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Yeah, great questions actually. Not sure I have a fully formed model I'm putting forth so just going to speak in generalities. > How do you see your proposed a

Yeah, great questions actually. Not sure I have a fully formed model I'm putting forth so just going to speak in generalities. > How do you see your proposed approach affecting healthcare quality? In the business end of healthcare, quality is just a base assumption. You (Okay most) would never make a business decision that erodes quality and clinicians are trying to improve quality all the time. The companies I've worked for have entire departments named simply "Quality" with significant budgets/headcount. That said, from an economic standpoint, it just needs to be a part of that formula. The current real thing that comes to mind is CMS (Medicare) issues quality scores to hospitals (star ratings) and their reimbursements go down if their quality score dips. It also helps folks "shop" providers as the star rating is public information. > does public-owned R&D lower incentives to generate new treatments? I don't think it has to. Scientist want to do science. If funded, I believe they will. I'm more concerned with what science we're ignoring because it has no obvious GTM strategy, link to some ROI, &/ random business objective. > Or, conversely, does it raise incentives for higher quality drugs for underserved (and unprofitable) diseases? I think it does, or can. Because I think it opens the field for more exploration. I've never been very close to how pharma R&D is performed, but my understanding is it's rather narrow. For example, "we want to solve X because we can make $Y". Once we solve X, we can do X.a, X.b, X.c, etc. It doesn't matter that they could make the world a better place by solving Z and perhaps that's what the scientist would rather be doing. I'd certainly entertain counter-arguements, this is just Sim City brain at work on hypothetical realities.

s1artibartfast 4y ago
>I think it does, or can. Because I think it opens the field for more exploration. I somewhat disagree. I think the best solution is for payers (single or not) to set prices based on quality adjusted life years (QALY). This is done in some single payer markets and makes a lot of sense as it couples incentives with impact. While cooperate Pharma pays most of R&D costs, Fundamental (extremely early) research is usually still publicly funded through academia. This is where the possible solutions to Z come from. The "problem" is that R&D spend can have more impact (lives saved) on mainstream diseases than rare diseases. Public-funding/ownership doesn't solve this fundamental issue. You can direct funding to rare diseases by decree, but you are still saving fewer lives than you would otherwise.
- conductr 4y ago
  Either approach would be an improvement to current format. My only issue, and I'm rather layman on this, is I don't think academia creates solutions. They generate ideas and the pharma has to figure out all the parts to manufacture/commercialize it. I'd think that process could be more seamless. Right now, I think academia may touch on Z but if there's no $ it just dies in academia and that's a shame. I also tend to agree that we should be solving problems that affect folks the most and factoring for the magnitude of the issue which is what QALY seems to do to gauge impact, so I like that idea. However, in doing so, I expect you're casting a larger net and bound to stumble on something that serves a smaller market as a byproduct of the R&D. In the current reality, the byproduct would get shelved and never commercialized because it had no ROI, which is also a shame.

s1artibartfast 4y ago

>I think it does, or can. Because I think it opens the field for more exploration. I somewhat disagree. I think the best solution is for payers (single or not) to set prices based on quality adjusted life years (QALY). This is done in some single payer markets and makes a lot of sense as it couples incentives with impact. While cooperate Pharma pays most of R&D costs, Fundamental (extremely early) research is usually still publicly funded through academia. This is where the possible solutions to Z come from. The "problem" is that R&D spend can have more impact (lives saved) on mainstream diseases than rare diseases. Public-funding/ownership doesn't solve this fundamental issue. You can direct funding to rare diseases by decree, but you are still saving fewer lives than you would otherwise.

conductr 4y ago
Either approach would be an improvement to current format. My only issue, and I'm rather layman on this, is I don't think academia creates solutions. They generate ideas and the pharma has to figure out all the parts to manufacture/commercialize it. I'd think that process could be more seamless. Right now, I think academia may touch on Z but if there's no $ it just dies in academia and that's a shame. I also tend to agree that we should be solving problems that affect folks the most and factoring for the magnitude of the issue which is what QALY seems to do to gauge impact, so I like that idea. However, in doing so, I expect you're casting a larger net and bound to stumble on something that serves a smaller market as a byproduct of the R&D. In the current reality, the byproduct would get shelved and never commercialized because it had no ROI, which is also a shame.