Month: October 2016

Puerto Rico: The Zika crisis is a reproductive crisis with women unable to obtain birth control…

We Know How to Fight Zika in Puerto Rico—But Aren’t Giving Women the Tools to Do It

BY: Kristyn BrandiPOSTED ON: September 14, 2016TOPICS: birth, contraception, maternal and child health, pregnancy, viewpoint, zika

Credit: Kristyn Brandi

A version of this article originally appeared in the Washington Post.

“She is just trying to do everything right for her baby,” my colleague in Puerto Rico told me. At that point, it was too late for her sister to try to prevent an unintended pregnancy. She was already a couple of months along and now trying to figure out what she could do to prevent Zika infection. She felt trapped—homebound in an air-conditioned apartment with her partner, too worried about being exposed to mosquitoes to even go to her doctor appointments. She often thought about leaving the country for the mainland United States, which Puerto Rican citizens can do at any time if they have the financial means.

My colleague was asking for my advice—as a friend, but more as a doctor. In June, when I was on the ground in Puerto Rico working with local providers at community health centers to help stop the spread of Zika, a virus that has become a public health emergency, there were 130 cases of Zika-positive pregnancies on the island. Since then, that number has shot up to about 900 and, today, there are probably many more. Unfortunately, I had little to share with her that day other than the typical lines: We don’t know much, she should stay protected if she can with mosquito nets and condoms.

During pregnancy, a woman often worries about the food she’s eating, if she’s sleeping in the right position. The threat of Zika doesn’t just alter the equation: It blows it up. As part of my OB/GYN family-planning fellowship at Boston Medical Center and my practicum experience for the Boston University School of Public Health, I helped educate health-care providers of obstetrics and gynecology about patient-centered contraceptive counseling and access to all forms of contraception. The harsh fact, though, is that the virus is spreading much faster than our efforts to spread awareness and resources, and the effects are devastating. Given how quickly people are becoming infected, it is critically important to put contraception into the hands of women in Puerto Rico. It is by no means a cure for those already infected by Zika, but contraception serves to drastically reduce the chances of those infected men and women creating unintended pregnancies that could result in children born with birth defects.

While I was there, I saw for myself how dire the situation is. Women, both pregnant and not pregnant, are terrified. At clinics throughout the island, patients have little or no information about Zika other than to use mosquito spray and nets. Some clinics had some forms of contraception, but the majority barely had oral contraceptive pills in their office to offer patients. Most did not have the newer forms of long-acting reversible contraception (LARC) like the intrauterine devices (IUDs) or an implant. Many providers do not offer abortion services and do not have a place to refer patients that desire counseling on their options. Community health centers, the poorest of clinics there, are doing their best to give people information while barely being able to stock free condoms. Between concerned patients and frustrated physicians, there is so much to be done.

I spent much of my time helping doctors who were new to placing LARC devices. Many doctors told me that they had waiting lists of 40 to 50 patients desperate for any birth control, but particularly for LARC. One patient I saw with a local provider worked in this clinic as a medical technician. She had been waiting for a Mirena (the five-year hormonal IUD), but none of the local providers in that area of the island had it. When she heard the clinic was getting a supply of them, she was first in line to have it placed. For some clinics, when the supply of the new LARC runs out, they may not be able to get more for a very long time.

For that reason, I believe we absolutely cannot make any strides in the fight against Zika without funding for family planning services. Period. We do not yet have an effective means to reduce infection rates or cure women or men currently infected with the virus. The only scientifically proven weapons we have against more babies born with Zika-related birth defects are reproductive health services. The sad fact is that while Congress delays access to much-needed resources because of ideological differences about whether family planning should be funded by a portion of the Zika bill, more and more women and men are becoming infected. Reproductive autonomy—the ability to control when and if a woman becomes pregnant or chooses to continue a pregnancy — is at the heart of all of these delays. But the bottom line is: Providing reproductive health services to those in Zika-affected areas is vital to protecting women’s and children’s health.

This is the worst time for Zika to have hit the island: right in the middle of an economic crisis, with many people migrating to the mainland in search of better jobs. Many women need a new birth-control method for reasons that have nothing to do with Zika—they’re more worried about work or feeding their children than a Zika-infected pregnancy. For some Puerto Ricans, Zika is just another mosquito-borne illness like dengue, one of the many that have hit the country and been overcome before. In their eyes, this is the government making a fuss over nothing. Or worse: the government using an alleged epidemic as an opportunity to push birth control on its people.

As a Puerto Rican, I am very sensitive to the terrible history of birth control here. This stems from the development of the first birth control pill, for which initial experiments were done on Puerto Rican women—some of whom did not know to what they were consenting. Puerto Rican women were also victim to coerced sterilization procedures during most of the 20th century, which has left Puerto Rico with one of the highest rate of sterilized people in the world. About 39 percent of Puerto Rican women use tubal ligation as their form of birth control, only topped by the Dominican Republic’s 47 percent. Despite 85 percent of Puerto Ricans identifying as Catholic, the majority use birth control in some form. Without access to effective alternatives, women typically chose between birth control pills or sterilization. Because most women are only familiar with those two contraceptive methods, many are skeptical about LARC and sing old tunes about infection and infertility risks that with new IUDs have long been disproved.

We must acknowledge this history, but it shouldn’t impede the work that needs to be done now. In Puerto Rico, more than 65 percent of pregnancies are unplanned. While education may be part of the battle, the lack of access to comprehensive contraception services leaves women vulnerable because they are unable to adequately control their fertility. Abortion care is still something that is not talked about without hushed voices, and there are few providers that advertise these services.

Each second we wait means more pregnant women will have affected pregnancies. We know that contraception and abortion access will prevent more children from being born with serious abnormalities—so why aren’t we giving women and their doctors the tools they need? First, information needs to be more available so that women can make informed decision about their reproductive health care. This includes the fact that Zika is transmitted sexually for possibly months after exposure, and condoms can reduce transmission risk. Contraception should become more readily accessible to all women, regardless of income. Also, abortion should not have the roadblocks it currently has, especially when a Zika-affected pregnancy diagnosed in the second trimester means that time is critical. Puerto Rico’s current Zika crisis should be a wake-up call for all Americans, particularly Congress. Our representatives should accept that the need for abortion care will increase as Zika spreads further into the mainland United States. We have a responsibility to all of our citizens to make it easier to access the full spectrum of care and accurate information so that women like my colleague’s sister have everything they need in the fight against this virus.

Kristyn Brandi is an MPH student at SPH, a fellow at the American Congress of Obstetricians and Gynecologists, and a family planning fellow at Boston Medical Center.

From The Nation Magazine…

How I Found Heaven in a Public Hospital

Britain’s National Health Service is a cosmopolitan, welfare-state utopia—one that conservatives everywhere want to abolish.

By Frederika Randal

I come to under a violet light; the hour uncertain. A thousand strange things are whirring and humming. Red and yellow sparks flicker on and off, transparent greenish vines hang down from above. The space is crawling with life, human beings and other, non-human things. There is great calm, but also a note of urgency

My reason is slow, numb. By my watch it is 4 o’clock, presumably morning. Where am I? What’s all this energy, this pulsing and thrumming? The American in me foggily deduces that this is Grand Central Station, where all the ways of the world meet. A busy hub in some great city inhabited by men and women of many tribes, everyone very alert and courteous.

Well, you could call it that. I’ve somehow landed in the intensive care unit of a major London hospital. The previous day, I was rushed into emergency care, laid low by a sudden infection that had set off something like the Battle of Stalingrad. It was sepsis, caused by a spirited bacillus of the Streptococcus pneumoniae clan—one that, luckily for me, was also quite responsive to antibiotics.

While my poor brain is struggling to process this news, across the way in the opposite bed, a man with dark skin is staring in horror at two boxing gloves of fluffy white cotton covering his fingers. He cannot take in what has become of his poor hands, so white and deformed. Like me, he does not remember how he came to be in this ward. He’s shocked to learn that the nurses put on the gloves to keep him from ripping out the IV line last night. He’s just off the plane from Ghana, and the nurse who explains the gloves to him is also Ghanaian, from Accra. I know that because a few minutes earlier, while he was taking my blood pressure, we spoke about his native city.

In the next week and a half, I will understand this is not just an ICU, but a kind of utopia. We are inside a London public hospital, part of a venerable but now deeply threatened national health system. Government-provided healthcare in itself is utopian for us Americans; I live in Italy, where my medical needs are covered by the Italian health system, which in turn will repay the British system for the 12 days I will spend in this hospital. When I say this is a utopia, that’s true in more ways than one.

Sepsis is life-threatening, but in this excellent hospital, the emergency-room staff diagnosed me correctly within 15 minutes. The hospital also used a pioneering method to identify the strain of Streptococcus and the appropriate antibiotic within hours, rather than the usual five to seven days. I know this because later, a doctor came around to get my permission to be part of a study of this experimental method. Accustomed to a gruffer breed of doctor in Italy, I was charmed by the way this one took time out to explain things to me. But in fact every staff member who came into my cubicle was unvaryingly polite and competent. All made it a point to explain some element of the treatment.

Remember, this was a public hospital. And we patients were anything but all-British. We were quite a mixed bag, by nationality, ethnic origin, religion. Some of the steady stream of friends and relatives who came to visit wore the hijab, others had shaved heads and piercings, still others wore tall black hats and sidelocks. But the society of people who worked in the ward was even more mixed, a genuine hybrid society, not just a multicultural stew. Hybrid because the orderlies, doctors, and nurses there all spoke, with various accents, a common language: a language governed by medicine’s firm rules, expressed with notable warmth and respect for us patients.

Here I met the majestic Nana from Jamaica, hair swept up like Nefertiti and a rare, calm authority. There was Neil, the assistant from Manila, who went to Rome with his husband to see Pope Francis because “he’s not against gays.” Bintou, from Abidjan, wore a head scarf and spoke in a voice so sweet I was ready to go to paradise immediately, if that’s where my medical condition was leading me. She told me her name means “daughter of” in Arabic, and the way she said it brushed away that ugly English slang wordbint, a relic of British rule in Egypt.

Sweetest of all was Hemant: tall, muscular, handsome, a gold earring, an Indian from Uttar Pradesh. When he was young he wanted to be a fashion designer. But in his family, the professional choices for men were limited to two, doctor or engineer. A cousin in London urged him to study nursing and then move to England. In the Middle Ages the Germans had an expression, Stadtluft macht frei. City air makes you free. For Hemant, London is freedom. Hebelongs here, he’s not a foreigner.

Isn’t this what Britain itself could one day be? A hybrid society like this ward, where English, Scottish, and Welsh nurses and assistants work alongside others born in (I counted them) Accra; Trinidad; Bremen; Basra; Galway; Kerala; Agra; the Philippines; Ivory Coast; Galicia, Spain; and Wroclaw, Poland. Of course it matters that they are inspired by a common goal that is anything but cynical—saving lives, in this case.

But that was then. I was hospitalized in 2014. Afterward came the sour fear-mongering that brought on the disastrous EU referendum, and Brexit. Once Britain formally leaves the EU, reciprocal hospital care for someone from Italy like myself will be a thing of the past. And far worse, Theresa May and her government are doubling down on nativism and xenophobia, promising, among other things, to replace foreign-born medical staff with natives. And this on top of longtime Conservative plans to keep cutting National Health Service costs, privatize health services, and further exploit overworked young doctors.

So I’m grateful to have seen another Britain—far from the small white island that Theresa May envisions—that open, cosmopolitan, and highly functional society I glimpsed in the ICU. Not by chance, perhaps, it sprang up inside the welfare state that conservatives everywhere want to abolish.

Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services – ODPHP

National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination

Action Plan Development

In recognition of health care-associated infections (HAIs) as an important public health and patient safety issue, the U.S. Department of Health and Human Services (HHS) convened the Federal Steering Committee for the Prevention of Health Care-Associated Infections (originally called the HHS Steering Committee, but was changed to reflect the addition of agencies outside of HHS). The Steering Committee’s charge is to coordinate and maximize the efficiency of prevention efforts across the federal government. Members of the Steering Committee include clinicians, scientists, and public health leaders representing:

  • Administration for Community Living (ACL)
  • Agency for Healthcare Research and Quality (AHRQ)
  • Centers for Disease Control and Prevention (CDC)
  • Centers for Medicare & Medicaid Services (CMS)
  • Food and Drug Administration (FDA)
  • Health Resources and Services Administration (HRSA)
  • Indian Health Service (IHS)
  • National Institutes of Health (NIH)
  • Office of the Secretary (OS)
    • National Vaccine Program Office (NVPO)
    • Office of Disease Prevention and Health Promotion (ODPHP)
  • Office of the Assistant Secretary for Planning and Evaluation (ASPE)
  • Office of the Assistant Secretary for Public Affairs (ASPA)
  • Office of the National Coordinator for Health Information Technology (ONC)
  • U.S. Department of Defense (DoD)
  • U.S. Department of Labor (DOL)
  • U.S. Department of Veterans Affairs (VA)

The Steering Committee marshaled the extensive and diverse resources of the Department, formed public and private partnerships, and initiated discussions that identified new approaches to HAI prevention and collaborations. Along with scientists and program officials across HHS, the Steering Committee released the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination (HAI Action Plan). The HAI Action Plan provides a road map for preventing HAIs in acute care hospitals, ambulatory surgical centers, end-stage renal disease facilities, and long-term care facilities.  The HAI Action Plan also includes a chapter on increasing influenza coverage of health care personnel.

The Office of Disease Prevention and Health Promotion, on behalf of the Federal Steering Committee for the Prevention of Health Care-Associated Infections, releases the April 2013 National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination. The latest HAI Action Plan reflects a significant update and expansion from the initial version issued in 2009. It includes new sections specific to infection reduction in ambulatory surgical centers, end-stage renal disease facilities, and long-term care facilities, as well as a section on increasing influenza vaccination of health care personnel.

The National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination includes:

Phase One: Acute-Care Hospitals

Phase One of the HAI Action Plan addresses the most common infections in acute care inpatient settings and outlines a prioritized research agenda, an integrated information systems strategy, policy options for linking payment incentives or disincentives to quality of care and enhancing regulatory oversight of hospitals, and a national messaging and communications plan to raise awareness of HAIs among the general public and prevention strategies among health care workers:

This HAI Action Plan includes five-year goals for eight specific measures of improvement in HAI prevention.

Phase Two: Ambulatory Surgical Centers, End-Stage Renal Disease Facilities, and Increasing Influenza Vaccination Among Health Care Personnel

The health care and public health communities are increasingly challenged to identify, respond to, and prevent HAIs across the continuum of settings where health care is delivered. The public health model’s population-based perspective can increasingly be deployed to enhance the prevention of HAIs, particularly given the shifts in health care delivery from acute care settings to ambulatory and long-term care settings. The Steering Committee clearly articulated the need to maintain the HAI Action Plan as a “living document,” developing successor plans in collaboration with public and private stakeholders to incorporate advances in science and technology, shifts in the ways health care is delivered, changes in health care system processes and cultural norms, and other factors.

Below are the latest chapters for Phase Two:

These chapters comprise the second phase – Phase Two – of the HAI Action Plan, extending its scope to the outpatient environment and addressing the health and safety of health care workers, as well as the risks of transmission of influenza from health care personnel to patients.

Phase Three: Long-Term Care Facilities

Since the publication of the original HAI Action Plan in 2009 which focused on the acute care setting, there has been awareness of the need for strategies to address HAIs in long-term care facilities. A growing number of individuals are receiving care in long-term care settings, such as skilled nursing facilities and nursing homes. The population in these facilities is requiring more complex medical care as a result of increased transitions between health care settings. These trends can create an increased risk for HAIs, which can worsen health status and increase health care costs. The Steering Committee chose to address HAIs in long-term care facilities for Phase Three.

Evaluation of the Health Care-Associated Infections Action Plan

The Office of Disease Prevention and Health Promotion (ODPHP), Division of Healthcare Quality, the Agency for Healthcare Research and Quality (AHRQ), and the Centers for Disease Control and Prevention (CDC) contracted with Insight Policy Research, IMPAQ International (IMPAQ) and the RAND Corporation (RAND) to produce iterative and comprehensive evaluations of HHS programs related to the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination.

Longitudinal Program Evaluation of the Health Care-Associated Infections HHS Action Plan-Year 1 Report (September 2011) [PDF – 1760 KB], the first report of the evaluation, examined initial progress toward achieving Action Plan targets. The evaluation found that measurable progress has been made in reducing health care-associated infections (HAIs) and specifically aimed to:

  • Record current and future design, content, and progress of the HAI Action Plan.
  • Provide feedback on how to strengthen monitoring capabilities
  • Offer insights to identify prospective high-yield opportunities to reduce HAIs.

In addition to the successes noted to date, the evaluation also identified several areas for improved coordination and outreach. For the Federal Steering Committee for the Prevention of Health Care-Associated Infections response to the report, view the cover letter [PDF – 315 KB].

State Healthcare-Associated Infection Prevention Plans

The 2009 Omnibus Law required states receiving Preventive Health and Health Services (PHHS) Block Grant funds to certify that they will submit a plan to prevent HAIs to the Secretary of Health and Human Services by January 2010. HHS received plans from all 50 states, the District of Columbia, and Puerto Rico.

The HHS Report to Congress on Healthcare-Associated Infections: FY 2010 State Action Plans addresses the adequacy of State Healthcare-Associated Infection (HAI) Action Plans for achieving state and national goals for reducing HAIs. It responds to the joint explanatory statement to accompany H.R. 1105, the Omnibus Appropriations Law, 2009 (Public Law 111-8):

“…Each State plan shall be consistent with the Department of Health and Human Services’ national action plan for reducing healthcare-associated infections and include measurable 5-year goals and interim milestones for reducing such infections: Provided further, That the Secretary shall conduct a review of the State plans submitted pursuant to the preceding proviso and report to the Committees on Appropriations of the House of Representatives and the Senate…”

Find out what each state is doing to prevent HAIs.

National State-Specific HAI Summary Data Reports

To see the current Standardized Infection Ratio (SIR) NHSN National Data report along with previous reports visit CDCs NHSNs National HAI Data Report page [PDF – 1.1 MB].

This icon, External Link: You are leaving Health.gov , means that you are leaving health.gov and entering a non-federal website. View full disclaimer.

From CDC: Updated Targets for Health Care-Associated Infections within Acute Care Hospitals

Updated Targets for Health Care-Associated Infections within Acute Care Hospitals 

The Office of Disease Prevention and Health Promotion is pleased to announce updated 2020 targets for the reduction of health care-associated infections in acute care hospitals. Through the development of measures and targets, ODPHP and other federal partners are tracking national progress in the reduction of health care-associated infections.

The 2020 targets address the following goals from the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination:

  • 50% reduction in central line-associated bloodstream infections (CLABSI) in intensive care units and ward-located patients.
  • 25% reduction in catheter-associated urinary tract infections (CAUTI) in intensive care units and ward-located patients: 25% reduction
  • 50% reduction in the incidence of invasive health care-associated methicillin-resistant Staphylococcus aureus (MRSA) infections.
  • 50% reduction in facility-onset methicillin-resistant Staphylococcus aureus (MRSA) in facility-wide health care.
  • 30% reduction in facility-onset Clostridium difficile infections in facility-wide health care.
  • 30% reduction in the rate of Clostridium difficile hospitalizations.
  • 30% reduction in surgical site infection (SSI) admission and readmission.

 

From the Wall Street Journal: Public Health Risk, The continuing escalation of police militarization…

Taser Explores Concept of Drone Armed With Stun Gun for Police Use

Project shows leap in thinking about technology, even as critics decry militarization of law enforcement

Police officers check out a venders booth at the International Association of Chiefs of Police conference in San Diego on Oct. 17, 2016.ENLARGE
Police officers check out a venders booth at the International Association of Chiefs of Police conference in San Diego on Oct. 17, 2016.PHOTO: MIKE BLAKE/REUTERS

By

ZUSHA ELINSON

5 COMMENTS

SAN DIEGO—The day when police zap suspects from the sky with drones carrying stun guns may be nearing.

Taser International Inc., known for its stun guns and body cameras, is exploring the concept of a drone armed with a stun gun for use by police. This week, the company held discussions with police officials about such a device during a law-enforcement conference here.

Taser spokesman Steve Tuttle said the company’s advanced research team met with law enforcement customers “to discuss various future concepts” to get feedback.

“Following recent events, including the use of a robot to deploy lethal force in Dallas to eliminate a highly dangerous threat, we’ve received questions about whether it would be feasible to similarly deploy a TASER from an autonomous vehicle,” said Mr. Tuttle, referring to the Dallas police department’s use of a bomb-disposal robot armed with C-4 explosive to take out a gunman who had targeted and killed five officers in July.

“One can certainly imagine high-risk scenarios such as terrorist barricades where such a capability could allow public safety officers to more rapidly incapacitate a threat and save many lives,” Mr. Tuttle said, adding these “remain conceptual discussions” at this time.

“We’re also considering the potential misuses of such a technology in our discussions and before we would make any decisions,” he said.

Employees assemble Taser smart weapons at the Taser International Inc. plant in Scottsdale, Ariz.ENLARGE
Employees assemble Taser smart weapons at the Taser International Inc. plant in Scottsdale, Ariz. PHOTO:PATRICK T. FALLON/BLOOMBERG NEWS

In a conference room away from the busy San Diego Convention Center floor where law-enforcement officials from around the world perused the latest police technology, a Taser employee showed some police leaders a drone, and discussed how different things could be attached to it, including a camera, a light and a stun gun—a less-lethal weapon that discharges an electric shock.

Mr. Tuttle said the drone was an off-the-shelf model, and not a prototype worked on by Taser.

But the very concept represents a leap in thinking about how technology can be deployed in law enforcement and comes as police seek safeguards after officer deaths. And, it is likely to generate backlash from those opposed to the militarization of police as tensions are already high among authorities and minority communities over police killings of black men.

“The public is going to initially be alarmed by this,” Jim Bueermann, president of the Police Foundation, a research group, who viewed the drone at the conference and talked with a Taser employee about it.

But Mr. Bueermann, a retired police chief from Redlands, Calif., said he sees benefit in such technology for preventing deadly encounters where an armed suspect might otherwise be shot by police or harm others.

Mr. Bueermann said he could imagine a scenario where police approach an armed suspect in an armored vehicle, stun the suspect with the drone, and then hop out and make the arrest.

He said that with policies to limit its use to very specific situations, it could be a useful tool for police, adding that they should be very cautious about adopting such technology.

“From a strictly tactical perspective I see the potential value of this but I also understand how apprehensive people are going to be,” said Mr. Bueermann. “Many people are going to be concerned that if you can put a Taser on one, what’s going to prevent you from putting a firearm on.”

The emergence of the Taser drone concept comes as police in the U.S. have just started to turn to robots in dealing with armed suspects, as they did in Dallas.

North Dakota passed a law last year allowing police drones to be equipped with stun guns.

These developments have increased worries about the blurring of lines between police and the military, said Ryan Calo, an assistant professor at the University of Washington School of Law who studies robots and the law.

“There is a longstanding belief in this country that the domestic police should not overlap with the military,” said Mr. Calo.

Pete Simpson, a spokesman for the Portland police department, said that it would likely not be adopted anytime soon because of public concern—but that it could be useful.

“The idea for a community to accept an unmanned vehicle that’s got some sort of weapon on it might be a hurdle to overcome,” said Mr. Simpson. But, he said, “we need the creative business folks to be thinking about how to resolve these things that everyone survives: How can we use technology to improve officer safety, community safety and suspect safety?”

Mark Lomax, executive director of the National Tactical Officers Association, a group for members of SWAT and similar teams, said he could see police eventually adopting such technology—but not soon because of the current climate of mistrust with police.

On a practical level, Mr. Lomax said tasing someone with a drone might not be easy.

“With a hand-held Taser it takes a lot of skill to operate it successfully,” Mr. Lomax said. “It’s very hard to envision flying at 50 feet in the air and this thing’s moving and the person’s moving—it could be hard to tase them.”

Like the bomb robot, such a product would raise fundamental questions about police use of force, said Elizabeth Joh, a professor at the University of California, Davis, School of Law.

When police use force, “the premise is there is an imminent danger to the police officer or to the public, but when you create a distance between the officer and the use of force that raises different questions,” said Ms. Joh.

Ms. Joh said that questions about whether a drone with a Taser would increase the use force by officers also need to be addressed. She said that before adopting such technology, policies governing its use must be put in place.

Though some states have taken up the issue, a spokeswoman for the Federal Aviation Administration, which regulates drones, said the agency’s rules “do not specifically prohibit someone from mounting a weapon on an aircraft.”

Write to Zusha Elinson at zusha.elinson@wsj.com

Neoliberals dismantling Finnish healthcare system…

First step of the privatisation of the Finnish health system

BY on •

doctor-1149149__340According to the online newspaper Finland Times, the government  announced plans to convert public health care units into publicly-owned companies.This is the next step towards a global privatization, which is the objective of the National Coalition Party.

Going towards a privately managed health system offers an interesting market for international health operators

Officially, such a change would make it possible to compare cost and efficiency of publicly-owned and private operators. In reality, transforming public services into publicly-owned company is always leading towards a situation where the state sells first a percentage of its shares, and finally the totality of them. If it was not the case, there would be no need to create (publicly own) private companies, as other solutions exist. And we have seen that it did not go so well in the sector of energy, where privatization has meant a steep increase of the costs for the users.

According to Finland Times, from 2019, regional health authorities would license the public, private and third sector operators including civic organizations to offer primary care services. Patients could then choose the service provider they want, but would have to stay with their choice for some time at least and would pay the same fees irrespective of whether the doctor is employed by a commercial or public company, as long as they are approved by the authorities to get public health money.

It is also mentioned that “the Confederation of Finnish Industries, EK, profiled as the leading lobbyist for Finnish business interests, praised the governmental plans“. International health care providers are already preparing their offers.

Why change the Finnish system for something less efficient

When the government wanted to change the health system, one could have expected that its experts would look at the systems which have been implemented in other countries, and in particular compare the impact of different solutions on the costs and on the quality of care, in order to achieve the best efficiency balance.

When you look for the best systems in the world, you can use the rankings provided by different operators: among the most recognized, one is the  Euro Health Consumer Index, which measures the quality of the services provides, and the other one is the most Efficient Health Care ranking, provided by Bloomberg.

The 2014 Euro Health Consumer Index (ECHI) ranked 37 countries according to several factors. These were patient rights and information disclosure; accessibility and waiting times for treatment; outcomes; the range of services offered; illness prevention and access to pharmaceuticals. In this ranking, which is according to experts is the best available on the market, Finland is in  4th position behind Netherlands, Switzerland and Norway. One can consider that it is quite a good result.

Then, one can think that the Finnish government wanted to make it more efficient and spare some money. In order to get an opinion on this topic, it is useful to consult the Bloomberg study, which is less quality oriented, but gives good data concerning the health systems’ costs. In terms of costs per capita in 2014, Finland spent $4,232, Norway $9,055, Switzerland $8,980  and Netherlands $5,737. Even in percentage of GDP, Finland fares quite well, with 9,1 % of the GDP spent on health care, against  12,5 % for Netherlands, 11,4 % for Netherlands, and 9,1 % for Norway. Compared to the other Nordic and Western  European countries, Finland does really good, and a serious analysis would show that it is today the most efficient health system,  providing the best quality for a relatively modest price.

Why change an brilliant health system instead of improving it

The government could have worked on the weaknesses of the present system, instead of deciding on a reform which is going to cost a lot in terms of money, unrest and political struggle, and not necessarily a winning one.

On the side of the national Coalition Party, the reform is pushed because the party is more and more changing from a conservative party to a supporter of big financial players. It is not so interested anymore in small businesses or conservative ideas, which explains the increased success of the Center party which can attract those abandoned by the NCP.

The Center party had an interest in the reform consisting in creating a large number of new regions, offering interesting political and administrative appointments for its members. M. Sipilä probably imagine that he will be able to control the private operators, but it may prove quite difficult, in particular when the resources of the  administration of the health system will continue to be cut , providing less people to implement the control.

The Finns Party was against, but as usual has difficulties to oppose such a reform: it would mean the end of the coalition, and they would lose their positions in the government. Being a Minister of Foreign Affairs seems important for Timo Soini.

And there is also for a inexperienced leader like M. Sipilä the temptation to appear like a strong reformer: it would have been easy to go the Swedish way and to limit the waiting lists in the public service, by providing incentives and improving the top management of the primary health care system, but is is not so attractive when you want to look bold and efficient. It would have also obliged the government to put an end to the present system where the people working have direct access to private health care with a funding provided by their employer, which would not have been good for M. Sipilä’s popularity (but it would have been good for Finland’s competitiveness) .

As matter of conclusion, I would strongly recommend that, before  deciding on new measures in the next weeks, M. Sipilä’s teams have a look at the health care in countries which are really more efficient: for example Singapore, the most efficient health care in the world, with low costs and excellent results, organized in a similar way as today’s Finland, but with very strong incentives to limit the costs for all actors. And if Finland wants really to go to a public-private mix, France or Germany could be used as references, but their costs are definitely higher. And they might visit the US, which, with a private health system in principle controlled by the state, have the most inefficient system in the world, with the highest costs and health indicators comparable to east Africa.

 

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