City of Paris

The annual meeting of the American Association of Clinical Chemistry (AACC), held in Chicago last week, is arguably the biggest annual gathering of laboratory diagnostics practitioners and vendors. As I attended the symposia and various presentations at exhibit booths, I couldn’t help but notice the focus on quality and, even more so, the cost of patient care and how laboratory diagnostics can help drive costs down. In particular, cost savings enabled by automation and information technology was a much-repeated theme as laboratory managers from hospitals reeled off statistics about how they are able to get better results to doctors faster and with fewer personnel. What is interesting is that there seems little resistance to this labor reduction, and managers can talk about attrition with little concern about people losing their jobs. The reason: a continuing shortage of qualified laboratory personnel.

The fact that laboratory medicine is able to drive labor costs down (and improve quality and service) is of course a direct result of technological advancements. Just as important is the fact that this industry does not have to contend with the consequences of job losses faced by the manufacturing sector—the auto industry being a prime example—where gains in productivity are often seen as a threat to livelihood. On the other hand, I cannot help but wonder about the reason for the lack of trained personnel. Surely, lack of incentive must be one, and I am reminded, once again, that laboratory medicine is surely one of the most undervalued components of healthcare, and that when it comes to healthcare costs, laboratory medicine gets a disproportionate amount of scrutiny as compared to imaging or therapeutics.

Perhaps this is an opportunity for an industry-academic collaboration, where IVD companies can team up with their customers in the medical centers to quantify the value of clinical diagnostics in healthcare.

My mailbox (snail mail, that is) has been filled with preshow mailers from various exhibitors at the annual meeting of the American Association of Clinical Chemistry (AACC), which opens this week at McCormick Place in Chicago. As I sifted through the stacks of postcards and brochures, I saw these promotional pieces in a new light, not as an agency person producing these incredibly important traffic builders, but as part of the audience and someone using the mailers to plan a walk through the convention hall. I came away with the conclusion that preshow mailers are not meant to be creative showpieces─none in my pile of more than 50 pieces is─but they must showcase the presentations (the exhibit, workshop or scientific sessions) and direct traffic to them. Sadly, while most of the mailers I received contain sufficient information to get me to these various venues, very few would arouse the curiosity of a naïve visitor (i.e., one who does not already know the company).

Beckman Coulter stands out with a very clear, coherent and easy-to-read program, complete with the URL of the web page showcasing activities at the meeting. Beckman Coulter won an extra point from me for sending a reminder just this last week to highlight key events. Siemens Healthcare Diagnostics also sent a very easy-to-read and helpful guide to their programs, but Beckman Coulter did better, in my opinion, with a simpler format (a four-page brochure) and of course the follow-up mailer. Bio-rad gave me the best reason to visit their booth—a go-green shopping bag, with which I can rack up my 5-cent refund every time I go to Whole Foods. Bio-Rad’s oversized postcard is nicely laid out, easy to read and no doubt inexpensive to produce. And I appreciate not having to hunt for their booth number!

The worst mailer I received came from a major player in clinical diagnostics with a booklet that was obviously produced by amateurs and that read like a product catalog with uncoordinated contributions from various divisions. Oh yes, I received a few mailers featuring the Chicago skyline (the meeting is being held in Chicago). Good for Chicago, but it doesn’t make much sense unless your company happens to be headquartered in the Windy City.

Now some dos and don’ts for those of us planning preshow mailers for the next convention.

• Do make it easy for people to find you by prominently displaying booth numbers or details on venues for special events.
• Do put function before form and put clarity of information and readability of layout ahead of design gimmicks.
• Do support your snail mail with a dedicated web page to provide more details and pre-registration for special events.
• Don’t devote too much space to product descriptions—let your salespeople tell the story at the exhibit booth.
• Don’t overspend on big pieces, complicated folds and cute copy, as they can become roadblocks to an audience looking for some quick information.

An agency principal reported an unusual RFP in last week’s Advertising Age whereby the entire first-round screening was completed online, with no human interaction whatsoever. This may sound like an efficient way to gather preliminary data from agencies, but there were unusual twists to the RFP process in this particular case. First, the participating agencies were required to submit line-by-line fee proposals. And, to qualify for the next round, agencies that had performed prior work for the client were asked to agree to a rate reduction. Even more surprising is the fact that the RFP was for strategic consulting and design services. Qualified agencies were then invited to continue the impersonal, Web-enabled bidding process.

In this case, there was clearly a mismatch between the RFP process and the assignment for consulting services, which as we know are highly dependent not only on the consultant’s expertise but also on the relationship between client and consultant, something that cannot be assessed by computers. I can see why the client would want to get a sense of costs before going too far down the path, but detailed line-by-line breakdowns and mandated discounts speak of a client that does not respect the agency’s time and one that places price over value. In the end, maybe this client will ask for agency services to be delivered via the same online process, with no live human interaction? Now that would really make it easy for the agency to deploy junior staff to do all this “strategic consulting.”

What are reasonable measures clients can take to manage costs? I say go back to the basics.

• Do a few things well, rather than spreading the budget too thin. It also helps to stick to your plan and not be tempted to be reactive.
• Be more efficient in your interactions with your agency.
• Be nice to your agency. Believe me, it pays!

At the Health Economics Forum on June 21, 2009, attended by 30 or more specialists representing China’s Ministry of Health, the Center for Disease Control, and the Chinese Medical Association, as well as hospitals and health journalists, the Ministry of Health reported that China’s healthcare expenditures will rise by 10 percent on an annual basis for the next five years.

Cancer, stroke and heart disease are the three major health threats representing a significant economic burden, with 7.2 million people hospitalized for these three diseases in 2003 at an average cost of 5972 RMB per person. To put this into context, urban per capita income in the same year was 8472 RMB, while rural per capita income was 2622 RMB.

Chronic diseases now represent 80 percent of all illnesses and 75 percent of total deaths. By 2010, chronic diseases will account for 85 percent of all deaths. Specialists at the forum cited cervical cancer and hypertension as examples of illnesses for which early detection and intervention can significantly improve outcome.

The forum commented on the cost of diagnostics, citing World Health Organization statistics that diagnostics accounts for only 1 percent of total healthcare expenditures, while two thirds of healthcare decisions are based on diagnostic results. The forum concluded that a broad use of diagnostics is an appropriate measure for healthcare cost containment.

During the opening ceremonies of the Stroke Prevention and Diagnosis Meeting attended by more than 300 specialists in China, Minister of Health Chen Zhu stated that the cost of treatment for stroke has reached 20 billion RMB. Slightly more than half of this total can be attributed to direct hospital costs associated with ischemic stroke. Mortality attributed to stroke is four to six times that attributed to cardiac arrest, and the cost burden of stroke is ten times that of cardiovascular disease.

Equally sobering is the comparison with other countries. Stroke is the number one cause of death in China, with a mortality rate four times higher than those of Western countries, and three and a half times that of Japan. Notably, the recurrence of stroke is 27 percent in Beijing—the highest among major cities worldwide. Overall, 40 percent of stroke patients presenting at outpatient clinics are recurrences, while one third of all stroke patients can be expected to have an event within three to five years after initial diagnosis.

According to Minister Chen, the strategy for reducing the incidence of stroke will include identifying high-risk populations and early diagnosis and intervention; thus, investments in screening and prevention may hold the greatest promise in the near future. Along these lines, developing standards of care for diagnosis, management and surgical intervention is the highest priority. The goal is to establish care centers at a regional, provincial and local level within three years. Public awareness and education will also be an important component.

Dental health product companies and orthodontists interested in the China market take heart!
An announcement from China’s Ministry of Health designated September 20, 2009, as National Dental Health Day. The theme is “Maintain oral health and elevate your quality of life,” with a focus on public awareness of dental health. The announcement outlined the rationale for improving dental health, which goes beyond health issues such as cardiovascular, respiratory, diabetes and prenatal care to potential effects on speech and psychological well-being. It cited a recent national survey that showed that 66 percent of five-year-olds show signs of tooth decay, while the prevalence is even higher (above 88 percent) in the older population. Furthermore, the survey showed that most cases are not receiving proper treatment. The announcement lists the necessary steps for improving oral health to be communicated to the public. In addition to standard good practice such as frequent brushing and checkups, the announcement specifies the use of dental floss and fluoridated toothpaste and rinses, as well as correction of tooth irregularities.