The challenges in estimating health system response to waiting time measurement systems

An article in the Wall Street Journal (May 25, 2012) describes different wiating time measurements and the consequent dysfunctional system response. Measuring the waiting time experienced by patients served or focusing on service within 48 hours creates an incentive to prioritize more recent patients to improve performance. A focus on the number waiting to see a specialist creates an incentive to wait to add patients to the queue. A Veterans Administration report claims that while records suggested that 95 % of patients seeking mental health waited less than 14 days, the actual % was 64 %, if one considered the total wait time. But perceptions of patient waiting time can also be erroneous. How should the system be measured to decrease the incentive to create unintended consequences ? Should the referral process be tracked across doctors and clinics to ensure end-to-end measurements ? How should the patient’s perspective be ensured in these measurements ? Could incentives be designed that wille ensure prompt service while maintaining quality ?

Pipeline flow direction in Canada to accomodate tar sands output growth

A article in the Economist (May 26, 2012) describes the increased oil production from the tar sands in Alberta, Canada, estimated to gow to 72 % of Canada’s output by 2020 (from 58 % now). But getting that oil, which can emit three to four times the greenhouse gases as regular oil, to market, has been a challenge. The holdup of oil pipelines from Canda through the US has now required potentially reversing the flow of a pipleine in Ontario – increase its utilization – which has dropped to 50%. Canadian gas exports have decreased as US exploration of shale gas has increased. Should the Canadian government focus on getting the gas to Canada’s eastern regions, that currently use more expensive imported oil ? Or should they focus on getting the tar sands oil to China via ports in British Colombia, albeit with a riskier long pipeline through native lands ? Should the nature of the oil flowing on existing pipelines, and the direction of flow, be subject to regulation ? Is the focus on blocking pipelines as a means to reduce exploration of tar sands, an acceptable approach for environmentalists ?

Can coordination of health care save 30 % of costs ?

An article in the New York Times (May 23, 2012) describes an effort by UCLA’s Health System to save 30% of costs by coordinating the hospital, patient, doctors and health insurers. These reductions will come from decreasing the number of X-rays per patient per day from 10 down to two, discouraging unnecessary blood transfusions (given the $ 400 cost per unit of blood), eliminating fried foods and encouraging wellness etc. Given the current $ 2.7 trillion cost of health care, can coordination of efforts and encouraging “accountable care organizations” enable realization of expected savings ? Will patient followup and after care responsibility have to be assumed by the accountable hospital to ensure compliance to medicine ? How will the system be incented to deliver on these expected savings ?

The deceptive global supply chain for Mercury

An article in Bloombergbusinessweek (May 28, 2012) describes the demand for mercury in Colombia, to extract small gold deposits, the lethal impact of vapors and errant disposal, and the global supply chain for its supply. Mercury exports were banned by the European Union in 2011 and US exports will be banned starting in 2013. But the 3 million pounds of mercury shipped from the US to the Netherlands (56 % of US mercury exports) enters an “in transit” status when in a warehouse in Rotterdam (and thus does not show entry into Europe) , then moves from Rotterdam to Colombia. From a paperwork perspective the US exports of mercury disappear from the global supply chain and appear in Colombia. When the European regaultors elimintaed the in transit exemption, mercury moved to Singapore as an in transit site before heading to Colombia. How should the global supply chain prevent errant use of mercury for gold extraction ? Should the inability of the Colombian government to enforce regulations (and thus deprive many citizens of a livelihood, albeit in a toxic environment) shift the responsibility to the exporting nations ? Or should the gold sales to donwstream customers require certification of an environmentally benign extraction process, thus dropping demand for gold extracted by toxic processes by small producers ?

Should GMO food be labeled ?

An artcile in the New York Times (May 25, 2012) describes an unlawful effort to put stickers identifying food conatining GMOs (Genetically Modified Organisms) – now prevalent in most corn or soyabeans grown in the US. Proponents of GMO foods describe the reduced use of pesticides and reslience of plants and their ability to feed a growing population. Opponents want the food labeled to enable consumers to choose. Any labels stuck on boxes would be a violation of manufacturer trademark or be considered store trespassing. Should information regarding GMOs be passed on to the consumer to let them decide ? Should scientific laims that GMO food is not unsafe be justification for them to skip labels identifying their use ? Should nonGMO foods claiming their supply chains be sufficient for consumers to express their preference ?

From fashion show to web sales in a day

An article in the New York Times (May 25, 2012) describes sales of Oscar de la Renta fashion items, immediately after the fashion show, in the website TheFancy.com, with five sweaters sold within 24 hours for $ 2490 each, per prior arrangement with the designer. Will such quick sales of items from a show be useful in forecasting product demand ? Will the observed demand be a useful indicator of customer preferences ? Should items be sold at a discount to encourage customers to both buy early and provide an early read of preferences ? Should early sales be satisfied by domestic production to ensure quick delivery ?

Making TVs in Detroit ?

An article in the Wall Street Journal (May 23, 2012) describes a decision by Element Electronics to assemble 46 inch flatscreen TVs, to be sold for $ 499 at Target, in a plant in Detroit. The company claims that the 5 % duty for imported TVs (about $ 27), the lower transport costs to retailers and the demand lift from the large US flag on the box with an assembled in the USA label, justify TV assembly in the US. But streamlined assembly, rising wages in China also help justify the decision. Will the demand lift from a US assembly label be sufficient to make this US production viable ? Is the competition that should be considered a production or assembly in China or in Mexico, where 50 % of US TVs are currently assembled ? Given that the 5 % duty justifies US manufacturing – is it a good idea to retain it and this increase costs for US consumers or is a better aproach to demand an even higher US productivity to justify domestic production ? Does the fact that the plant is owned by a Chinese producer and product sold by a branding company impact evaluation of its success in generating jobs in the US ?