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 Health  Vol.8 No.5 , March 2016
Health Analytics, Economics and Medicine toward a 21st Century Health Care System
Abstract: After a review of recent developments in precision medicine, population health sciences and innovative clinical trial designs, and in health economics and policy, we show how innovations in health analytics can capitalize on the advances in biomedicine and health economics towards developing a data-driven and cost-effective 21st century health care system. In particular, we propose a mutually beneficial public-private partnership that combines individual responsibility with community solidarity in building this health care system.
Cite this paper: Choi, A. , Lai, D. , Lai, T. , (2016) Health Analytics, Economics and Medicine toward a 21st Century Health Care System. Health, 8, 428-443. doi: 10.4236/health.2016.85046.
References

[1]   Arrow, K., Auerbach, A., Bertko, J., Brownlee, S., Casalino, L.P., Cooper, J., Crosson, F.J., Enthoven, A., Falcone, E., Feldman, R.C., Fuchs, V.R., Garber, A.M., Gold, M.R., Goldman, D., Hadfield, G.K., Hall, M.A., Horwitz, R.I., Hooven, M., Jacobson, P.D., Jost, T.S., Kotlikoff, L.J., Levin, J., Levine, S., Levy, R., Linscott, K., Luft, H.S., Mashal, R., McFadden, D., Mechanic, D., Meltzer, D., Newhouse, J.P., Noll, R.G., Pietzsch, J.B., Pizzo, P., Reischauer, R.D., Rosenbaum, S., Sage, W., Schaeffer, L.D., Sheen, E., Silber, B.M., Skinner, J., Shortell, S.M., Their, S.O., Tunis, S., Wulsin Jr., L., Yock, P., Nun, G.B., Bryan, S., Luxenburg, O. and van de Ven, W.P. (2009) Toward a 21st Century Health Care System: Recommendations for Health Care Reform. Annals of Internal Medicine, 150, 493-495.
http://dx.doi.org/10.7326/0003-4819-150-7-200904070-00115

[2]   Arrow, K.J. (1963) Uncertainty and the Welfare Economics of Medical Care. American Economic Review, 53, 941- 973.

[3]   Grossman, M. (1972) On the Concept of Health Capital and the Demand for Health. Journal of Political Economy, 80, 223-255.
http://dx.doi.org/10.1086/259880

[4]   Rago, J. (2011) The Biomedical Century. The Wall Street Journal, Nov. 19, 2011: The Weekend Interview.
http://www.wsj.com/articles/SB10001424052970203611404577042813309766648

[5]   Zhou, X., Liu, S., Kim, K.S., Herbst, R.S. and Lee, J.L. (2008) Bayesian Adaptive Design for Targeted Therapy Development in Lung Cancer—A Step toward Personalized Medicine. Clinical Trials, 5, 181-193.
http://dx.doi.org/10.1177/1740774508091815

[6]   Barker, A.D., Sigman, C.C., Kelloff, G.J., Hylton, N.M., Berry, D.A. and Esserman, L.J. (2009) I-SPY 2: An Adaptive Breast Cancer Trial Design in the Setting of Neoajduvant Chemotherapy. Clinical Pharmacology & Therapeutics, 86, 97-100.
http://dx.doi.org/10.1038/clpt.2009.68

[7]   Ledford, H. (2010) Big Science: The Cancer Genome Challenge. Nature, 464, 972-974.
http://dx.doi.org/10.1038/464972a

[8]   Berry, S.M., Carlin, B.P., Lee, J.J. and Müller, P. (2010) Bayes-ian Adaptive Methods for Clinical Trials. Chapman & Hall/CRC Press, Boca Raton.
http://dx.doi.org/10.1201/EBK1439825488

[9]   Lai, T.L. and Lavori, P.W. (2011) Innovative Clinical Trial Designs. Toward a 21st-Century Health Care System. Statistics in Biosciences, 3, 145-168.
http://dx.doi.org/10.1042/BSR20100087

[10]   Bartroff, J., Lai, T.L. and Shi, M.C. (2013) Sequential Experimentation in Clinical Trials. Design and Analysis. Springer, New York.
http://dx.doi.org/10.1007/978-1-4614-6114-2

[11]   Lai, T.L., Liao, O.Y. and Kim, D.W. (2013) Group Sequential Designs for Developing and Testing Biomarker-Guided Personalized Therapies in Comparative Effectiveness Research. Contemporary Clinical Trials, 36, 651-663.
http://dx.doi.org/10.1016/j.cct.2013.08.007

[12]   Lai, T.L., Lavori, P.W. and Liao, O.Y. (2014) Adaptive Choice of Pa-tient Subgroup for Comparing Two Treatments. Contemporary Clinical Trials, 39,191-200.
http://dx.doi.org/10.1016/j.cct.2014.09.001

[13]   Lai, T.L., Lavori, P.W. and Tsang, K.W. (2015) Adaptive Design of Confirmatory Trials: Advances and Challenges. Contemporary Clinical Trials, 45, 93-102.
http://dx.doi.org/10.1016/j.cct.2015.06.007

[14]   He, P., Lai, T.L. and Zheng, S. (2015) Design of Clinical Trials with Failure-Time End-Points and Interim Analysis: An Update after 15 Years. Contemporary Clinical Trials, 45A, 103-112.
http://dx.doi.org/10.1016/j.cct.2015.05.018

[15]   Stukel, T.A., Fisher, E.S., Wennberg, D.E., Alter, D.A., Gottlieb, D.J. and Vemeulen, M.J. (2007) Analysis of Observational Studies in the Presence of Treatment Selection Bias: Effects of Invasive Cardiac Management of AMI Survivial Using Propensity Score and Instrumental Variable Methods. JAMA, 2009, 278-285.
http://dx.doi.org/10.1001/jama.297.3.278

[16]   Shih, M.C. and Lavori, P.W. (2013) Sequential Methods for Comparative Effectiveness Experiments: Point of Care Clinical Trials. Statistica Sinica, 23, 1775-1791.

[17]   Schwartz, D. and Lellouch, J. (1967) Explanatory and Pragmatic Attitudes in Therapeutical Trials. Journal of Chronic Diseases, 20, 637-648.
http://dx.doi.org/10.1016/0021-9681(67)90041-0

[18]   ALLHAT Offices and Coordinators for the ALLHAT Collaborative Research Group (2002) Major Outcomes in High-Risk Hypertensive Patients Randomized to Angioten-sin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs. Diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA, 288, 2981-2997.
http://dx.doi.org/10.1001/jama.288.23.2981

[19]   Tunis, S.R., Stryer, D.B. and Clancy, C.M. (2003) Practical Clinical Trials: Increasing the Value of Clinical Research for Decision Making in Clinical and Health Policy. JAMA, 290, 1624-1632.
http://dx.doi.org/10.1001/jama.290.12.1624

[20]   Pollack, A. (2008) The Evidence Gap: The Minimal Impact of a Big Hypertension Study. New York Times.

[21]   Fiore, L., Brophy, M., D’Avolio, L., Conrad, C., O’Neil, G., Sabin, T., Kauf-man, J., Hermos, J., Swartz, S., Liang, M., Gaziano, M., Lawler, E., Ferguson, R., Lew, R., Doras, G. and Lavori, P. (2011) A Point-of-Care Clinical Trial Comparing Insulin Administered Using a Sliding Scale versus a Weight-Based Regimen. Clinical Trials, 8, 183-195.
http://dx.doi.org/10.1177/1740774511398368

[22]   Shih, M.C., Turakhia, M. and Lai, T.L. (2015) Innovative Designs of Point-of-Care Comparative Effectiveness Trials. Contemporary Clinical Trials, 45, 61-68.
http://dx.doi.org/10.1016/j.cct.2015.06.014

[23]   Armony, M., Israelit, S., Mandelbaum, A., Marmor, Y.N., Tseytlin, Y. and Yom-Tov, G.B. (2015) On Patient Flow in Hospitals: A Data-Based Queuing-Science Perspective. Stochastic Systems, 5, 146-194.
http://dx.doi.org/10.1214/14-SSY153

[24]   Xu, M., Wong, T.C. and Chin, K.S. (2013) Modeling Daily Patient Arrivals at Emergency Department and Quantifying the Relative Importance of Contributing Variables Using Artificial Neural Network. Decision Support Systems, 54, 1488-1498.
http://dx.doi.org/10.1016/j.dss.2012.12.019

[25]   Xu, M., Wong T.C., Wong, S.Y., Chin, K.S., Tsui, K.L. and Hsia, R.Y. (2013) Delays in Service for Non-Emergent Patients due to Arrival of Emergent Patients in the Emergency Department: A Case Study in Hong Kong. The Journal of Emergency Medicine, 45, 271-280.
http://dx.doi.org/10.1016/j.jemermed.2012.11.102

[26]   Dixon, M. (2008) Will Polyclinics Deliver Real Benefits for Patients? Yes. BMJ, 336, 1164.
http://dx.doi.org/10.1136/bmj.39577.488507.AD

[27]   Ham, C. (2007) Clinically Integrated Systems; the Next Step in English Health Reform? Nuffield Trust, London.

[28]   Light, L. and Dixon, M. (2004) Making the NHS More Like Kaiser Permanente. BMJ, 328, 763-765.
http://dx.doi.org/10.1136/bmj.328.7442.763

[29]   Loh, V.W.K., Hwang, S.W., Chin, K., Samarasekera, D.D. and Kowitlawakul, Y. (2015) Learning on the Go. Innovation, 14, 12-16.

[30]   Reid, T.R. (2010) The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care. Penguin Press, London.

[31]   Kelley, A.S., McGarry, K., Fahle, S., Marshall, S.M., Du, Q. and Skinner, J.S. (2013) Out-of-Pocket Spending in the Last 5 Years of Life. Journal of General Internal Medicine, 28, 304-309.
http://dx.doi.org/10.1007/s11606-012-2199-x

[32]   Biller-Andorno, N. and Zeltner, T. (2015) Individual Responsibility and Community Solidarity—The Swiss Health Care System. The New England Journal of Medicine, 373, 2193-2197.
http://dx.doi.org/10.1056/NEJMp1508256

[33]   World Health Organization (2000) The World Health Report-Health Systems: Improving Performance. World Health Organization, Switzerland.

[34]   Lim, M.K. (1998) Health Care Systems in Transition II. Singapore, Part I. An Overview of Health Care Systems in Singapore. Journal of Public Health, 20, 16-22.
http://dx.doi.org/10.1093/oxfordjournals.pubmed.a024711

[35]   Haseltine, W.A. (2013) Affordable Excellence—The Singapore Healthcare Story. Brookings Institution Press, Washington DC.

[36]   Blumenthal, D. and Hsiao, W. (2015) Lessons from the East—China’s Rapidly Evolving Health Care System. The New England Journal of Medicine, 372, 1281-1285.
http://dx.doi.org/10.1056/NEJMp1410425

[37]   Hsiao, W.C.L. (1995) The Chinese Health Care System: Lessons for Other Nations. Social Science & Medicine, 41, 1047-1055.
http://dx.doi.org/10.1016/0277-9536(94)00421-o

[38]   Hsiao, W.C. (1984) Transformation of Health Care in China. The New England Journal of Medicine, 310, 932-936.
http://dx.doi.org/10.1056/NEJM198404053101428

[39]   Einav, L., Finkelstein, A., Ryan, S.P., Schrimpf, P. and Cullen, M.R. (2013) Selection on Moral Hazard in Health Insurance. American Economic Review, 103, 178-219.
http://dx.doi.org/10.1257/aer.103.1.178

[40]   Manning, W.G., Newhouse, J.P., Duan, N., Keeler, E.B. and Leibowitz, A. (1987) Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment. American Economic Review, 77, 251-277.

[41]   Aron-Dine, A., Einav, L. and Finkelstein, A. (2013) The RAND Health Insurance Experiment, Three Decades Later. Journal of Economic Perspectives, 27, 197-222.
http://dx.doi.org/10.1257/jep.27.1.197

[42]   Insel, T. (2011) Director’s Blog: The Economics of Health Care Reform. National Institute of Mental Health.
http://www.nimh.nih.gov/about/director/2011/the-economics-of-health-care-reform.shtml

[43]   Blumenthal, D., Stremikis, K. and Cutler, D. (2013) Health Care Spending—A Giant Slain or Sleeping? The New England Journal of Medicine, 369, 2551-2557.
http://dx.doi.org/10.1056/NEJMhpr1310415

[44]   Duggan, M. and Hayford, T. (2013) Has the Shift to Managed Care Reduced Medicaid Expenditures? Evidence from State and Local-Level Mandates. Journal of Policy Analysis and Management, 32, 505-535.
http://dx.doi.org/10.1002/pam.21693

[45]   Alpert, A., Duggan, M. and Heller-stein, J.K. (2013) Perverse Reverse Price Competition: Average Wholesale Prices and Medicaid Pharmaceutical Spending. Journal of Public Economics, 108, 44-62.
http://dx.doi.org/10.1016/j.jpubeco.2013.08.010

[46]   Dickstein, M.J., Duggan, M., Orsini, J. and Tebaldi, P. (2014) The Impact of Market Size and Composition on Health Insurance Premiums: Evidence from the First Year of ACA. Working Paper, Department of Economics, Stanford University, Stanford.

[47]   Einav, L. and Levin, J. (2015) Managed Competition in Health Insurance. The Journal of the European Economic Association, 13, 998-1021.
http://dx.doi.org/10.1111/jeea.12146

[48]   Aron-Dine, A., Einav, L., Finkelstein, A. and Cullen, M. (2015) Moral Hazard in Health Insurance: Do Dynamic Incentives Matter? Review of Economics and Statistics, 97, 725-741.
http://dx.doi.org/10.1162/rest_a_00518

[49]   Einav, L., Finkelstein, A. and Schrimpf, P. (2015) The Response of Drug Expenditure to Nonlinear Contract Design: Evidence from Medicare Part D. Quarterly Journal of Economics, 130, 841-899.
http://dx.doi.org/10.1093/qje/qjv005

[50]   Einav, L., Finkelstein, A. and Williams, H. (2016) Paying on the Margin for Medical Care: Evidence from Breast Cancer Treatments. American Economic Journal: Economic Policy, 8, 52-79.

[51]   Curto, V., Einav, L., Levin, J. and Bhattacharya, J. (2015) Can Health Insurance Competition Work? Evidence from Medicare Advantage. The National Bureau of Economic Research Working Paper, No. 20818.

[52]   Cutler, D.M., McClellan, M. and Newhouse, J.P. (1998) What Has Increased Medical-Care Spending Bought? American Economic Review, 88, 132-136.

[53]   Fuchs, V.R. (1974) Some Economic Aspects of Mortality in Developing Countries. In: Pelman, M., Ed., The Economics of Health and Medical Care, Macmillan, London, 174-193.

[54]   Fagnan, D.E., Fernandez, J.M., Lo, A.W. and Stein, R.M. (2013) Can Financial Engineering Cure Cancer? American Economic Review: Papers & Proceedings, 103, 406-411.
http://dx.doi.org/10.1257/aer.103.3.406

[55]   Fagnan, D.E. Yang, N.N., McKew J.C. and Lo, A.W. (2015) Financing Translation: Analysis of the NCATS Rare-Disease Portfolio. Science Translational Medicine, 7, 276ps3.
http://dx.doi.org/10.1126/scitranslmed.aaa2360

[56]   Fernandez, J.M., Stein, R.M. and Lo, A.W. (2012) Commercializing Biomedical Research through Securitization Techniques. Nature Biotechnology, 30, 964-975.
http://dx.doi.org/10.1038/nbt.2374

[57]   Lo, A.W., Hom, C., Cummings, J. and Kosik, K.S. (2014) Parallel Discovery of Alzheimer’s Therapeutics. Science Translational Medicine, 6, 241cm5.
http://dx.doi.org/10.1126/scitranslmed.3008228

[58]   Lo, A.W. and Stein, R.M. (2014) To Cure Cancer, Provide a Profit Motive.
http://www.scientificamercian.com/article/to-cure-cancer-provide-a-profit-motive

[59]   Morris, D. (2013) Health Care Reform: Analytics May Offer a Cure. LiveScience Expert Voices: Op-Ed & Insights.
http://www.livescience.com/37065-health-analytics.html

[60]   Lai, T.L. (2013) Data Science, Statistical Modeling, and Financial and Health Care Reforms. Notices of the International Congress of Chinese Mathematicians, 1, 47-57.
http://dx.doi.org/10.4310/iccm.2013.v1.n2.a6

[61]   Witten, I.H. (2005) Text Mining. In: Singh, M.P., Ed., Handbook of Internet Computing, Chapman & Hall/CRC, Baton Raton, 314-341.

[62]   Robson, B., Caruso, T.P. and Balis, U.G.J. (2013) Suggestions for a Web Based Universal Exchange and Inference Language for Medicine. Computers in Biology and Medicine, 43, 2297-2310.
http://dx.doi.org/10.1016/j.compbiomed.2013.09.010

[63]   Collins, F. (2012) The Real Promise of Mobile Health Apps.
http://www.scientificamerican.com/article/real-promise-mobile-health-apps/

[64]   Seaburg, L., Hess, E.P., Coylewright, M., Ting, H.H., McLeod, C.J. and Montori, V.M. (2014) Shared Decision Making in Atrial Fibrillation: Where We Are and Where We Should Be Going. Circulation, 129, 704-710.
http://dx.doi.org/10.1161/CIRCULATIONAHA.113.004498

[65]   Lin, G.A. and Fagerlin, A. (2014) Shared Decision Making: State of the Science. Circulation: Cardiovascular Quality and Outcomes, 7, 328-334.
http://dx.doi.org/10.1161/CIRCOUTCOMES.113.000322

[66]   Ting, H.H., Brito, J.P. and Montori, V.M. (2014) Shared Decision Making: Science and Action. Circulation: Cardiovascular Quality and Outcomes, 7, 323-327.
http://dx.doi.org/10.1161/CIRCOUTCOMES.113.000288

[67]   Gartner, Inc. (2014) Gartner Says in 2015, 50 Percent of People Considering Buying a Smart Wristband Will Choose a Smart Watch Instead.
http://www.gartner.com/newsroom/id/2913318

[68]   Crupi, R., Faetti, T. and Paradiso, R. (2015) Preliminary Evaluation of Wearable Wellness System for Obstructive Sleep Apnea Detection. 37th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC), Milan, 25-29 August 2015, 4142-4145.
http://dx.doi.org/10.1109/embc.2015.7319306

[69]   Collins, F.S. and Varmus, H. (2015) A New Initiative on Precision Medicine. The New England Journal of Medicine, 372, 793-795.
http://dx.doi.org/10.1056/NEJMp1500523

[70]   Einav, L. and Levin, J. (2014) Economics in the Age of Big Data. Science, 346, 715.
http://dx.doi.org/10.1126/science.1243089

 
 
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