Telehealth available for follow up as well as new consultations. Please contact us Here
1-818-812-7222 Office Hours: 8:00 AM to 5:00 PM
10 Congress St., Suite #405
Pasadena, CA 91105

Category: Coronavirus

What does efficiency in healthcare delivery mean? Examples of two market failures

October 08, 2021 3:41 pm

Introduction: Economic efficiency measures system performance (Enrique & Marta, 2020); the Healthcare delivery system (HCDS) is no different. In non-biologic systems, the efficiency can be measured and optimized since all variables are predictable. However, efficiency becomes a complex and possibly unachievable task in a biological environment such as HCDS. The summary report will define the efficiency and examine the limitation of achieving efficiency in the healthcare delivery system. Definitions: Efficiency measures the adeptness of a system allowing identification of the inadequacies and opportunities for improvement. Economic efficiency minimizes cost and maximizes production for profit (Petrou, 2014). Healthcare is a commodity (Mills & Gilson, 2009).  Increased need and limited resources, environment, illnesses are forces on an equilibrium of efficiency that requires flexibility. These are why economically competitive markets fail to achieve healthcare efficiency (Johansen & van den Bosch, 2017). The concept of efficiency in health care has been described as Technical, Productive, and Allocative (Palmer & Torgerson, 1999). Extensive work has looked at special measures and populations for optimizing efficiency (Cylus & Papanicolas, 2016). Efficient systems require predictable input, components, processes, and output, unlike efficiency in HCDS. The differences include:
  • Biologic environments introduce variability in the system. Therefore, the HCDS efficiency will need to be flexible to diversity. Unfortunately, flexibility and efficiency counteract each other at industrial levels (Adler et al., 1999; AHRENS & CHAPMAN, 2004), and thus inefficiency is to be expected.
  • Efficiency can be measured at two points:
    1. Efficiency of delivery
    2. Efficiency of outcome
Efficiency in HCDS means providing the most cost-efficient healthcare to those in need. As equity is a pillar of the HCDS, efficiency and equity are opposing forces (Guinness et al., 2011). Therefore, it is critical to have the broader determinants of health into consideration on HCDS. This broad spectrum of variables, individual level, and upstream factors (Dahlgren G & Whitehead M, 1991)  will affect efficiency models applicable in one setting for a given population and inefficient in another (Hussey et al., 2009). Healthcare Market: The principle of maximizing profits applies to the four market types[1][2]. However, healthcare markets achieve Social Efficiency[3] and not economic efficiency (Folland & Goodman, 2013). This is due to Asymmetry of the information, Adverse selection, Moral hazard, Independent supply and demand stresses, and Externalities (Mwachofi & Al-Assaf, 2011). Examples of Market Failure At the onset of the pandemic, most governments, WHO assumed the costs of COVID-19 vaccination as they became available. Social media has disseminated incorrect information on vaccines (Lin et al., 2020; Wajahat Hussain, 2020). The Asymmetry of the information (AOI) has resulted in a sizable portion of the eligible population not being vaccinated (Coe et al., 2021; Malik et al., 2020). HCDS’s failure is a public relations problem and a breakdown in the trust of institutions (Soares et al., 2021). Adverse selection (AS) compounds the AOI. There have been pockets of efficiency in vaccination with no equity for the world population (Mathieu et al., 2021). This is due to the AOI and the structural inequities in HCDS (Hyder et al., 2021). Few countries are offering vaccine boosters, where most of the world’s population has not received any.   References: Adler, P. S., Goldoftas, B., & Levine, D. I. (1999). Flexibility Versus Efficiency? A Case Study of Model Changeovers in the Toyota Production System. Organization Science, 10(1), 43–68. https://doi.org/10.1287/orsc.10.1.43 Adler, P. S., Goldoftas, B., & Levine, D. I. (1999). Flexibility Versus Efficiency? A Case Study of Model Changeovers in the Toyota Production System. Organization Science, 10(1), 43–68. https://doi.org/10.1287/orsc.10.1.43 AHRENS, T., & CHAPMAN, C. S. (2004). Accounting for Flexibility and Efficiency: A Field Study of Management Control Systems in a Restaurant Chain*. Contemporary Accounting Research, 21(2), 271–301. https://doi.org/https://doi.org/10.1506/VJR6-RP75-7GUX-XH0X Coe, A. B., Elliott, M. H., Gatewood, S. B. S., Goode, J. V. R., & Moczygemba, L. R. (2021). Perceptions and predictors of intention to receive the COVID-19 vaccine. Research in Social and Administrative Pharmacy. https://doi.org/10.1016/j.sapharm.2021.04.023 Cylus, J., & Papanicolas, I. (2016). Health System Efficiency 46 How to make measurement matter for policy and management. London. Dahlgren G, & Whitehead M. (1991). Dahlgren and Whitehead (1991) – Policies and strategies to promote social equity in health. Stockholm: Institute for future studies. Dahlgren G, Whitehead M. Retrieved from https://core.ac.uk/display/6472456 Enrique, B., & Marta, B. (2020). Efficacy, Effectiveness and Efficiency in the Health Care: The Need for an Agreement to Clarify its Meaning. International Archives of Public Health and Community Medicine, 4(1). https://doi.org/10.23937/2643-4512/1710035 Folland, S., & Goodman, A. (2013). The Economics of Health and Health Care. Oakland: Pearson. Guinness, L., Wiseman, V., & Wonderling, D. (2011). Introduction to health economics. (2nd ed. /). Maidenhead: McGraw-Hill/Open University Press. Hussey, P. S., de Vries, H., Romley, J., Wang, M. C., Chen, S. S., Shekelle, P. G., & McGlynn, E. A. (2009). A systematic review of health care efficiency measures. Health Services Research, 44(3), 784–805. https://doi.org/10.1111/j.1475-6773.2008.00942.x Hyder, A. A., Hyder, M. A., Nasir, K., & Ndebele, P. (2021). Inequitable COVID-19 vaccine distribution and its effects. Bulletin of the World Health Organization, 99(6), 406-406A. https://doi.org/10.2471/BLT.21.285616 Johansen, F., & van den Bosch, S. (2017). The scaling-up of Neighbourhood Care: From experiment towards a transformative movement in healthcare. Futures, 89, 60–73. https://doi.org/https://doi.org/10.1016/j.futures.2017.04.004 Lin, C. Y., Broström, A., Griffiths, M. D., & Pakpour, A. H. (2020). Investigating mediated effects of fear of COVID-19 and COVID-19 misunderstanding in the association between problematic social media use, psychological distress, and insomnia. Internet Interventions, 21. https://doi.org/10.1016/j.invent.2020.100345 Malik, A. A., McFadden, S. A. M., Elharake, J., & Omer, S. B. (2020). Determinants of COVID-19 vaccine acceptance in the US. EClinicalMedicine, 26. https://doi.org/10.1016/j.eclinm.2020.100495 Mathieu, E., Ritchie, H., Ortiz-Ospina, E., Roser, M., Hasell, J., Appel, C., … Rodés-Guirao, L. (2021). A global database of COVID-19 vaccinations. Nature Human Behaviour, 5(7), 947–953. https://doi.org/10.1038/s41562-021-01122-8 Mills, A., & Gilson, L. (2009). Health Economics for Developing Countries: A Survival Kit. Esocialsciences.Com, Working Papers. Mwachofi, A., & Al-Assaf, A. F. (2011). Health care market deviations from the ideal market. Sultan Qaboos University Medical Journal, 11(3), 328–337. Retrieved from https://pubmed.ncbi.nlm.nih.gov/22087373 Palmer, S., & Torgerson, D. J. (1999). Economic notes: definitions of efficiency. BMJ (Clinical Research Ed.), 318(7191), 1136. https://doi.org/10.1136/bmj.318.7191.1136 Petrou, A. (2014). Economic Efficiency. In A. C. Michalos (Ed.), Encyclopedia of Quality of Life and Well-Being Research (pp. 1793–1794). Dordrecht: Springer Netherlands. https://doi.org/10.1007/978-94-007-0753-5_818 Soares, P., Rocha, J. V., Moniz, M., Gama, A., Laires, P. A., Pedro, A. R., … Nunes, C. (2021). Factors associated with COVID-19 vaccine hesitancy. Vaccines, 9(3). https://doi.org/10.3390/vaccines9030300 Wajahat Hussain. (2020). Role of Social Media in COVID-19 Pandemic. The International Journal of Frontier Sciences, 4(2), 59–60. https://doi.org/10.37978/tijfs.v4i2.144 [1] Perfect competition, Monopoly, Oligopoly, Monopolistic competition [2] Control of Total revenue (TR) and Cost (TC) to maximize profit [3] An equilibrium point (Pareto Optimality) where Social Marginal Benefit (SMB) and the Cost (SMC) are equal

Vitamin D, Immune Responce and COVID-19

January 26, 2021 6:45 pm

Regardless of whether vitamin D protects against COVID-19, adequate levels are important for bone health. “Avoiding vitamin D deficiency is always a goal,” Ross wrote. “If the diet doesn’t include vitamin D fortified milk or natural products like fish, then a supplement of the RDA [recommended dietary allowance] amount (600-1000 IU per day) provides good assurance. I consider this a ‘good idea,’ but I don’t want to leave the impression that diet cannot be sufficient.”
Related articles:     https://www.dssurgery.com/articles/rationale-and-pl…d-guidance-paper/ https://www.dssurgery.com/articles/exploring-links-…ncy-and-covid-19/ https://www.dssurgery.com/articles/does-vitamin-d-d…rity-of-covid-19/ https://www.dssurgery.com/articles/an-estimate-of-t…vitamin-d-levels/ https://www.dssurgery.com/articles/short-term-high-…tudy-shade-study/ https://www.dssurgery.com/articles/association-betw…ovid-19-pandemic/ https://www.dssurgery.com/articles/vitamin-d-supple…elderly-covid-19/ https://www.dssurgery.com/articles/association-of-v…-19-test-results/ https://www.dssurgery.com/articles/sorting-out-whet…es-covid-19-risk/

Vitamin A and Wound healing

December 21, 2020 9:37 am

We have discussed the importance of vitamin A and eyesight at length previously.
Night Blindness – Vitamin A Deficiency
Nyctalopia (Night Blindness) An Early Sign of Vitamin A Deficiency with Video
A recent article discusses the types and function of vitamin A. As with the pandemic of COVID-19 continuous to stress our body and mind, we must stay vigilant with our nutritional status. Therefore, Vitamin supplements are critical in maintaining a robust immune system. For some, oral supplements are adequate; others may require injectable forms. If the oral supplements do not correct the vitamin A levels, please contact your primary care or our office to available vitamin A injections.  

Zoom Group Meeting November 24, 2020

November 24, 2020 4:40 pm

This is a summary of the Zoom Covid-19 meeting from November 24, 2020. The link to the slides is here.Zoom-Leture_11_24-2020 CDC guidelines for wearing masks are available here. Link to CDC website.   What is PCR – Polymerase Chain Reaction:   Types of Vaccines…. “The final two vaccine candidates (from Moderna and BioNTech/Fosun Pharma/Pfizer) are mRNA vaccines. What are those? First it helps to remember that DNA is the gene and RNA gives instructions for certain proteins. So an mRNA vaccine is the instructions for the SARS-CoV2 protein. Once inside the cell, the protein is made and that triggers the immune response. Just like the vector vaccines which use viruses to deliver the protein instructions, here you are delivering the instructions alone. It’s another way of getting the protein made inside of you. Is there any risk of getting COVID-19 or COVID-19-like side effects from these vaccines? When people talk about side effects of a vaccine, people often believe you’re getting a weaker version of the virus and a minor version of the disease. That is not what these things do. Most vaccine side effects — which include anything from a sore arm, to feeling warm to muscle aches — are a sign of the immune response. It’s not that you get a mild form of the disease. That’s important to be clear about. People keep a very close eye because you want to make sure these vaccines are safe.” https://labblog.uofmhealth.org/rounds/top-5-covid-19-vaccine-candidates-explained

Covid-19 Mutation – Please physically distance and Wear Masks

August 18, 2020 1:16 pm

Introduction:

There is evidence emerging of Covid-19 mutation. This may explain the difference between the severity and intesity of the disease presented in the those geographical locations where the disease  first.

Scientists from The Scripps Research Institute, Jupiter, Florida have identified changes in the Spike protein. This protein is used to bind the virus to host membranes. As we now know Florida is one of the few hot spots of the Covid-19 pandemic.

This has significant implications for the long term strategy needed to control transmission and manage resurrgence.

Until there is effective vaccination or effective treatment available for everyone, prevention by wearing face mask is the most efficient form to avoid transmistion.

Prevention:

The facts are that the most consistent effective preventive measures are wearing face masks and physical distancing.

There are those who may feel invincible and think that you will 1. either not get the disease or even if you get it it will 2-not affect your health.  Lets first remind ourselves that wearing a mask is more to prevent passing the virus that getting it. We should all assume that someone that we come in contact with may already have it. Would you like them to breath the virus toward you ? This then brings the second issue: We do not know what the long term health effect of the virus is for those who develop significant symptoms and those who are asymtphomatic.

The unkown:

Let’s look at other viral infections that provide either no or minimal disease condition at the time of initial exposure only to result in long term health conditions that may result in death. These include hepatitis and HIV exposures and infections. Admitedly  Coronavirus is a differnt family of virus. I am not suggesting that this will behave like other family of the viruses. We just do not have enough information to know what happens to those exposed to the virus (regardless of being asymptotic or not). Could the virus become dormant and over time result in organ injury (lung) like in the case  of hepatitis (liver). Or make a home in our body and have recurrent debilitating infections and symptoms as it is seen with Varicella-zoster virus (VZV) which causes chickenpox and the time of the initial infection and makes residence in our body to reappear later on as herpes zoster (shingles). Will we need a new strain of vaccine every year similar to the flu vaccine?

That is the crux.  We do not know because the COVID virus is new and we do not know the long term effects.

Symptoms of Coronavirus

April 15, 2020 8:10 pm

Symptoms of Covid-19 are broad. Thus a subset of patients present with different symptoms.

(c) https://thenativeantigencompany.com/

As the table demonstrates, there is not a clear clinical picture to distinguish betweem Covid-19 and other similar upper respiratory conditions early on. This is why testing is critical for the entier population. This will lead to identification of those at risk. Furthermore, It will also help with early and selective vacination when one becomes available.

Covid-19 Pandemic and Obesity

April 12, 2020 7:44 pm

We have now seen several articles with data collection regarding patients with obesity and COVID-19 being at greater risk of hospitalization.  We can look at metabolic syndrome associated with obesity as a risk factor also.

We have all been in physical isolation due to Covid-19 pandemic. The strategy of minimizing contact has worked. The data is clear when comparing information from states that instituted an aggressive containment plans compared to those who have not. This shows a sigifnicat flattening of the curve in California for example.

The CDC publishes the Morbidity and Mortality Weekle Report (MMWR) . The latest publushed summary (as of date of publucation of this blog) provides an insight to the risk factors of hospitalization.

The above table outlines the underlying conditions of those hospitalized with Covid-19.

Concerning to see that a respiratory virus is more likely to hospitalize those with Obesity, Diabetes and hypertension at a higher rate than lung and pulmonary related conditions.

Let us recognize that this is only a summary collected data. Therefore, there are limitatation to making any assumption of conclusion based on this information.

With those limitation aknowldged, and relying on our obesity related comobidities, we can make a few conclusions:

Not surprising, Obesity as with other diseases, compounds Covid-19 exposure and infection. Diabates is also a risk factor. There are no indepth information available on the diabetic patients. There is now data showing superior outcome of diabetes resoultion with weight loss surgery compared ro medical treatment.

 

Potential Treatment for Coronavirus-19

March 15, 2020 7:34 pm

There are a number of possible medications (Hydroxychloroquine and Azithromycin) being reported in the literature. They are mostly small series and not proven scientifically. Some of the medications that are being discussed in the media in fact have significant and deadly side effects. The use of these medications should be avoided until and unless some preliminary data shows any improvement. There are numerous pathways and approaches being considered for both vaccines and medications for the treatment of Coronavirus-19. One of the approaches is to try to minimize and mute the inflammation that is caused by the virus entering the lung cells leading to destructive damage of the lung tissue. There are a number of medications in this class, however, most of them have significant side effects. Baricitinib, a medication currently available for the treatment of rheumatoid arthritis may be such a molecule.