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Should Google Be Allowed to Mine Your Health Care Data?

Should Google Be Allowed to Mine Your Health Care Data? | Healthcare and Technology news | Scoop.it

On the heels of the I/O keynote on Thursday, Google cofounder Larry Page spilled his guts to Farhad Manjoo from The New York Times. "Right now we don't data-mine health care data," Page said. "If we did we'd probably save 100,000 lives next year." But is that actually a good idea?

Mining health care is a very slippery slope, whether it's done by Google or some government agency or anyone really. The privacy concerns alone have always kept prying eyes out of your health records. But now that technology has advanced to the point where we could anonymize the data and use the information to cure diseases, it's worth revisiting that topic.

The data store is only going to get bigger, too, as gadgets like fitness and health trackers become more ubiquitous. (Google, of course, is leading the charge on this front as well.) While Page's 100,000 figure is probably completely made up—and not even that many lives in the grander scheme of things—it seems pretty clear that a better understanding of health care data is a good thing.

So what do you think? Is it time to chill out about privacy so that Google algorithms can start saving some lives? Or would you rather keep your personal health care data personal?

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How Medicaid for Children Recoups Much of Its Cost in the Long Run

How Medicaid for Children Recoups Much of Its Cost in the Long Run | Healthcare and Technology news | Scoop.it

When advocates talk about the advantages of government health care, they often talk about a moral obligation to ensure equal access. Or they describe the immediate health and economic rewards of giving people a way to pay for their care.

Now a novel study presents another argument for the medical safety net, at least for children: Giving them health coverage may boost their future earnings for decades. And the taxes they pay on those higher incomes may help pay the government back for some of its investment.

The study used newly available tax records measured over decades to examine the effects of providing Medicaid insurance to children. Instead of looking at the program’s immediate impact on those children and their families, it followed them once they became adults and began paying federal taxes.

People who had been eligible for Medicaid as children, as a group, earned higher wages and paid higher federal taxes than their peers who were not eligible for the federal-state health insurance program. And the more years they were eligible for the program, the larger the difference in earnings.

“If we examine kids that were eligible for different amounts of Medicaid over the course of their childhood, we see that the ones that were eligible for more Medicaid ended up paying more taxes through income and payroll taxes later in life,” said Amanda Kowalski, an assistant professor of economics at Yale and one of the study’s authors.

The results mean that the government’s investment in the children’s health care may not have cost as much as budget analysts expected. The study, by a team that included economists from the Treasury Department, was able to calculate a return on investment in the form of tax revenue.

The return wasn’t high enough to pay the government back for its investment in health insurance by the time the children reached age 28, when the researchers stopped tracking the subjects. By that age, the Treasury had earned back about 14 cents for every dollar that the federal and state governments had spent on insurance. But it did suggest that, if the subjects’ wages continued to follow typical trajectories as they aged, the federal government would earn back about what it spent on its half of the program by the time the children reached 60 — about 56 cents on the dollar, calculated using a formula that took into account the time value of money.

The split in spending between the federal and state governments for Medicaid varies by state, but, on average, federal taxpayers pay 57 cents of each dollar. There may also be some return on investment for states that collect income taxes, but the researchers didn’t measure that.

Here’s what that means in real numbers: The average person in the study with no Medicaid earned a total of $149,000 by age 28. For each year a person was eligible for Medicaid, that income went up by $250, and the taxes the person paid went up accordingly.

“What’s exciting about this is how good the outcome variables that they can look at,” said Janet Currie, a professor of economics and public affairs at Princeton. A few studies have tracked the health outcomes of children who were eligible for Medicaid over time, including one Ms. Currie wrote, but the study’s measures of economic outcomes are new.


The new paper was made possible by a series of policy changes throughout the 1980s and 1990s that slowly expanded Medicaid to cover more and more American children. The changes essentially happened in two phases: First, the federal government allowed the program to include older children, and then individual states approved expansion to those groups. The slow, state-by-state spread of the policy enabled the researchers to compare children who were eligible for Medicaid with a control group of similar children of the same age and family income level who were not eligible for the program. The study looked at children who were eligible for Medicaid, even though not every eligible child actually signed up.




Expanded eligibility had two other important effects closely related to the earnings statistics: Children who were eligible for coverage were less likely to die before reaching 28, and they were more likely to attend college. Those are outcomes that, Ms. Kowalski points out, the government may value even if the program doesn’t return any money to the Treasury.

The study can’t entirely explain how access to childhood health insurance helped low-income children earn more later in life. But Ms. Kowalski has a few theories. One is that it may have helped the girls, in particular, by offering them a way to get contraception (which Medicaid covers to varying degrees in all states) and avoid unplanned pregnancies. The earnings effect was much more pronounced for girls than it was for boys.

The difference may also come from the way that public health insurance changed the budgets of the children’s families, she said. By taking care of health care bills, Medicaid may have freed the parents to make other investments in their children’s development that paid off.

Ms. Currie said that earlier studies of children’s health outcomes also suggest that children with serious illnesses often go on to be sick as adults as well — meaning they are more likely to miss work or have limited career options. Medicaid supports and funds a lot of important preventive health care for very young children. She said the lesson could be that “an ounce of prevention is worth a pound of cure.”

Now that the earlier expansions have had a chance to spread, nearly every low-income child in the country is eligible for Medicaid, and more than a third of all American children are currently enrolled in either Medicaid or a closely related federal-state program, called the Children’s Health Insurance Program.

“If this is right, then we’re going to be seeing a lot more impact for the kids that are born now and in the future,” said Judy Solomon, a vice president for health policy at the left-leaning Center on Budget and Policy Priorities.


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U.S. needs to raise investment, shift medical research priorities

U.S. needs to raise investment, shift medical research priorities | Healthcare and Technology news | Scoop.it

The U.S. is losing its lead in global medical research, and many of the projects that do get funded overlook common diseases that afflict millions of people, according to a new analysis.

Experts point to falling public and private spending on the kind of basic research that leads to new discoveries, and a lack of innovation in delivering healthcare, in a paper in the Journal of the American Medical Association that’s part of a series on the future of medicine,

"With respect to U.S. public financing there has not been the political will to make biomedical research a priority in the same way that it was in the 1970s with the war on cancer or in the 1980s with the war on AIDS," said lead study author Dr. Hamilton Moses, of the Alerion Institute and Alerion Advisors LLC in North Garden, Virginia.

At the same time, private U.S. companies have concentrated investment in advanced clinical trials rather than on the basic research that’s needed to tackle some of the chronic conditions like diabetes that afflict the greatest number of people, Moses told Reuters Health in an interview.

Overall U.S. investment in biomedical and health services research grew just 0.8 percent a year from 2004 to 2012, down from a 6-percent annual growth rate between 1994 and 2004, Moses and his colleagues found.

Government funding in the U.S. fell to 49 percent of the world's public research investment by 2011, down from 57 percent in 2004.

U.S. industry, which accounted for nearly half of corporate investment worldwide in 2004, slipped to 41 percent of private funding in 2011.

Asia, aided largely by China, tripled investment to $9.7 billion in 2012 from $2.6 billion in 2004.

In the U.S., public funding concentrated on cancer and rare diseases, with less than half of government investment targeting 27 common diseases – including chronic obstructive lung disease, injuries, stroke, dementia and pneumonia - that account for 84 percent of deaths in the U.S. and significant disability.

Cancer alone accounted for 16 percent of total funding from the National Institutes of Health and was the target of one in four medicines in clinical trials, the study found.

"With cardiovascular disease, the number one killer, some of the large pharmaceutical companies have really pulled back in this area," said Dr. Kenneth Kaitin, director of the Tufts Center for the Study of Drug Development in Boston, Massachusetts.

"The industry has changed over the last few years and there has been tremendous pressure to reduce research and development costs that has resulted in a tremendous shift away from high-volume, low-cost medicines toward seeking a billion- dollar drug that treats a very, very small population," said Kaitin, who wasn't involved in the study.

Health services research, which looks at issues around access to care as well as quality and costs, has accounted for less than 0.33 percent of national health expenditures between 2003 and 2011, the study found.

Private insurers ranked last (0.04 percent of revenue) and health systems 19th (0.1 percent of revenue) among 22 industries in their investment in innovation in this area, the authors note.

"This is concerning in terms of trying to tackle improved quality of care and improved access to care, and in terms of bending the cost curve," said Glen Giovannetti, a global life sciences expert at Ernst & Young in Boston.

"There's lots and lots of research done on drug development and much less done on whether one course of treatment is better than another," said Giovannetti, who wasn't involved in the study.

With respect to both biotech and health services research, there is an acute need to increase research investment and to create more reliable funding mechanisms, said Dr. Victor Dzau, president of the Institute of Medicine, a division of the U.S. National Academies of Science.

Dzau, who co-wrote an editorial accompanying the study in JAMA, said the danger of disparate, unreliable funding streams is that it forces scientists to work in fits and starts, often abandoning promising basic research.

"If you think about all of the major advances in health care services, biomedical research, and diagnostics, there is no question that it's based on innovation and relied at the start on basic research," Dzau told Reuters Health.

"When we decided to put a man on the moon that was an aspirational goal, and we as a nation should be able to recognize that this is now an important moment in medical research," Dzau said. "We aren't saying give money for money's sake. We are saying set priorities, and give researchers at least five years of stable funding to pursue specific goals."



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