This session dealt with global ethics. When attempting to improve health in any way, such as, through clinical trials, governmental interventions, etc., there are a host of ethical issues that one must consider. Am I doing my job in the most fair way? Are minority groups being represented? Am I giving an unfair advantage to some groups over others?
One major health ethics issue, I believe, harkens back to what was discussed in session 11. When a government prioritizes diseases and bases those investments on these priorities, who is being left out? By doing this, we again get back to the very problem: the systematic isolation of the minority. Indeed, by prioritizing disease concerns, we will be leaving out that small percentage of people who have difficult, hard to treat, expensive diseases. Is this not an ethical issue that must be taken into account? How do we find a balanced solution?
I think ethics will also be a huge issue in terms of a potential avian influenza pandemic.
The WHO Ethics Report on preparing for an influenza pandemic poses several questions. If there is a shortage of drugs and vaccines, who will receive access to such vaccines, especially given potentially hectic conditions? What responsibility do countries have to each other? Do rich countries, such as the U.S. have a responsibility to help poorer countries in their fight against avian influenza? What is the role of healthcare workers and what are their obligations (given that they are at high risk for harm due to extensive interaction with sick patients).
I think it is highly important to develop a protocol and ask such questions on a regular basis. Having a sound and effective plan can eliminate a lot of dicey, ethical issues. It is extremely important that governments around the world prioritize such issues.
To apply a quote from Sicko (great presentation + video Charlyn and Funsho!), instead of spending so much money on killing people, such as through the Iraq War, why not spend that money helping people,say, by helping to prepare for a potential pandemic?
Here is the link to the article…its very interesting.
http://www.who.int/csr/resources/publications/WHO_CDS_EPR_GIP_2007_2c.pdf
Thursday, April 24, 2008
Public Private Partnerships
This lecture discussed the role of public private partnerships in creating global change. We had Dr. Shahi buzz in from Nigeria, which was pretty cool =).
It is too difficult for one organization to do it alone. We cannot rely solely on the public sector to create global change in this world. In addition, the private sector often has the resources to truly speed global development and bring about positive changes. But, as anything, there are issues. These public private partnerships must be created very carefully and in such a way that both parties are excited about the process and outcome.
Here is an article that highlights some issues:
Layton: P3 projects not the answerNDP boss slams partnerships; N.S. minister fights backBy AMY SMITH Provincial ReporterThu. Apr 24 - 5:39 AM
Nova Scotians shouldn’t be fooled into thinking public-private partnerships will be good for the province, says federal NDP Leader Jack Layton.
Mr. Layton said Brampton, Ont., residents had a bad experience with a new hospital built through the P3 process.
"The funding wasn’t there for the number of beds that they were promised," Mr. Layton said after a speech Wednesday to the Service Employees International Union in Halifax.
"The result was horrific waiting times because their public hospital had been closed and replaced by this new profit-making facility, one-third of which was never allowed to really operate."
In February, The Canadian Press reported Ontario’s auditor general is conducting a value-for-money audit of the Brampton Civic Hospital, that province’s first P3 hospital.
Last month, the Tory government unveiled 10 projects as possible public-private partnerships — everything from a new or refurbished Victoria General hospital in Halifax to a new jail in northern Nova Scotia to twinning Highway 104 from Sutherlands River, Pictou County, to the Canso Causeway.
The province is paying a West Coast company, Partnerships British Columbia, $200,000 to determine which, if any, of the projects should be done through the P3 process.
Mr. Layton said problems occur when "the boardroom takes priority over the operating room."
"When you build these facilities with these private approaches, what we do is set up an obligation for a return on the investment to the shareholders, which ultimately can compromise the health care that the people in the community are looking for," he told reporters.
But Health Minister Chris d’Entremont said Nova Scotians have to be open to new ideas when it comes to making their tax dollars go further.
A recent report on Nova Scotia’s health-care system estimated the cost of replacing the entire VG site of the Queen Elizabeth II Health Sciences Centre at $500 million.
"I don’t have the cash flow to build a $500- million to $750-million building," he said. "So if we can find a partner in it and it can alleviate that kind of cash crunch, then it’s worth looking at."
Mr. d’Entremont stressed that patients are priority.
"It’s not about boardrooms. It’s not about departments. It’s not about doctors. It’s about patients."
The minister wasn’t familiar with the Brampton hospital but said he knows of a few in British Columbia that seem to be working well.
Murray Scott, minister of transportation and infrastructure renewal, said the province hasn’t made any decisions about any of the projects that were sent to Partnerships British Columbia for review.
He said Mr. Layton should concentrate his efforts on federal politics.
"We’ll decide what’s good for Nova Scotia or not," Mr. Scott said Wednesday.
He said it would be irresponsible for the MacDonald government not to at least look at the idea of P3 arrangements, given the fact Nova Scotia has an $8-billion infrastructure deficit.
Under a P3 agreement, a private company comes up with the money to build a project and the government signs a long-term lease and may end up owning the asset, whether it’s a school or a hospital, upon completion of the deal.
The former Liberal government in Nova Scotia worked out P3 agreements for construction of the Cobequid Pass toll highway and more than 30 schools.
Five years ago, the province lost an arbitration decision on who got to keep the revenue from cafeterias and pop machines in schools owned by Scotia Learning Centres.
That decision said the private consortium could keep 35 per cent of the profits and could also set fees for after-school rental of the buildings’ facilities.
( asmith@herald.ca)
As one can see, there is a fear that including the private sector in the building of hospitals will lead to an increased focus on making profits and other beaureaucratic (sp?) red tape issues.
I think the solution is to find a private partner who has a solid interest in social services and helping the community. It is highly important that the goals of the public and private entities be properly aligned. There are several private institutions out there that want to do good social work. It is just a matter of finding them. Once these entities are found and the partnership is established, there will be less of a focus on making a profit (on part of the private sector) and more of a focus on doing what is needed to really improve the health of the population.
It is too difficult for one organization to do it alone. We cannot rely solely on the public sector to create global change in this world. In addition, the private sector often has the resources to truly speed global development and bring about positive changes. But, as anything, there are issues. These public private partnerships must be created very carefully and in such a way that both parties are excited about the process and outcome.
Here is an article that highlights some issues:
Layton: P3 projects not the answerNDP boss slams partnerships; N.S. minister fights backBy AMY SMITH Provincial ReporterThu. Apr 24 - 5:39 AM
Nova Scotians shouldn’t be fooled into thinking public-private partnerships will be good for the province, says federal NDP Leader Jack Layton.
Mr. Layton said Brampton, Ont., residents had a bad experience with a new hospital built through the P3 process.
"The funding wasn’t there for the number of beds that they were promised," Mr. Layton said after a speech Wednesday to the Service Employees International Union in Halifax.
"The result was horrific waiting times because their public hospital had been closed and replaced by this new profit-making facility, one-third of which was never allowed to really operate."
In February, The Canadian Press reported Ontario’s auditor general is conducting a value-for-money audit of the Brampton Civic Hospital, that province’s first P3 hospital.
Last month, the Tory government unveiled 10 projects as possible public-private partnerships — everything from a new or refurbished Victoria General hospital in Halifax to a new jail in northern Nova Scotia to twinning Highway 104 from Sutherlands River, Pictou County, to the Canso Causeway.
The province is paying a West Coast company, Partnerships British Columbia, $200,000 to determine which, if any, of the projects should be done through the P3 process.
Mr. Layton said problems occur when "the boardroom takes priority over the operating room."
"When you build these facilities with these private approaches, what we do is set up an obligation for a return on the investment to the shareholders, which ultimately can compromise the health care that the people in the community are looking for," he told reporters.
But Health Minister Chris d’Entremont said Nova Scotians have to be open to new ideas when it comes to making their tax dollars go further.
A recent report on Nova Scotia’s health-care system estimated the cost of replacing the entire VG site of the Queen Elizabeth II Health Sciences Centre at $500 million.
"I don’t have the cash flow to build a $500- million to $750-million building," he said. "So if we can find a partner in it and it can alleviate that kind of cash crunch, then it’s worth looking at."
Mr. d’Entremont stressed that patients are priority.
"It’s not about boardrooms. It’s not about departments. It’s not about doctors. It’s about patients."
The minister wasn’t familiar with the Brampton hospital but said he knows of a few in British Columbia that seem to be working well.
Murray Scott, minister of transportation and infrastructure renewal, said the province hasn’t made any decisions about any of the projects that were sent to Partnerships British Columbia for review.
He said Mr. Layton should concentrate his efforts on federal politics.
"We’ll decide what’s good for Nova Scotia or not," Mr. Scott said Wednesday.
He said it would be irresponsible for the MacDonald government not to at least look at the idea of P3 arrangements, given the fact Nova Scotia has an $8-billion infrastructure deficit.
Under a P3 agreement, a private company comes up with the money to build a project and the government signs a long-term lease and may end up owning the asset, whether it’s a school or a hospital, upon completion of the deal.
The former Liberal government in Nova Scotia worked out P3 agreements for construction of the Cobequid Pass toll highway and more than 30 schools.
Five years ago, the province lost an arbitration decision on who got to keep the revenue from cafeterias and pop machines in schools owned by Scotia Learning Centres.
That decision said the private consortium could keep 35 per cent of the profits and could also set fees for after-school rental of the buildings’ facilities.
( asmith@herald.ca)
As one can see, there is a fear that including the private sector in the building of hospitals will lead to an increased focus on making profits and other beaureaucratic (sp?) red tape issues.
I think the solution is to find a private partner who has a solid interest in social services and helping the community. It is highly important that the goals of the public and private entities be properly aligned. There are several private institutions out there that want to do good social work. It is just a matter of finding them. Once these entities are found and the partnership is established, there will be less of a focus on making a profit (on part of the private sector) and more of a focus on doing what is needed to really improve the health of the population.
Healthcare Financing
Healthcare financing is a huge issue in terms of global health. Every year, money is being poured into ensuring the health of individuals. Yet, where is this money going? Is it being spent wisely?
There are two issues. I will try and tackle them both in this post.
Issue 1: Countries, such as the U.S., spend a ridiculous amount of money on healthcare. I believe the latest statistic is that healthcare is 16% of the GDP. Yet, the health of our citizens is actually not very good. In fact, there are 47 million people in the U.S. without healthcare. This is scary, because healthcare costs are continuing to rise. Dr. Shahi even mentioned that a large percentage of bankruptcy’s filed in the U.S. are caused by the expense of treating health conditions.
How is this possible in a country that spends SO much money on healthcare? A lot of people say that the very health system is not sound. A system of health insurance jacks up the price of healthcare while simultaneously making it hard for people to access necessary health services. It was mentioned in class that a health savings account may be a better solution. I will get back to this later.
Issue 2: Countries, such as Burundi, spend very little on healthcare, due to lack of resources. I believe Burundi spends something like $2 on healthcare per citizen. How can countries such as Burundi, then, even ensure the health of their citizens?
I gave a presentation in class (along with my colleague, Mark Krel), that I believe partially addresses issue 2. There is a need to prioritize healthcare needs and invest accordingly. There are a number of interventions that can be delivered that are effective but also give the most bang for the buck (and are often not too expensive). For example, delivering basic childhood vaccines is very cheap, effective, and can drastically reduce a number of long term health complications. Investing in such an intervention (such as a country-wide vaccination program) can be a very effective solution.
It is of utmost importance that governments of developing countries take disease prioritization as a top priority. They must do everything they can to invest wisely and make smart choices. This can be difficult. Many cost effective health interventions rely heavily on sound governmental policy. For example, one cost effective intervention proposed was a tobacco tax. Taxing tobacco will likely discourage people to smoke and thus reduce many long term health effects. Yet, many governments have been opposed to such a measure.
Now, back to issue 1: The debate between health insurance and a health savings account. Here is my issues with a health savings account. Suppose you save a certain amount of money for your healthcare needs. Then, you get diagnosed with a rare, expensive disorder, such as leukemia. If you count the treatment, plus hospital stays, plus ancillary care, you are talking about a pretty expensive disease to treat (some say around $400,000). What if you haven’t saved enough money? Thus, I still believe it is impossible to rely solely on a health savings account.
Of course health insurance has its holes as well (as we all know too well). Insurance companies want to make a profit, exclude high risk customers, deny treatment, etc.
So, what is the solution? I believe, in this case, the government must step in and actively control prices. Right now, esp. in the U.S., the private sector has way too much control on healthcare costs.
Of course, I can’t really say whether I have any specific ideas on how costs should be countered by the government…so please feel free to leave comments!!
There are two issues. I will try and tackle them both in this post.
Issue 1: Countries, such as the U.S., spend a ridiculous amount of money on healthcare. I believe the latest statistic is that healthcare is 16% of the GDP. Yet, the health of our citizens is actually not very good. In fact, there are 47 million people in the U.S. without healthcare. This is scary, because healthcare costs are continuing to rise. Dr. Shahi even mentioned that a large percentage of bankruptcy’s filed in the U.S. are caused by the expense of treating health conditions.
How is this possible in a country that spends SO much money on healthcare? A lot of people say that the very health system is not sound. A system of health insurance jacks up the price of healthcare while simultaneously making it hard for people to access necessary health services. It was mentioned in class that a health savings account may be a better solution. I will get back to this later.
Issue 2: Countries, such as Burundi, spend very little on healthcare, due to lack of resources. I believe Burundi spends something like $2 on healthcare per citizen. How can countries such as Burundi, then, even ensure the health of their citizens?
I gave a presentation in class (along with my colleague, Mark Krel), that I believe partially addresses issue 2. There is a need to prioritize healthcare needs and invest accordingly. There are a number of interventions that can be delivered that are effective but also give the most bang for the buck (and are often not too expensive). For example, delivering basic childhood vaccines is very cheap, effective, and can drastically reduce a number of long term health complications. Investing in such an intervention (such as a country-wide vaccination program) can be a very effective solution.
It is of utmost importance that governments of developing countries take disease prioritization as a top priority. They must do everything they can to invest wisely and make smart choices. This can be difficult. Many cost effective health interventions rely heavily on sound governmental policy. For example, one cost effective intervention proposed was a tobacco tax. Taxing tobacco will likely discourage people to smoke and thus reduce many long term health effects. Yet, many governments have been opposed to such a measure.
Now, back to issue 1: The debate between health insurance and a health savings account. Here is my issues with a health savings account. Suppose you save a certain amount of money for your healthcare needs. Then, you get diagnosed with a rare, expensive disorder, such as leukemia. If you count the treatment, plus hospital stays, plus ancillary care, you are talking about a pretty expensive disease to treat (some say around $400,000). What if you haven’t saved enough money? Thus, I still believe it is impossible to rely solely on a health savings account.
Of course health insurance has its holes as well (as we all know too well). Insurance companies want to make a profit, exclude high risk customers, deny treatment, etc.
So, what is the solution? I believe, in this case, the government must step in and actively control prices. Right now, esp. in the U.S., the private sector has way too much control on healthcare costs.
Of course, I can’t really say whether I have any specific ideas on how costs should be countered by the government…so please feel free to leave comments!!
Global Surveillance Capabilities:
This session talked about the different monitoring and surveillance capabilities for natural disasters, etc.
We went over the different disasters that our world has faced during this century as well as potential solutions to such disasters.
The interesting thing is this: In many of these situations, it seems like the response to such disasters in some ways caused even more harm than the disasters themselves!
For example, take Hurricane Katrina: Yes, the hurricane itself devastated the city of New Orleans. The government response, however, seemed to make it worse! First of all, people were not properly evacuated. Secondly, those who were evacuated often suffered from extreme hunger and thirst due to lack of food/water supplies (which should have properly been distributed by the government).
To further this criticism, many government officials, including those from FEMA, had promised to provide transportation for all citizens who needed to evacuate within 48 hours. Yet, many people were still forced to find their own transportation.
My favorite government excuse is this: Many people criticized the government, saying that the emergency relief response was too slow. One of the things that the U.S. Congress said in response was that there weren’t enough National Guard members in the New Orleans area due to being on active duty in Iraq. They were on duty in Iraq! It is ironic to me that these troops were in Iraq fighting an utterly useless war while there was a major hurricane going on in the U.S. and thus a major need for them to be on U.S. soil.
So my question or dilemma is this. We can say that we are creating fancy detection technologies. We can advertise the need for good epidemiology and surveillance systems. Indeed, this class lecture was great in identifying promising new technologies in the future. Yet, this seems completely useless without the government having the political will and compassion to address such situations. The U.S. is one of the richest countries in the world and has all the tools available to ensure a safe, smooth response to any disaster that occurs on this soil. Yet, laziness on part of the government made the situation with Katrina so much worse.
A key part of developing sound surveillance and monitoring systems to detect potential disasters is encouraging governments to prioritize such a need.
Basically, in the case of the U.S., we need to stop spending so much money on a useless war and invest the money spent on the Iraq war in protecting our citizens. Without this move, I fear we will face another Hurricane Katrina type disaster very soon.
We went over the different disasters that our world has faced during this century as well as potential solutions to such disasters.
The interesting thing is this: In many of these situations, it seems like the response to such disasters in some ways caused even more harm than the disasters themselves!
For example, take Hurricane Katrina: Yes, the hurricane itself devastated the city of New Orleans. The government response, however, seemed to make it worse! First of all, people were not properly evacuated. Secondly, those who were evacuated often suffered from extreme hunger and thirst due to lack of food/water supplies (which should have properly been distributed by the government).
To further this criticism, many government officials, including those from FEMA, had promised to provide transportation for all citizens who needed to evacuate within 48 hours. Yet, many people were still forced to find their own transportation.
My favorite government excuse is this: Many people criticized the government, saying that the emergency relief response was too slow. One of the things that the U.S. Congress said in response was that there weren’t enough National Guard members in the New Orleans area due to being on active duty in Iraq. They were on duty in Iraq! It is ironic to me that these troops were in Iraq fighting an utterly useless war while there was a major hurricane going on in the U.S. and thus a major need for them to be on U.S. soil.
So my question or dilemma is this. We can say that we are creating fancy detection technologies. We can advertise the need for good epidemiology and surveillance systems. Indeed, this class lecture was great in identifying promising new technologies in the future. Yet, this seems completely useless without the government having the political will and compassion to address such situations. The U.S. is one of the richest countries in the world and has all the tools available to ensure a safe, smooth response to any disaster that occurs on this soil. Yet, laziness on part of the government made the situation with Katrina so much worse.
A key part of developing sound surveillance and monitoring systems to detect potential disasters is encouraging governments to prioritize such a need.
Basically, in the case of the U.S., we need to stop spending so much money on a useless war and invest the money spent on the Iraq war in protecting our citizens. Without this move, I fear we will face another Hurricane Katrina type disaster very soon.
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