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Leisure and death : an anthropological tour of risk, death, and dying / edited by Adam Kaul, Jonathan Skinner
\"Interdisciplinary study of dark tourism that examines the relationship between leisure and death, specifically how leisure practice is used to meditate upon and mediate life. Grounded in international anthropological case studies, the authors theorize on the links between spaces of death and leisure\"--Provided by publisher.
Book
The Impact Of The COVID-19 Pandemic On Hospital Admissions In The United States
Hospital admissions in the US fell dramatically with the onset of the coronavirus disease 2019 (COVID-19) pandemic. However, little is known about differences in admissions patterns among patient groups or the extent of the rebound. In this study of approximately one million medical admissions from a large, nationally representative hospitalist group, we found that declines in non-COVID-19 admissions from February to April 2020 were generally similar across patient demographic subgroups and exceeded 20 percent for all primary admission diagnoses. By late June/early July 2020, overall non-COVID-19 admissions had rebounded to 16 percent below prepandemic baseline volume (8 percent including COVID-19 admissions). Non-COVID-19 admissions were substantially lower for patients residing in majority-Hispanic neighborhoods (32 percent below baseline) and remained well below baseline for patients with pneumonia (-44 percent), chronic obstructive pulmonary disease/asthma (-40 percent), sepsis (-25 percent), urinary tract infection (-24 percent), and acute ST-elevation myocardial infarction (-22 percent). Health system leaders and public health authorities should focus on efforts to ensure that patients with acute medical illnesses can obtain hospital care as needed during the pandemic to avoid adverse outcomes.
Journal Article
Technology Growth and Expenditure Growth in Health Care
In the United States, health care technology has contributed to rising survival rates, yet health care spending relative to GDP has also grown more rapidly than in any other country. We develop a model of patient demand and supplier behavior to explain these parallel trends in technology growth and cost growth. We show that health care productivity depends on the heterogeneity of treatment effects across patients, the shape of the health production function, and the cost structure of procedures such as MRIs with high fixed costs and low marginal costs. The model implies a typology of medical technology productivity: (I) highly cost-effective \"home run\" innovations with little chance of overuse, such as anti-retroviral therapy for HIV, (II) treatments highly effective for some but not for all (e.g., stents), and (III) \"gray area\" treatments with uncertain clinical value such as ICU days among chronically ill patients. Not surprisingly, countries adopting Category I and effective Category II treatments gain the greatest health improvements, while countries adopting ineffective Category II and Category III treatments experience the most rapid cost growth. Ultimately, economic and political resistance in the United States to ever-rising tax rates will likely slow cost growth, with uncertain effects on technology growth.
Journal Article
Are You Sure You're Saving Enough for Retirement?
Many view the soon-to-retire Baby Boomers as woefully unprepared for their golden years, while other economists have taken a more sanguine view of American levels of saving. And if Americans are failures at saving enough for retirement, why are some retirees so happy? The seemingly simple question of “Am I saving enough for retirement?” is apparently not so simple at all. Instead, it touches on a variety of deeper issues in economics, psychology, and health policy. I use the program ESPlanner to present life-cycle retirement wealth targets for a range of incomes and situations typical of American Economic Association members. (Readers are warned that life-cycle retirement wealth targets presented in this paper may lead to feelings of financial inadequacy.)
Journal Article
Physician Beliefs and Patient Preferences
There is considerable controversy about the causes of regional variations in health care expenditures. Using vignettes from patient and physician surveys linked to fee-for-service Medicare expenditures, this study asks whether patient demand-side factors or physician supply-side factors explain these variations. The results indicate that patient demand is relatively unimportant in explaining variations. Physician organizational factors matter, but the most important factor is physician beliefs about treatment. In Medicare, we estimate that 35 percent of spending for end-of-life care and 12 percent of spending for heart attack patients (and for all enrollees) is associated with physician beliefs unsupported by clinical evidence.
Journal Article
Comparative Effectiveness and Health Care Spending — Implications for Reform
In this Sounding Board article, the authors argue that health care costs can be reduced without a negative effect on quality by reducing spending on interventions that are not cost-effective.
The authors argue that health care costs can be reduced without a negative effect on quality by reducing spending on interventions that are not cost-effective.
Title VIII of the American Recovery and Reinvestment Act of 2009 authorizes the expenditure of $1.1 billion to conduct research comparing “clinical outcomes, effectiveness, and appropriateness of items, services, and procedures that are used to prevent, diagnose, or treat diseases, disorders, and other health conditions.” Federal support of “comparative effectiveness” research has been viewed as a cornerstone in controlling runaway health care costs.
Although cost is not mentioned explicitly in the comparative effectiveness legislation, the American College of Physicians and others have called for cost-effectiveness analysis — assessment of the added improvement in health outcomes relative to cost — to . . .
Journal Article
Slowing the Growth of Health Care Costs — Lessons from Regional Variation
Most observers see rising health care costs as an inexorable force. Dr. Elliott Fisher, Dr. Julie Bynum, and Jonathan Skinner write that by learning from regions that have attained sustainable growth rates and building on successful models of delivery-system and payment-system reform, we might manage to “bend the cost curve.”
The expansion of health insurance coverage in the United States is likely to be on the front burner of health care reform efforts in the new presidential administration. But boiling on the back burner is perhaps the most serious threat to Americans' access to care: rapid growth in health care costs.
Pessimism abounds. Most observers see rising costs as an inexorable force, blame advancing technology, and conclude that only by rationing beneficial care or making draconian price cuts can we slow the growth of health care costs.
But a careful look at variations in spending growth and spending patterns among . . .
Journal Article
A Prospective Study of Sudden Cardiac Death among Children and Young Adults
In 490 cases of sudden cardiac death identified over a 3-year period (annual incidence of 1.3 per 100,000), causes were found in 60% through conventional autopsy, and a clinically relevant cardiac gene mutation was found in 27% of the remaining cases in which genetic testing was performed.
Sudden cardiac death among children and young adults is a devastating event for the family and wider community. Coronary artery disease is the predominant cause of sudden cardiac death in older persons,
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whereas among persons 1 to 35 years of age, sudden cardiac death is more often caused by structural heart disease, including hypertrophic cardiomyopathy, dilated cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, myocarditis, and primary arrhythmogenic disorders (such as the congenital long-QT syndrome, the Brugada syndrome, and catecholaminergic polymorphic ventricular tachycardia).
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Many of these cardiac causes of sudden cardiac death among children and young adults have an underlying genetic basis. . . .
Journal Article