Dr. Bowman:

I agree with you on value-based health care purchasing, based on outcomes
and social priorities.

Steven Woolf recently reminded an audience that research on how to deliver
existing services and technologies more consistently can be FAR more
cost-effective than research aimed at developing new technologies.

In the USA, you could make an argument that the Agency for Health Research
and Quality (AHRQ) saves as many lives as the National Cancer Institute
(NCI).  But you'd never know it from looking at the two agencies' budgets.

Best wishes!

Dave Cundiff, MD, MPH
Olympia, Washington, USA

***

On 3/15/07 12:33 PM, "Robert C Bowman" <[log in to unmask]> wrote:

> In the United States, the rates of infectious diseases are much higher
> where the most people are packed together.
> 
> In United Health Care rankings there are differences by population
> concentrations that impact the state rankings and sometimes the associated
> relationships with a specialty choice, such as family medicine.
> 
> For example, the most densely populated states have the most care delivered
> in major medical centers, the fewest family physicians, and the worst
> levels of TB, hepatis B, and STDs. They have the best rates of screening
> for cholesterol.
> 
> The least densely populated have the opposite in all groups.
> 
> Now it could be that FPs do not screen or it could be that those most
> interested in screening are those with bachelors degrees and professional
> school diplomas, the ones more likely to be found in the most densely
> populated states.
> 
> Immunization rates and access to prenatal care do no vary by state level
> analysis, suggesting some success in these areas, but with poor results in
> most other areas. Of course we continue to pour more funding into
> immunizations and less than the most useful immunizations and more funding
> into prenatal care and less than effective prenatal care, when we should be
> diverting funding into areas more likely to result in better health.
> 
> With concentrations of people, especially those with less healthy behaviors
> and lower income levels, there will be higher rates of a number of
> different morbidities and mortalities.
> 
> Robert C. Bowman, M.D.
> [log in to unmask]
> 
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