Category Archives: politics

complex adaptive systems, data saving lives, EF, healthy habits, meaning, nutrition, policy, politics, rapid learning health systems

McKinsey’s Plan to fight obesity…

http://www.mckinsey.com/Insights/Economic_Studies/How_the_world_could_better_fight_obesity

Executive Summary: Innovation vs Obesity_McKinsey

MGI Obesity_Full report_November 2014

Sensible stuff. Possibly the most sensible stuff I’ve seen on this. Good for them…

How the world could better fight obesity

November 2014 | byRichard Dobbs, Corinne Sawers, Fraser Thompson, James Manyika, Jonathan Woetzel, Peter Child, Sorcha McKenna, and Angela Spatharou

Obesity is a critical global issue that requires a comprehensive, international intervention strategy. More than 2.1 billion people—nearly 30 percent of the global population—are overweight or obese.1 That’s almost two and a half times the number of adults and children who are undernourished. Obesity is responsible for about 5 percent of all deaths a year worldwide, and its global economic impact amounts to roughly $2 trillion annually, or 2.8 percent of global GDP—nearly equivalent to the global impact of smoking or of armed violence, war, and terrorism.

Podcast

Implementing an Obesity Abatement Program

MGI’s Richard Dobbs and Corinne Sawers discuss how a holistic strategy, using a number of interventions, could reverse rising rates of obesity around the world.

And the problem—which is preventable—is rapidly getting worse. If the prevalence of obesity continues on its current trajectory, almost half of the world’s adult population will be overweight or obese by 2030.

Much of the global debate on this issue has become polarized and sometimes deeply antagonistic. Obesity is a complex, systemic issue with no single or simple solution. The global discord surrounding how to move forward underscores the need for integrated assessments of potential solutions. Lack of progress on these fronts is obstructing efforts to address rising rates of obesity.

A new McKinsey Global Institute (MGI) discussion paper,Overcoming obesity: An initial economic analysis, seeks to overcome these hurdles by offering an independent view on the components of a potential strategy. MGI has studied 74 interventions (in 18 areas) that are being discussed or piloted somewhere around the world to address obesity, including subsidized school meals for all, calorie and nutrition labeling, restrictions on advertising high-calorie food and drinks, and public-health campaigns. We found sufficient data on 44 of these interventions, in 16 areas.

Although the research offers an initial economic analysis of obesity, our analysis is by no means complete. Rather, we see our work on a potential program to address obesity as the equivalent of the maps used by 16th-century navigators. Some islands were missing and some continents misshapen in these maps, but they were still helpful to the sailors of that era. We are sure that we have missed some interventions and over- or underestimated the impact of others. But we hope that our work will be a useful guide and a starting point for efforts in the years to come, as we and others develop this analysis and gradually compile a more comprehensive evidence base on this topic.

We have focused on understanding what it takes to address obesity by changing the energy balance of individuals through adjustments in eating habits or physical activity. However, some important questions we have not yet addressed require considerable further research. These questions include the role of different nutrients in affecting satiety hormones and metabolism, as well as the relationship between the gut microbiome and obesity. As more clarity develops in these research areas, we look forward to the emergence of important insights about which interventions are likely to work and how to integrate them into an antiobesity drive.

The main findings of this discussion paper include:

  • Existing evidence indicates that no single intervention is likely to have a significant overall impact. A systemic, sustained portfolio of initiatives, delivered at scale, is needed to reverse the health burden. Almost all the identified interventions (exhibit) are cost effective for society—savings on healthcare costs and higher productivity could outweigh the direct investment required by the intervention when assessed over the full lifetime of the target population. In the United Kingdom, for instance, such a program could reverse rising obesity, saving the National Health Service about $1.2 billion a year.
  • Education and personal responsibility are critical elements of any program aiming to reduce obesity, but they are not sufficient on their own. Other required interventions rely less on conscious choices by individuals and more on changes to the environment and societal norms. They include reducing default portion sizes, changing marketing practices, and restructuring urban and education environments to facilitate physical activities.
  • No individual sector in society can address obesity on its own—not governments, retailers, consumer-goods companies, restaurants, employers, media organizations, educators, healthcare providers, or individuals. Capturing the full potential impact requires engagement from as many sectors as possible. Successful precedents suggest that a combination of top-down corporate and government interventions, together with bottom-up community-led ones, will be required to change public-health outcomes. Moreover, some kind of coordination will probably be required to capture potentially high-impact industry interventions, since any first mover faces market-share risks.
  • Implementing an obesity-abatement program on the required scale will not be easy. We see four imperatives: (1) as many interventions as possible should be deployed at scale and delivered effectively by the full range of sectors in society; (2) understanding how to align incentives and build cooperation will be critical to success; (3) there should not be an undue focus on prioritizing interventions, as this can hamper constructive action; and (4) while investment in research should continue, society should also engage in trial and error, particularly where risks are low.

Exhibit

Cost-effective interventions to reduce obesity in the United Kingdom include controlling portion sizes and reducing the availability of high-calorie foods.

The evidence base on the clinical and behavioral interventions to reduce obesity is far from complete, and ongoing investment in research is an imperative. However, in many cases this requirement is proving a barrier to action. It need not be so. Rather than wait for perfect proof of what works, we should experiment with solutions, especially in the many areas where interventions are low risk. We have enough knowledge to do more.

About the authors

Richard Dobbs, James Manyika, and Jonathan Woetzel are directors of the McKinsey Global Institute, where Corinne Sawers is a fellow and Fraser Thompson is a senior fellow; Peter Child is a director in McKinsey’s London office; Sorcha McKenna is a principal in the Dublin office; and Angela Spatharou is a principal in the Mexico City office.

 

MGI_Implementing_an_Obesity_Abatement_Program_Exibit18 MGI_Implementing_an_Obesity_Abatement_Program_Exibit3 MGI_Implementing_an_Obesity_Abatement_Program_ExibitE3 MGI_Implementing_an_Obesity_Abatement_Program_Exibit1

data saving lives, health market quality, healthcare, policy, politics

Health Data “Interoperability”: A $30 Billion Unicorn Hunt

too funny

http://www.forbes.com/sites/theapothecary/2014/09/03/health-data-interoperability-a-30-billion-unicorn-hunt/

Health Data “Interoperability”: A $30 Billion Unicorn Hunt

John R. GrahamJohn R. Graham , Contributor
Comment Now

Having cheered as $26 billion of taxpayers’ money has been spent since 2009 inducing hospitals and physicians to install electronic health records (EHRs), many champions of the effort are dismayed that the EHRs are not interoperable. That is, they cannot talk to each other – which was the whole point of subsidizing the exercise.

All this money has achieved a process goal: There has been a significant uptake of EHRs. According to a recent review, the proportion of physicians who have at least a basic EHR has increased from under 22 percent to 48 percent. Doctors were motivated by the bounty offered, plus the threat of having reimbursements being clawed back in 2015 if they have not adopted EHRs. The proportion of hospitals has similarly increased from 12 percent to 44 percent.

But these EHRs do not  talk to each other. According to the same review, “only 10 percent of ambulatory practices and 30 percent of hospitals were found to be participating in operational health information exchange efforts.”

All those billions of taxpayers’ dollars were paid out to providers who attest to “meaningful use” of EHRs. However, there are three stages of meaningful use.  Stage 1 was relatively simple. Stage 2 was originally supposed to be achieved by 2013, but that has been pushed back until 2016. The hang up is that stage 2 has a high hurdle for interoperability.

According to the final rule published in September 2012, requirements include “the expectation that providers will electronically transmit patient care summaries with each other and with the patient to support transitions in care. Increasingly robust expectations for health information exchange in Stage 2 and Stage 3 would support the goal that information follows the patient.”

Despite the delay, providers are still complaining that the requirements are too demanding. According to Russell Branzell, president and CEO of the College of Healthcare Information Management Executives: “Now the very future of Meaningful Use is in question.”

So it should be: Evidence from Congressional investigations suggests that meaningful-use bounties have encouraged the adoption of EHRs that are deliberately closed to exchange with other parties. The problem is that exchanging data with competitors is fundamentally against the self-interest of the party which created the data. Nobody would expect The U.S. Department of Transportation to set up a fund to incentivize car-markers to exchange data with each other, or the U.S. Department of Agriculture to set up a fund to incentivize grocery stores to exchange data with each other.

670px-obama_signing_health_care-201003231

That is not to say that there would be no value to such data exchange. IfSafeway were out of my favorite brand of breakfast cereal, I’d love for the clerk to tell me that Giant had plenty in stock just down the road, instead of selling me something similar. However, the amount of government funding required to overwhelm competitors’ resistance to doing this would surely not be worth it.

I’m sure readers can come up with many examples that would demonstrate the public benefit of competing hospital systems sharing data seamlessly. An epidemic or terrorist attack are easy ones. However, advocates of health information exchange emphasize how it would reduce friction in the day to day operations of our health system.

But at what cost? $26 billion has not done the trick. It is unlikely that the remaining $4 billion in the pot will get the job done. The Office of the National Coordinator of Health IT has been promoting a ten-year plan for more funding – even a trust fund like the Federal Highway Trust Fund!

When the Office of the National Coordinator of Health IT was established during the Bush Administration, its purpose was to “coordinate,” not underwrite nor regulate. Congress should be wary of appropriating yet more funding to hunt the unicorn of health data interoperability.

health market quality, healthcare, policy, politics

Terry Barnes: Doctors have a fat co-payment scheme of their own

Another cracking, clean head shot from Terry… totally concur with this one!

http://www.afr.com/p/business/healthcare2-0/doctors_have_fat_co_payment_scheme_g9tVCa7kjp7RkGhXIHh3tN

TERRY BARNES

Doctors have a fat co-payment scheme of their own

PUBLISHED: 13 AUG 2014 00:05:00 | UPDATED: 20 AUG 2014 11:53:54

Doctors have a fat co-payment scheme of their own

Even if Medicare rebates don’t cover the full cost of medical services plus a reasonable margin, their subsidies make costly specialist services accessible and affordable to most Australians on low to middle incomes. Photo: Glenn Hunt

TERRY BARNES

While relentlessly attacking the federal budget’s $7 co-payment on bulk-billed GP services measure as unfair, neurosurgeon and Australian Medical Association president Brian Owler asserts doctors’ rights to charge co-payments generally. His specialist members certainly do with gusto, and presumably he does too.

If he but realises it, Health Minister Peter Dutton is ideally placed to drive a hard bargain with the AMA on containing excessive out-of-pockets, especially given the doctors’ trade union is pressuring the government to dump the $5 cut to Medicare rebates intended to drive GPs to charge the co-payment.

The ace up Dutton’s sleeve is that doctors, particularly surgeons and specialists, depend on Medicare income like a smoker depends on his nicotine fix. Even if Medicare rebates don’t cover the full cost of medical services plus a reasonable margin, their subsidies make costly specialist services accessible and affordable to most Australians on low to middle incomes, especially the pensioners and fixed-income retirees who dominate the demand for medical services.

Given this financial reality, the government should use its domination of purchasing by Medicare on behalf of patients to bring the AMA to heel on excessive specialist charging. Doctors are entitled to a fair and reasonable fee above the Medicare schedule fee, and there’s no cap on what doctors can charge, but too many specialists have assumed this is carte blanche to gouge poor paying punters.

To end specialist billing rorts, the government can and should impose out-of-pocket capping that is simple, elegant, and transparent, using the AMA’s own benchmarks against it.

The AMA has its own private fee schedule, in which it determines what it considers appropriate prices for specific Medicare service items. AMA fees have long been an unofficial benchmark for doctors, the association stressing that it is staying on the right side of competition law by offering general advice to its members rather than giving them direction. The government’s published Medicare schedule fee observance and out-of-pocket data indicate that a great many doctors, notably GPs, apply the AMA recommended fee when they don’t bulk bill.

‘FAIR AND REASONABLE’

 

What’s more, specialist association submissions to the current Senate inquiry into patient out-of-pocket expenses repeatedly cite AMA recommended fees as being fair and reasonable, especially when compared with what they depict as woefully inadequate Medicare rebates.

With this in mind, the government should take doctors at their word and insist, as a condition of specialists’ access to Medicare, that patient contributions for any billed service that exceed AMA recommended fees will be prohibited. If doctors exceeds this cap, they could be fined have their Medicare billing rights suspended or cancelled, and be required to refund gouged patients their contributions plus credit care-level interest. The current but secret AMA recommended fee schedule would be published as a baseline, and subsequently indexed annually under a formula agreed by the government and the profession.

Recommended fees for future new items would be set by the AMA and relevant specialist colleges in consultation with the government.

Should a doctor want to be more competitive on price, there would be no prohibition on their charging a fee lower than the AMA’s recommendation.

But they would not be permitted to exceed it if they bill Medicare as their patients would expect.

Further, private health insurers should be permitted to cover the gap between specialist Medicare rebates and AMA recommended fees. This would be fairer to patients than current arrangements in which insurers have no gap, or no known gap deals with some specialists but not with others. It would also tackle those GPs and specialists, most notoriously anaesthetists, who blatantly ignore their patients’ rights to be informed of and consent to fees before a service is provided.

Private insurers also should be able to advise their members on the comparative performance of doctors, especially in relation to price. In a market for health services bedevilled by information asymmetry, insurers have a wealth of consumer knowledge that can be shared without compromising the privity of the doctor-patient relationship. Let them share it. For too long, medical specialists have got away with ripping off patients through excessive charging practices. Dutton, therefore, should use his negotiations with the AMA to take a stand for patients, call Owler’s bluff, and wield his own market power to bring the AMA to heel over specialists’ stubborn, arrogant and contemptuous disregard for their patients as customers. If the minister does take on the AMA over blatant fee-gouging, he’d be onto a political winner.

Terry Barnes authored the Australian Centre for Health Research’s $7 GP co-payment proposal.

The Australian Financial Review

facts & data points, health market quality, healthcare, healthy habits, policy, politics

Nearly half of all Americans will get type 2 diabetes

 

http://www.theguardian.com/society/the-shape-we-are-in-blog/2014/aug/13/diabetes-usdomesticpolicy

Nearly half of all Americans will get type 2 diabetes, says study

Type 2 diabetes, linked in 90% of cases to overweight and obesity, is soaring. New research shows 40% of Americans and 50% of Hispanics and non-Hispanic black women will get the disease at some point in their life and the numbers are unlikely to be much different elsewhere in the developed world

A patient undergoes a blood test for diabetes

A patient undergoes a blood test for diabetes, a condition which brings icnreased risk of stroke and heart failure. Photograph: Hugo Philpott/PA

How much worse can the type 2 diabetes epidemic get? Shockingly, a new study published by a leading medical journal says that 40% of the adult population of the USA is expected to be diagnosed with the disease at some point in their lifetime. And among Hispanic men and women and non-Hispanic black women, the chances are even higher – one in two appear to be destined to get type 2 diabetes.

As Public Health England spelled out in a recent report urging local authorities to take action, 90% of people with type 2 diabetes are overweight or obese. There is no mystery behind the rise in diagnoses – they match the soaring weight of the population. The climb dates back to the 1980s and is associated with our more sedentary lifestyles and changing eating habits – more food, containing more calories, more often. It is those things that will have to be tackled if the epidemic is to be contained.

The new study in The Lancet Diabetes & Endocrinology journal, from a team of researchers from the Centers for Disease Control and Prevention in Atlanta, shows that the risk of developing type 2 diabetes for the average 20 year-old American rose from 20% for men and 27% for women in 1985–1989, to 40% for men and 39% for women in 2000–2011. The study was big – involving data including interviews and death certificates from 600,000 Americans.

Americans are generally living longer, which is a factor in their increased lifetime chance of developing type 2 diabetes. They are also not dying in the same proportions that they were, because of better treatment. However, that means they are going to spend far more years of their lives suffering from type 2 diabetes, which can lead to blindness and foot amputations as well as heart problems.

This is very bad news for the US healthcare system, says Dr Edward Gregg, study leader and chief of the epidemiology and statistics branch of the Division of Diabetes Translation at CDC:

As the number of diabetes cases continue to increase and patients live longer there will be a growing demand for health services and extensive costs. More effective lifestyle interventions are urgently needed to reduce the number of new cases in the USA and other developed nations.

Both he and Canada-based Dr Lorraine Lipscombe, who has written a commentary on the study, point out that the situation in the US is unlikely to be much different from that elsewhere in the developed world. Dr Lipscombe, from Women’s College Hospital and the University of Toronto, writes:

The trends reported by Gregg and colleagues are probably similar across the developed world, where large increases in diabetes prevalence in the past two decades have been reported.

Primary prevention strategies are urgently needed. Excellent evidence has shown that diabetes can be prevented with lifestyle changes. However, provision of these interventions on an individual basis might not be sustainable.

Only a population-based approach to prevention can address a problem of this magnitude. Prevention strategies should include optimisation of urban planning, food-marketing policies, and work and school environments that enable individuals to make healthier lifestyle choices. With an increased focus on interventions aimed at children and their families, there might still be time to change the fate of our future generations by lowering their risk of type 2 diabetes.

cool, healthcare, management and leadership, policy, politics, quotes & aphorisms, storytelling

Eisenhower’s Farewell Address – The Military-Industrial Complex

President Dwight Eisenhower’s Farewell Address to the nation January 17, 1961

In the councils of government, we must guard against the acquisition of unwarranted influence, whether sought or unsought, by the military-industrial complex. The potential for the disastrous rise of misplaced power exists and will persist.

We must never let the weight of this combination endanger our liberties or democratic processes. We should take nothing for granted only an alert and knowledgeable citizenry can compel the proper meshing of huge industrial and military machinery of defense with our peaceful methods and goals, so that security and liberty may prosper together.

….

The prospect of domination of the nation’s scholars by Federal employment, project allocations, and the power of money is ever present and is gravely to be regarded.

Yet, in holding scientific research and discovery in respect, as we should, we must also be alert to the equal and opposite danger that public policy could itself become the captive of a scientific-technological elite.

It is the task of statesmanship to mold, to balance, and to integrate these and other forces, new and old, within the principles of our democratic system-ever aiming toward the supreme goals of our free society.

 

Transcript of President Dwight D. Eisenhower’s Farewell Address (1961)

My fellow Americans:

Three days from now, after half a century in the service of our country, I shall lay down the responsibilities of office as, in traditional and solemn ceremony, the authority of the Presidency is vested in my successor.

This evening I come to you with a message of leave-taking and farewell, and to share a few final thoughts with you, my countrymen.

Like every other citizen, I wish the new President, and all who will labor with him, Godspeed. I pray that the coming years will be blessed with peace and prosperity for all.

Our people expect their President and the Congress to find essential agreement on issues of great moment, the wise resolution of which will better shape the future of the Nation.

My own relations with the Congress, which began on a remote and tenuous basis when, long ago, a member of the Senate appointed me to West Point, have since ranged to the intimate during the war and immediate post-war period, and, finally, to the mutually interdependent during these past eight years.

In this final relationship, the Congress and the Administration have, on most vital issues, cooperated well, to serve the national good rather than mere partisanship, and so have assured that the business of the Nation should go forward. So, my official relationship with the Congress ends in a feeling, on my part, of gratitude that we have been able to do so much together.

II

We now stand ten years past the midpoint of a century that has witnessed four major wars among great nations. Three of these involved our own country. Despite these holocausts America is today the strongest, the most influential and most productive nation in the world. Understandably proud of this pre-eminence, we yet realize that America’s leadership and prestige depend, not merely upon our unmatched material progress, riches and military strength, but on how we use our power in the interests of world peace and human betterment.

III

Throughout America’s adventure in free government, our basic purposes have been to keep the peace; to foster progress in human achievement, and to enhance liberty, dignity and integrity among people and among nations. To strive for less would be unworthy of a free and religious people. Any failure traceable to arrogance, or our lack of comprehension or readiness to sacrifice would inflict upon us grievous hurt both at home and abroad.

Progress toward these noble goals is persistently threatened by the conflict now engulfing the world. It commands our whole attention, absorbs our very beings. We face a hostile ideology-global in scope, atheistic in character, ruthless in purpose, and insidious in method. Unhappily the danger it poses promises to be of indefinite duration. To meet it successfully, there is called for, not so much the emotional and transitory sacrifices of crisis, but rather those which enable us to carry forward steadily, surely, and without complaint the burdens of a prolonged and complex struggle-with liberty at stake. Only thus shall we remain, despite every provocation, on our charted course toward permanent peace and human betterment.

Crises there will continue to be. In meeting them, whether foreign or domestic, great or small,there is a recurring temptation to feel that some spectacular and costly action could become the miraculous solution to all current difficulties. A huge increase in newer elements of our defense; development of unrealistic programs to cure every ill in agriculture; a dramatic expansion in basic and applied research-these and many other possibilities, each possibly promising in itself, may be suggested as the only way to the road we which to travel.

But each proposal must be weighed in the light of a broader consideration: the need to maintain balance in and among national programs-balance between the private and the public economy, balance between cost and hoped for advantage-balance between the clearly necessary and the comfortably desirable; balance between our essential requirements as a nation and the duties imposed by the nation upon the individual; balance between action of the moment and the national welfare of the future. Good judgment seeks balance and progress; lack of it eventually finds imbalance and frustration.

The record of many decades stands as proof that our people and their government have, in the main, understood these truths and have responded to them well, in the face of stress and threat. But threats, new in kind or degree, constantly arise. I mention two only.

IV

A vital element in keeping the peace is our military establishment. Our arms must be mighty, ready for instant action, so that no potential aggressor may be tempted to risk his own destruction.

Our military organization today bears little relation to that known by any of my predecessors in peace time, or indeed by the fighting men of World War II or Korea.

Until the latest of our world conflicts, the United States had no armaments industry. American makers of plowshares could, with time and as required, make swords as well. But now we can no longer risk emergency improvisation of national defense; we have been compelled to create a permanent armaments industry of vast proportions. Added to this, three and a half million men and women are directly engaged in the defense establishment. We annually spend on military security more than the net income of all United State corporations.

This conjunction of an immense military establishment and a large arms industry is new in the American experience. The total influence-economic, political, even spiritual-is felt in every city, every state house, every office of the Federal government. We recognize the imperative need for this development. Yet we must not fail to comprehend its grave implications. Our toil, resources and livelihood are all involved; so is the very structure of our society.

In the councils of government, we must guard against the acquisition of unwarranted influence, whether sought or unsought, by the military-industrial complex. The potential for the disastrous rise of misplaced power exists and will persist.

We must never let the weight of this combination endanger our liberties or democratic processes. We should take nothing for granted only an alert and knowledgeable citizenry can compel the proper meshing of huge industrial and military machinery of defense with our peaceful methods and goals, so that security and liberty may prosper together.

Akin to, and largely responsible for the sweeping changes in our industrial-military posture, has been the technological revolution during recent decades.

In this revolution, research has become central; it also becomes more formalized, complex, and costly. A steadily increasing share is conducted for, by, or at the direction of, the Federal government.

Today, the solitary inventor, tinkering in his shop, has been over shadowed by task forces of scientists in laboratories and testing fields. In the same fashion, the free university, historically the fountainhead of free ideas and scientific discovery, has experienced a revolution in the conduct of research. Partly because of the huge costs involved, a government contract becomes virtually a substitute for intellectual curiosity. For every old blackboard there are now hundreds of new electronic computers.

The prospect of domination of the nation’s scholars by Federal employment, project allocations, and the power of money is ever present and is gravely to be regarded.

Yet, in holding scientific research and discovery in respect, as we should, we must also be alert to the equal and opposite danger that public policy could itself become the captive of a scientific-technological elite.

It is the task of statesmanship to mold, to balance, and to integrate these and other forces, new and old, within the principles of our democratic system-ever aiming toward the supreme goals of our free society.

V

Another factor in maintaining balance involves the element of time. As we peer into society’s future, we-you and I, and our government-must avoid the impulse to live only for today, plundering, for our own ease and convenience, the precious resources of tomorrow. We cannot mortgage the material assets of our grandchildren without risking the loss also of their political and spiritual heritage. We want democracy to survive for all generations to come, not to become the insolvent phantom of tomorrow.

VI

Down the long lane of the history yet to be written America knows that this world of ours, ever growing smaller, must avoid becoming a community of dreadful fear and hate, and be, instead, a proud confederation of mutual trust and respect.

Such a confederation must be one of equals. The weakest must come to the conference table with the same confidence as do we, protected as we are by our moral, economic, and military strength. That table, though scarred by many past frustrations, cannot be abandoned for the certain agony of the battlefield.

Disarmament, with mutual honor and confidence, is a continuing imperative. Together we must learn how to compose difference, not with arms, but with intellect and decent purpose. Because this need is so sharp and apparent I confess that I lay down my official responsibilities in this field with a definite sense of disappointment. As one who has witnessed the horror and the lingering sadness of war-as one who knows that another war could utterly destroy this civilization which has been so slowly and painfully built over thousands of years-I wish I could say tonight that a lasting peace is in sight.

Happily, I can say that war has been avoided. Steady progress toward our ultimate goal has been made. But, so much remains to be done. As a private citizen, I shall never cease to do what little I can to help the world advance along that road.

VII

So-in this my last good night to you as your President-I thank you for the many opportunities you have given me for public service in war and peace. I trust that in that service you find somethings worthy; as for the rest of it, I know you will find ways to improve performance in the future.

You and I-my fellow citizens-need to be strong in our faith that all nations, under God, will reach the goal of peace with justice. May we be ever unswerving in devotion to principle, confident but humble with power, diligent in pursuit of the Nation’s great goals.

To all the peoples of the world, I once more give expression to America’s prayerful and continuing inspiration:

We pray that peoples of all faiths, all races, all nations, may have their great human needs satisfied; that those now denied opportunity shall come to enjoy it to the full; that all who yearn for freedom may experience its spiritual blessings; that those who have freedom will understand, also, its heavy responsibilities; that all who are insensitive to the needs of others will learn charity; that the scourges of poverty, disease and ignorance will be made to disappear from the earth, and that, in the goodness of time, all peoples will come to live together in a peace guaranteed by the binding force of mutual respect and love.

Transcription courtesy of the Dwight D. Eisenhower Presidential Library and Museum.

data saving lives, policy, politics, rapid learning health systems

Singapore appoints first Chief Data Scientist

this is a brilliant move….

http://www.futuregov.asia/articles/2014/aug/14/singapore-governments-first-chief-data-scientist-p/

ANALYSIS, CONNECTED GOVERNMENT, GOVERNMENT ANALYTICS

SINGAPORE GOVERNMENT’S FIRST CHIEF DATA SCIENTIST PRABIR SEN ON HIS NEW ROLE AND GOALS

By Kelly Ng | 14 August 2014 | Views: 689

From traffic updates to tax returns, cities and countries have more data than ever before – but how can they manage it?

FutureGov has exclusively interviewed Prabir Sen, Singapore government’s first Chief Data Scientist. He was appointed by the Infocomm Development Authority of Singapore (IDA) in January, and spoke on why his role was created, what he wants to achieve and the challenges he faces.

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Vision to be a global analytics hub

Singapore aspires to be the world’s centre of data science and analytics. This vision required a dedicated team to guide the development of skills on data sciences and advanced analytic across the government and industry. The role of the Chief Data Scientist and his supporting team, called the Data Sciences Group, were created to drive the private and public sectors’ adoption of data analytics, said Sen.

Sen is excited about the potential for expanding Singapore’s work in this area: “I wonder if it is possible to invite the international sports and games industry, such as the Olympics Association, to collaborate with Singapore-based tech companies and talents on sports analytics right here in Singapore? Is it possible to attract aerospace and logistics companies here to do machine-to-machine data analytics? Is it possible to drive the multinational consumer good corporations to work with local small tech companies on advanced consumer insights?”

Using analytics to improve quality of decisions & lives

The government believes that data analytics has huge opportunities to impact government services and improve citizens’ lives in a wide range of areas, such as healthcare, transportation, education, retail and waste management.

A large volume of data is being generated from sensors and mobile devices today. This includes communication between person-to-person, person-to-machine and machine-to-machine, added Sen. He and his team are tasked to evaluate and apply advanced analytics techniques and models that can help organisations get a “360-degree view on people, technology and policies to improve the quality of decisions and improve citizens’ lives and journey of experience at various touch points.”

Cross agency data analytics

The greatest opportunity for using analytics within government is what Sen calls “cross data analysis”, where one agency can use data of another agency to solve their problem. “For example, the Ministry of Manpower can analyse healthcare data from Ministry of Health to determine skill gaps and future talent development requirements, or, transportation use environment to determine impact of weather in commuters’ behaviour” he said. “Such cross data analyses also require greater attention to and better governance of data protection, privacy and anonymity,” he added.

Some agencies are currently using this strategy and are achieving great results, he said, and the Singapore government is now encouraging them to explore more cross-agency data use.

Innovation therefore requires agencies to be even more ready to experiment: “Data analytics is fanning the flames of entrepreneurship in the Singapore government, to adopt a philosophy called ‘start up’. Government is obviously not a start up but initiatives to effect change are best thought of as start-ups where we should be more ready to trial and be comfortable with small failures.”

“Compare a project that takes months and costs a lot of money; with one that takes two persons and a couple of weeks of effort. If the former fail, it will be catastrophic, while a failure of a small trial is still acceptable. We can adopt a risk management methodology where the cost of failing becomes exceedingly tiny,” he said.

Developing analytics talent

One of Sen’s key performance indicators is to strengthen data talent locally. According to a recent IDA release, “McKinsey forecasts that there will be a shortage of 140,000 to 190,000 data sciences and analytics professionals by 2018 in just the US alone”.

Sen shared that the need to increase the local data talent pool is a real challenge. Most organisations are struggling to recruit enough candidates with the right skills. “We are shorthanded in several areas: data scientists who have both computational experience and business acumen, data visualisers who are skilled in both analytics and graphic design, analytics consultants who hold domain knowledge besides their analytics experience, and data engineers who can source and integrate data from disparate systems.”

Retaining this data talent is even more difficult, he continued. “Most of these data professionals are creative people. They require space and freedom and a stimulating environment to explore new approaches and insights that challenge them. So we need to facilitate and grow this local community, to drive engagement with them, pulling together users, data analytics companies, cloud providers to form an ecosystem to exchange ideas.”

To this end, IDA has launched a Massive Open Online Course (MOOC) on data science and analytics this month, offering locals the chance to develop the vital skills to respond to the growing demand for data professionals. The class has attracted more than 350 registrations from both the private and public sector.

Chief Data Officer vs Chief Data Scientist

Sen also clarified how his role is different from a Chief Data Officer. “A Chief Data Officer typically has responsibility to govern and protect data, and find ways to use data across the agencies. My role, on the other hand, is to find ways to build transformative products using data sciences, analytics and insights; drive rapid development and adoption of analytical techniques, and develop the local data and tech talent.”

The skills and experience that make a good Chief Data Scientist, Sen added, is not limited to quantitative and computation proficiency. The candidate must be good at understanding human behaviour, how people go about solving their problems and making decisions, and able to think laterally to engage in cross-cutting strategic dialogues. Most importantly, he must be able to learn, unlearn and relearn.

Learning will be vital as Singapore seeks to become a global hub for analytics. Agencies are being challenged to work together on trialling new approaches, while the government is seeking to build greater scientific communities and talent in the city state. Ultimately, though, these efforts could lead to greater personalisation of citizen services – a new way in which the government engage and does business with its customers.

health market quality, healthcare, policy, politics

Barnes: Cap specialist fees to maintain access to medicare

Good call…

http://www.medicalobserver.com.au/news/call-to-cap-specialists-fees-gathers-support

Call to cap specialists’ fees gathers support

7th Aug 2014

Flynn Murphy   all articles by this author

THE former Howard government adviser who reignited the co-payment debate is back. In his sights: exorbitant out-of-pocket expenses being charged by overpaid specialists.

Terry Barnes has called for the fees that surgeons and other specialists can charge to be capped at their AMA-recommended rates. And if they charge too much they should be refused access to Medicare, he told Medical Observer.

“If the AMA schedule is considered fair and reasonable, then any out-of-pocket in excess of that is, by definition, unreasonable,” Mr Barnes said.

“What I propose is that if the government gives ground on cutting the GP rebate [for the co-payment], the quid pro quo is that the government works together with the AMA to reduce patient out-of-pockets.”

Mr Barnes showed MO a recent anaesthetist’s bill that saw him pay four times the rebate he was entitled to under the MBS.

“She should have delivered an anaesthetic with her [bill],” he said.

The proposal is backed by the Grattan Institute’s Dr Stephen Duckett, a prominent health economist who gave evidence to the recent Senate inquiry into out-of-pocket costs.

In his submission to the inquiry, Dr Duckett reported that for people in the lowest disposable income decile, average fees for specialists were nearly four times the average GP fee.

“I think it’s a good idea,” he said of Mr Barnes’s call.

“I think the profession has to have some responsibility for moderating out-of-pocket costs. There is an issue here about professional responsibility.”

The comments follow a statement from the Royal Australasian College of Surgeons (RACS) expressing concern about reports of “excessive… even extortionate” and “unethical” surgical fees being charged to patients by its own members.

RACS president Professor Michael Grigg said the reported fees were “damaging to the health system and to the standing of surgeons and the surgical profession”.

“RACS believes that extortionate fees, where they are manifestly excessive and bear little if any relationship to utilisation of skills, time or resources, are exploitative and unethical. As such, they are in breach of the college’s code of conduct and will be dealt with by the college,” the statement said.

But an RACS spokesman said the college does not support a cap on fees.

An AMA spokesman said: “The AMA is currently in talks with the government on the disastrous and hugely unpopular budget co-payments proposal, and doubts that the government would be rushing to adopt any other ‘thought bubbles’ from the author of that policy.”