City of Paris

Hepatitis B carriers in China hailed the announcement by the Ministry of Health on December 31 that positive hepatitis B status would no longer be a barrier to schools and employment as a significant breakthrough. This announcement came four years after the publication of hepatitis B prevention and management guidelines, which stated that hepatitis B is not transmitted through general day-to-day contact such as handshakes, sharing of meals or use of public restrooms. On the Internet, 175,453 exuberant comments were immediately posted.

In January, the “Notice Regarding the Protection of Rights of Hepatitis B Surface Antigen Carriers to Education and Employment” was published for public comment. The policy statement eliminates routine pre-entry or pre-employment screening of the hepatitis B panel, which in China includes surface antigen, surface antibody, e antigen, e antibody and core antibody, except when explicitly permitted by the Ministry of Health based on justifications provided by the educational institution or employer. Alanine aminotransferase (ALT) testing for evaluating liver function is, however, permitted under this new policy. Abnormal results will trigger additional testing and medical intervention as needed. (Does this sound a little like a loophole?) Additionally, the policy includes a provision for protecting the privacy of those tested, as well as public education on the modes of transmission of hepatitis B. The policy paper was issued jointly by the Ministry of Human Resources and Social Security, Ministry of Education and Ministry of Health. The public was given a week (January 21-27) to comment by email. As of last week, a newspaper in southern China had published an editorial that pointed out some of the fallacies of this new policy. Referring to the privacy provision, the editorial suggested that protecting the rights of the infected might result in an environment that breeds suspicion and discomfort. It also suggested that the new policy diminishes the independence of institutions and their right to make their own policy decisions.

There are many reminders in the media that the anticipated defeat of the current healthcare reform bill is nothing but history replaying itself, and 75 years of history at that. But it’s easy to forget how similar the issues are. In 1994, when all the buzz was around Hillary Clinton’s efforts, my agency, Lena Chow Advertising, worked with the team at Syva Company (today a part of Siemens Healthcare through multiple iterations of acquisitions) to conduct a healthcare reform survey as part of a promotion. A preshow mailer drew hundreds of attendees to Syva’s booth on the exhibit floor of the annual meeting of the American Association of Clinical Chemistry. We then published the results in a journal ad. The bottom line: 80.3 percent of those surveyed agreed that “the cost of doing nothing far outweighs the cost of reform.”

Now I want to go back and read, one more time, the last chapter of The Heart of Power: Health and Politics in the Oval Office, where authors David Blumenthal and James Morone highlight the critical steps required for passage of healthcare reform. Obviously, every president since Roosevelt has managed to skip one or more steps, leading to the demise of the aspired-to reform.

Roger Martin, the dean of the Rotman School of Management at the University of Toronto, must be engaged in some publicity program for his school. He appeared in an article in Sunday’s New York Times and wrote an editorial in today’s Financial Times. Both articles argue for the importance of critical and creative thinking, and lament the inability of today’s MBA programs to provide the necessary training. “True value in business comes not from applying quantitative analytical techniques to choose from among existing options but from creating options that do not yet exist,” writes Martin. He points to a major barrier to critical, creative thinking: the overreliance on theories and models that are seldom multidisciplinary, and advocates a more “liberal arts” (interdisciplinary, cross-cultural) approach to business school curriculum.

For those of us who are marketing and communication practitioners, our MBAs behind us, what can we do to improve our critical and creative thinking skills? In this time of New Year’s resolutions, I can think of three things I want to do or do more of. First, I plan on reading more—not just more business books, but more reading, in general. Being an immigrant, I have become, belatedly, very interested in politics and history. And, these days, healthcare is inextricably linked to politics. Second, I am going to look for the right venue for developing my thinking skills—a workshop or some other form of professional or personal development, or participating in a novel project. Third, I want to spend more time with my clients and my creative teams, working with them to look at problems and issues from different perspectives, writing tighter briefs, asking the creative teams more questions (and in turn giving more ideas the benefit of the doubt).

On December 31, China’s Ministry of Health published “Electronic patient record basic framework and standards (Preliminary).” Importantly, detailed records of all related expenses are required. This is another step to ensure visibility of charges and to quell continuing complaints about high medical expenses.

This preoccupation with expenses is reflected in the year-end survey conducted jointly by China’s consumer health publication and portals, which asked visitors about their overall impression of the impact of reform. (China began implementing healthcare reform earlier in 2009.) Two-thirds of the 2,073 who completed the survey were between ages 30 and 50; 55 percent were male and 45 percent were female. Only 11.6 percent felt that healthcare reform improved their access to care. When asked what the most significant practical impact was, 36 percent believed that drug prices have come down and, just as important, more are included in the national formulary for reimbursement. None of the other impacts, such as better facilities, ability to make appointments to see doctors, or a simplified payment process, was noted by 20 percent or more of the respondents. In fact, 6 percent of those surveyed said they continued going to tertiary care hospitals to seek routine care.

Experts offered perspective on why the impact of healthcare reform seems relatively minor, or, as the Chinese saying goes, like “loud thunder for just a little rain.” One expert noted that healthcare reform is a process and it will be years before significant impact can be felt by the average citizen. Another suggested that some policy changes, such as increased investment in human resources, will not have an immediate, noticeable effect on the average citizen. Another suggested that much of healthcare reform targets the older population and those suffering from chronic diseases, and both groups were not well represented among those surveyed.

There are subtle but noticeable behavioral changes. Of those surveyed, 23 percent reported that they no longer procrastinated in seeking medical care when they felt ill. An impressive 36 percent changed their habit of only visiting a clinic (at a hospital) early in the morning and are now likely to schedule their visits to the doctor during other times of the day and weekends. (Previously, patients went to hospital clinics early in the day to make sure they saw the doctor, usually a specialist, of their choice.) And 29 percent are willing to try smaller or community hospitals and resort to tertiary care hospitals only if their symptoms persist. The bias toward seeing specialists is abating as well. Even though a full 40 percent still choose the leading doctors at major hospitals, the majority now believe that it is not always necessary to head to a tertiary care hospital on the first sign of illness.

When asked about the type of improvements they are looking for, almost 50 percent wanted cost comparisons from doctors, once again suggesting that lowering healthcare costs is still a primary concern. The next most important is reducing drug costs (26 percent). The ability to make appointments with doctors ranks third (13 percent).

More sobering is the overall image of community hospitals. More than 51 percent still believe that community hospital doctors cannot meet the standard of doctors practicing at larger hospitals. Substandard facilities were cited by 35 percent of those surveyed, while 10percent felt that charges are unreasonable and another 3 percent complained about the attitude of doctors.

The dawn of the new millennium doesn’t feel like that long ago. Remember the days when the Y2K bug was our primary concern? A look at the lists of “10 best” and “10 most” of the year—or the decade—is telling of our times and the choices we face.

On energy, Financial Times posed two lists of questions to consider:
Top 10 energy questions for 2010 - Hydrocarbons edition
Top 10 questions for 2010 - Climate change and clean tech edition

For a quick recap, here is a comic strip to take us through the history of finance of the past decade.

Where do we begin on healthcare? For those of us who are still undecided, here are 10 reasons to support the healthcare reform bills.

Or vote on the healthcare deal of the year.

Everyone is writing about social media. Here are two that may interest healthcare marketers. Top 50 Twitter Topics of the Year and the Top Viral Videos of 2009.

And finally, lest we forget: Top 10 Worst Humanitarian Crises.

Earlier this year, March 4 to be exact, I opened a Twitter account, out of curiosity about what it could do and wanting to learn more about social media. I had a few friends who were on Twitter and I started off having one-on-one exchanges with them. Then I began tweeting to let people know when I posted a new blog. Slowly but surely, Twitter has become one of the first sites I visit in the morning when I sit down at my desk. I made a number of new friends, and many of the people I follow have become one of my primary sources of information about healthcare, marketing, communications, ethics, business policy—all the things that I need to stay relevant in my work. I am not a “high profile” user with hundreds and thousands of followers, but perhaps next year I’ll aspire to becoming a Brand or Maven or Mensch as described by Guy Kawasaki.

What I really like about Twitter is the openness. Unlike on LinkedIn or Facebook, for example, most Twitter users welcome new followers. In most cases you can start following someone right away. Out of curiosity, the people you choose to follow may follow you back, and vice versa. This is how I’ve made most of my “friends” on Twitter. Even though I’ve never met many of them, I feel like many of them are friends after seeing each person’s picture next to his or her tweet almost every day. By contrast, LinkedIn is most useful to me when I want to look up someone I know and reconnect with them. Ditto Facebook.

The catch is that some people who sign up as followers have ulterior motives. Here is what I mean. Many people consider followers on Twitter more or less as assets. The more followers you have, the broader your reach. At the very minimum I suppose it confers bragging rights. Taking this to the extreme, you can “buy” followers. (I have lost track of the link to information about how this can be done.) Another strategy sometimes used is to sign up as a follower, ostensibly, to as many different Twitter users as possible, knowing that some will reciprocate. I discovered how this worked by accident, when I observed that, at times, when a follower signs up and I don’t reciprocate, I get dropped in short order.

If you’re not already on Twitter and want to give it a try in 2010, I highly recommend it! And here are a few interesting people to consider following. Most of them are in the healthcare space.

http://twitter.com/ChristianeTrue
http://twitter.com/EdBennett
http://twitter.com/rilescat
http://twitter.com/Phrmageddon2012
http://twitter.com/kevinmd
http://twitter.com/FierceBiotech
http://twitter.com/scotthensley
http://twitter.com/pharmalot
http://twitter.com/ThisIsSethsBlog
http://twitter.com/GuyKawasaki
http://twitter.com/cityofparis (that’s me!)