Iran: Nationwide integration of mental health into primary care

Saudi Arabia: Integrated primary care for mental health in the Eastern Province

South Africa: Integrated primary care services and a partnership for mental health primary care – Ehlanzeni District, Mpumalanga Province, and Moorreesburg District, Western Cape Province.

Uganda: Integrated primary care for mental health in the Sembabule District

United Kingdom of Great Britain and Northern Ireland: Primary care for mental health for disadvantaged communities in London

Report conclusions

Annex 1: Improving the practice of primary care for mental health

 

 

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[EQ] Doctors, Dollars & Quality

Doctors, Dollars & Quality

Health Affairs, doi: 10.1377/hlthaff.28.1.w91 - Published online December 4, 2008

Table of Contents

From The Editor Susan Dentzer

“……..examining the connections among the supply of doctors, the composition of the physician workforce, the quality of health care, and health spending. It is critically important to establish just what these connections are. The United States faces a number of major and potentially competing challenges: improving the health status of the population; expanding health coverage and access to care; coping with a future of aging and chronically ill individuals; and constraining the growth of health spending. Policymakers clearly need to understand how to get the biggest bang for the buck in improving health and in delivering high-quality health care. Among the top priorities is determining whether or not the nation needs more physicians, and of what sort, to accomplish these goals….”

Preface

Philip Musgrove, Deputy Editor, Health Affairs

“…..Does the United States have enough doctors, given the enormous demand for health care and forecasts about a future filled with aging and chronically ill baby boomers? And do we have the right mix of doctors--since specialists "cost" more to produce than general practitioners, are paid more under current reimbursement systems, and prescribe more health care to boot? …”

 

States With More Physicians Have Better-Quality Health Care

Richard A. Cooper, is a professor of medicine in the Leonard Davis Institute at the Wharton School, University of Pennsylvania, in Philadelphia.

“…..As efforts begin to expand the physician workforce in response to deepening shortages of physicians, attention has focused on the value of what physicians do. There is a widely held belief that states with more specialists have poorer-quality health care, while quality is better in states with more family physicians. This is myth. Quality is better in states with more physicians, both specialists and family physicians. Access depends on total physician supply, irrespective of specialty. Population density, per capita income, and regional factors all influence this relationship, but the data are unequivocal….”

States With More Health Care Spending Have Better-Quality Health Care: Lessons About Medicare

Richard A. Cooper, is a professor of medicine in the Leonard Davis Institute at the Wharton School, University of Pennsylvania, in Philadelphia.

“….Based on broad measures of health system quality and performance, states with more total health spending per capita have better-quality care. This fact contrasts with a previous finding that states with higher Medicare spending per enrollee have poorer-quality care. However, quality results from the total funds available and not from Medicare or any single payer. Moreover, Medicare payments are disproportionately high in states that have a disproportionately large social burden and low health care spending overall. These and other vagaries of Medicare spending pose critical challenges to research that depends on Medicare spending to define regional variation in health care….”

Cooper's Analysis Is Incorrect

Katherine Baicker is professor of health economics at the Harvard School of Public Health and a research associate at the National Bureau of Economic Research (NBER) in Cambridge, Massachusetts.
 Amitabh Chandra is an assistant professor of public policy at Harvard's Kennedy School of Government and a faculty research fellow at the NBER.

“….In his papers, Richard Cooper finds positive associations between health care quality and both specialist and generalist physicians, but he misinterprets his results. Instead of undermining the findings of our study, which found higher quality in areas with more generalists relative to specialists, his results bolster ours: they suggest that the effect of generalists on quality is ten times larger than that of specialists. Furthermore, his rejection of multiple regression in favor of exclusive reliance on isolated correlations precludes him from gauging the relative contributions of specialists, generalists, and other factors. Unfortunately, these deficiencies mean that we can learn little from Cooper's analyses…”

The Elusive Connection Between Health Care Spending And Quality

Jon Skinner is the John Sloan Dickey Third Century Professor in Economics in the Department of Economics, Dartmouth College, in Hanover, New Hampshire.
Amitabh Chandra is a professor in the Kennedy School of Government, Harvard University, in Cambridge, Massachusetts.
David Goodman is a professor of pediatrics and of community and family medicine at Dartmouth Medical School and associate director of the Center for Health Policy Research at Dartmouth.
Elliott Fisher is director of the Center for Health Policy Research and a professor of medicine and of community and family medicine, Dartmouth Institute for Health Policy and Clinical Practice

“…..Richard Cooper has shown a positive association between health care quality and "total spending" at the state level, but he does not appear to understand the limitations of this total spending measure; simply adjusting for median age causes the significant positive correlation to disappear. Cooper also finds that some third factor--we think that it is "social capital"--is the key to explaining health care quality. Cooper may believe that this result challenges three decades of research by the Dartmouth group. Instead, it supports the group's view that improved efficiency--and not more doctors and hospital beds--is central to improving quality…”

More Is More And Less Is Less: The Case Of Mississippi

Richard A. Cooper, is a professor of medicine in the Leonard Davis Institute at the Wharton School, University of Pennsylvania, in Philadelphia

“….One can't help but admire the vigor with which some members of the Dartmouth group defend their core belief that "more is less." But polemics aside, some questions still linger. Does Mississippi actually have more specialists (as represented in Katherine Baicker and Amitabh Chandra's Exhibit 6), and does it spend more on health care (as in their Exhibit 1) than almost every other state? And can Mississippi, which ranks near the bottom in health care quality, lift its status by simply improving its health care productivity, as Jon Skinner and colleagues suggest? If these questions gnaw at you, as they did at me, there's a need to probe further…”

 

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