SUMMARY

From the point of view of biomedicine, the publication in Science that completes the analysis of the human genome should be highlighted, which seems to open the door to the therapy of various diseases.

As far as Global Health is concerned, polio reappearance in Malawi is of concern.

As for international health policy, problems with the covid-zero policy in China continue, which has led to the confinement of millions of people in Shanghai. As it happens, many older Chinese are unvaccinated, apparently out of fear. The satisfaction of the British public with the NHS falls to the lowest levels in history. At this rate, the UK is going to lose faith in what is said to be their last remaining religion.

If we talk about national health policy (Spain), we are witnessing a new phase of the pandemic, with cases on the rise and hospitalizations on the decline. The Lancet shows that the consumption of opioid analgesics is higher in Spain than in the United States.

In the field of companies, from the international point of view, the plan of the Cleveland Clinic to build a hospital in the center of London, with a large investment of 1 Billion pounds, should be highlighted, which could herald the landing of hospitals Americans in Europe. In our country, the private equity company KKR will pay almost 3 Billion euros for IVI, the largest fertility company in the world, in what is one of the largest operations of its kind in Spain. IMQ approves the sale of shares (50% of the insurer) to SegurCaixa Adeslas, which was already a minority shareholder in the company. Important announcement by Sanitas to launch its fifth hospital in Spain. It will be in Valdebebas, it will come into operation in 2025 and will have 100 beds, 23 of which are for mental health, which is a very innovative element in the Spanish hospital landscape.

BIOMEDICINE

A publication in Science that completes the analysis of the human genome (https://www.science.org/doi/10.1126/science.abl3533) which seems to open the door to the cure of several diseases (https://www. elespanol.com/ciencia/salud/20220401/lectura-completa-genoma-abre-puerta-multiples-enfermedades/661434317_0.html)
An article in Nature (https://www.nature.com/articles/s41591-022-01737-y) opens the door to healing the skin of “butterfly children” (https://elpais.com/ science/2022-03-28/the-first-gene-therapy-on-the-skin-heals-butterfly-children-of-wounds-that-had-not-healed-for-years.html)
Researchers study Alzheimer’s through alterations in a kind of lymphatic system in the brain (https://www.economist.com/science-and-technology/alzheimers-researchers-are-studying-the-brains-plumbing/ 21808465)
Ivermectin, an antiparasitic that had gained some popularity to treat covid, is shown not to reduce the risk of hospitalization (https://www.nytimes.com/2022/03/30/health/covid-ivermectin-hospitalization. html)

GLOBAL HEALTH

An outbreak in Malawi resurrects polio in Africa (https://elpais.com/planeta-futuro/2022-04-01/un-brote-en-malawi-resuscita-la-polio-en-africa.html)
Time is running out for vaccine patent release, Nature Editorial (https://www.nature.com/articles/d41586-022-00878-x)

INTERNATIONAL HEALTH POLICY

COVID

o Many older Chinese remain unvaccinated, many out of fear (https://www.economist.com/china/2022/04/02/why-so-many-elderly-chinese-are-unvaccinated)

o Lockdown in Shanghai, while covid cases rise throughout China (https://www.theguardian.com/world/2022/mar/28/shanghai-to-lock-down-millions-for-mass-testing-as -chinas-covid-cases-surge)

o The FDA allows a second “booster” for those over 50 (https://www.nytimes.com/2022/03/29/us/politics/second-coronavirus-booster-shot.html)

o The CDC lifts the order that prevented immigration during the pandemic (https://www.nytimes.com/2022/03/30/us/politics/immigration-cdc-biden.html)

Other themes

o British public satisfaction with the NHS drops to lowest levels since 1997 (https://www.theguardian.com/society/2022/mar/30/public-satisfaction-with-nhs-sinks-to-lowest- level-since-1997)

o The growth of health spending in the USA was reduced, after the pandemic. In 2021 it rose 4.2%, while in 2020 it had risen 9.7% (https://www.wsj.com/articles/us-healthcare-spending-slowed-in-2021-after-covid-19- surge-11648497601)

NATIONAL HEALTH POLICY (SPAIN)

COVID

o New phase of the pandemic: cases on the rise and hospitalizations on the decline (https://elpais.com/sociedad/2022-03-29/espana-entra-en-la-nueva-fase-de-control-de- the-pandemic-with-cases-on-the-rise-and-hospitalizations-on-the-low.html)

Other themes

o The flu gets out of control in Spring, it already supposes more hospitalizations than covid in several autonomous communities (https://www.elespanol.com/espana/20220331/descontrola-primavera-supone-ingresos-hospitalarios-covid-ccaa/660934368_0. html)

o The health plan against tobacco will raise its price and will prohibit smoking in cars and terraces, seeking a 25% drop in smoking (https://theobjective.com/sociedad/2022-03-30/sanidad-tabaco-precio- taxes/)

o Spain exceeds the United States in the consumption of opioid analgesics, according to The Lancet (https://www.elindependiente.com/vida-sana/salud/2022/03/31/espana-supera-a-eeuu-en-el -consumption-of-opioid-analgesics-according-to-the-lancet/)

COMPANIES, EMPLOYERS AND OTHER AGENTS IN THE SECTOR

International News

o United Health buys home care firm LHC for $5.4 billion (https://www.wsj.com/articles/unitedhealth-to-buy-home-health-firm-lhc-group-for-5-4- billion-11648550701)

o Great bet by the Cleveland Clinic, to build a hospital in central London for 1 Billion pounds (https://www.ft.com/content/c42bc01c-346c-4ae7-a931-4bbf0605e3ec)

o BioNTech returns almost 2 Billion euros to shareholders after the success of the vaccine (https://www.ft.com/content/db1c6786-6707-4d22-bf43-9c7686cbe97b)

o Fresenius acquires mABxscience and Ivenix to accelerate “biopharma” and “medtech” (https://www.plantadoce.com/empresa/fresenius-acquires-mabcience-and-ivenix-to-accelerate-in-biopharma-and-medtech .html)

National News

o The EMA begins the evaluation of HIPRA, the Spanish vaccine against covid (https://www.eldiario.es/sociedad/ema-comienza-evaluacion-hipra-vacuna-espanola-covid-19_1_8871634.html)

o The private equity company KKR will pay almost 3 Billion euros for IVI, the Spanish company that is the largest fertility company in the world (https://www.elconfidencial.com/empresas/2022-03-28/kkr-ivi -rma-transition-fertility_3399221/)

o IMQ approves the sale of shares to SegurCaixa Adeslas (https://www.redaccionmedica.com/secciones/privada/los-medicos-de-imq-aproven-la-venta-del-grupo-a-segurcaixa-adeslas-1096 )

o IMED hospitals opens a new polyclinic in Alcoy (https://www.plantadoce.com/empresa/imed-hospitales-abre-una-nueva-policlinica-en-alcoy.html)

o Sanitas will open a new hospital in Madrid, in the Valdebebas neighbourhood, it will be its fifth hospital in Spain and it is expected to open in 2025. It will have 100 individual rooms, 22 dedicated to mental health. Sanitas will be the tenant, the property will be owned by Pryconsa (https://cincodias.elpais.com/cincodias/2022/04/01/companias/1648816602_273605.html)

o LetsGetChecked acquires the Spanish biotechnology company Veritas (https://www.europapress.es/corporate-y-ma/noticia-letsgetchecked-adquiere-100-biotecnologica-espanola-veritas-20220329123245.html)

“Virtual-First” Primary Care

A revolution among American insurers

JAMA magazine has just published (see PDF) an article on the growing phenomenon of “Virtual First” Primary Care.

It all arises when in October 2021, the United Health group announced that it was going to offer a cheaper premium with a “virtual-first primary care” plan in which subscribers would receive longitudinal care by a virtual doctor for most of their primary care needs. This announcement follows similar initiatives from other large insurers such as Humana, Aetna, and many regional plans last year. Doctor on Demand, a telecare company supports many of these plans and announced that it is in the process of recruiting more than 1,000 doctors. Firefly Health, another telemedicine company, decided to launch its own insurance plan.

This growing phenomenon follows the rise of telemedicine during the pandemic and the fact that this practice has been achieving more and more comfort among patients and doctors.

Conceptually, this “virtual-first primary care” phenomenon means that patients will use the virtual channel as the first option to obtain service.

There are several variants, such as that of MDLive, in which the doctor or other virtual professional complements the activity of the doctor who is seen in person. But patients are encouraged to use their virtual doctor, whatever the problem they have, and the expectation is that this will be used more and more frequently.

The shift towards virtual care models arises from the difficulties of maintaining face-to-face activity in chronic diseases, which require almost continuous monitoring.

Possible concerns

Despite all its advantages, virtual care in primary care raises a number of questions. The first, that although many health problems can be solved by telemedicine, the question arises as to what portion of primary care can be solved without problems in a virtual way, without personal interaction and a physical examination. The second problem is how virtual models coexist with traditional primary doctors, if there is not a very adequate coordination between them.

A robust evaluation is needed to determine if these models deliver on the promise of better chronic disease management, fewer avoidable emergency room visits, and better referrals. There are no minor issues of analyzing patient satisfaction, or the responsibility of doctors when they offer their assistance virtually.

The future will tell us

Logically, it remains to be seen if this form of care substantially attracts patients to be viable in the long term, but we are inclined to think that a wise combination of face-to-face care-virtual care, with a good protocolization of in which cases virtual care is recommended and in which cases direct care is required can be the key to success.

An opportunity also for Spanish insurers

The operation of Spanish insurers is through an endless list of specialists who are accessed directly. There is, in practice, no primary care as such. This is one of the problems for Spanish insurers and a great challenge if they want to continue advancing in cost and quality control. This is an opportunity to set up primary care, without the need for a large investment or the creation of a new network. Success may be for Spanish insurers to reproduce an experience similar to “virtual-first primary care”, without breaking direct access to the specialist, one of the great attractions of the model.