December 22, 2024

Bucks Blog: Consumers Help Slow Growth in Health Spending

Growth in health care spending is expected to slow next year, in part because of a shift in consumer behavior, a report from PricewaterhouseCoopers’s Health Research Institute predicts.

The institute, the research arm of PricewaterhouseCoopers’s health care consulting practice, forecasts overall medical inflation of 6.5 percent in 2014 — down from the institute’s estimate of 7.5 percent for this year. The growth rate — which reflects changes in the actual cost to treat patients, and is influenced mostly by the cost of products and services as well as the number of services used — is often a crucial factor used by insurance companies in setting health insurance premiums.

The estimate is based on medical costs in the large employer market, which covers about 150 million Americans who have insurance through their jobs.

The net growth in spending — after employers tweak their packages of health benefits, such as by raising deductibles for workers — is expected to be about 4.5 percent.

The slower growth is notable, said Ceci Connolly, the institute’s managing director, because in the early 1990s, double-digit medical inflation was the norm. But changes in the health care delivery system — some driven by consumers, who are bearing more of the cost of their medical care — as well as some provisions of the new Affordable Care Act, are helping to slow the rate of increase.

As employers have shifted health care costs to workers by increasing their deductibles — the portion of care they must pay for, before their plan starts paying — consumers are becoming more interested in prices. “When consumers move into high deductible plans, they behave differently,” Ms. Connolly said. “They’re starting to become savvy shoppers.”

They are asking, for instance, whether care can be provided at a retail clinic rather than at a hospital, and requesting lower-cost generic drugs.

When the recession began, consumers started to cut back on medical care or to seek lower-cost options, like retail medical clinics, Ms. Connolly said. But even as the economy has improved, consumers have stuck with the clinics, which typically offer convenient hours as well as lower cost, she said.

According to the report, a visit to a retail clinic costs about $76, compared with about $120 for a visit to a traditional physician’s office.

Consumers are likely to continue seeking more affordable ways to get care, since medical costs aren’t falling, they’re just not going up as fast. Patients can also expect to get more direction from their employers about where to seek medical care, as companies contract directly with “high-value” health systems — those that are seen as delivering quality care at lower cost — to treat their covered employees who need complex care, like heart surgery, the report found.

Have you altered the way you seek medical care because of rising costs? What changes have you made?

Article source: http://bucks.blogs.nytimes.com/2013/06/18/consumers-help-slow-growth-in-health-spending/?partner=rss&emc=rss

Logging In With a Touch or a Phrase (Anything but a Password)

Neither idea is far-fetched. Computer scientists in Brooklyn are training their iPads to recognize their owners by the touch of their fingers as they make a caressing gesture. Banks are already using software that recognizes your voice, supplementing the standard PIN.

And after years of predicting its demise, security researchers are renewing their efforts to supplement and perhaps one day obliterate the old-fashioned password.

“If you ask me what is the biggest nuisance today, I would say it’s the 40 different passwords I have to create and change,” said Nasir Memon, a computer science professor at the Polytechnic Institute of New York University in Brooklyn who is leading the iPad project.

Many people would agree. The password has become a monkey on our digital backs — an essential key to our many devices and accounts, but increasingly a source of exasperation and insecurity.

The research arm of the Defense Department is looking for ways to use cues like a person’s typing quirks to continuously verify identity — in case, say, a soldier’s laptop ends up in enemy hands on the battlefield. In a more ordinary example, Google recently began nudging users to consider a two-step log-in system, combining a password with a code sent to their phones. Google’s latest Android software can unlock a phone when it recognizes the owner’s face or — not so safe — when it is tricked by someone holding up a photograph of the owner’s face.

Still, despite these recent advances, it may be premature to announce the end of passwords, as Bill Gates famously did in 2004, when he said “the password is dead.”

“The spectacularly incorrect assumption ‘passwords are dead’ has been harmful, discouraging research on how to improve the lot of close to two billion people who use them,” Cormac Herley, a researcher at Microsoft, the company that Mr. Gates founded, wrote in a recent paper. Mr. Herley suggested instead that developers try “to better support the use of passwords” — for example, by helping people protect their wireless connections from eavesdroppers. “Passwords,” Mr. Herley continued, “have proved themselves a worthy opponent: all those who have attempted to replace them have failed.”

The touch-screen approach of Professor Memon in Brooklyn works because, as it happens, each person makes the same gesture uniquely. Their fingers are different, they move at different speeds, they have what he calls a different “flair.” He wants logging in to be easy; besides, he said, some people find biometric measures like an iris scan to be “creepy.”

In his research, the most popular gestures turned out to be the ones that feel most intuitive. One was to turn the image of a combination lock 90 degrees in one direction. Another was to sign one’s name on the screen. In principle, the gesture can be used to unlock a device, or an app on the device that safely holds a variety of passwords.

Despite their resilience, passwords are weak, notably because their users have limited memories and a weakness for blurting out secrets. Most people need dozens of them, and they tend to pick ones that are so complex they need to be written down, or so simple they can be easily guessed. Recently, criminals have become adept at stealing passwords by sneaking malicious software onto computers or tricking users into typing them into an illegitimate site.

Companies like Facebook and Twitter have sought to address the frustration with passwords by allowing their usernames and passwords to open the door to millions of Web sites, a convenience that brings obvious risks. A thief with access to a master username and password can have access to a host of accounts.

Rachna Dhamija, a California computer scientist turned entrepreneur, sought to combat those weaknesses by breaking up the password. The user first logs in to the service that Ms. Dhamija built, UsableLogin, and signs in with her own partial password. Behind the scenes, the service verifies that the user is on an authorized device, and pulls the third piece from the cloud, generating a unique password for any Web site that the user wants to log in to — Facebook, for instance. In other words, one piece of the password rests with the user, another is stored in her device, and a third piece is kept online.

“You take a secret and you spread it across,” said Ms. Dhamija, whose service was recently acquired by Webroot Software, based in Broomfield, Colo. “You’re spreading the risk. The password is not stored in its whole form anywhere.”

But even if a user has been authorized at the start of a session, what if someone else gains access to her computer an hour later? Darpa, the Defense Department’s technology research arm, has invited security researchers to develop ways to verify a user every instant, based on the way the individual uses the machine — “for example, how the user handles the mouse and how the user crafts written language in an e-mail or document,” it explains on its Web site.

Each of these techniques is driven by the notion that a password alone is an insufficient means to verify online identity. Think of them as a fortification: a password-plus.

Many companies use a smart card or a security “dongle” — a small piece of hardware that plugs into the computer and functions as a key — as that second step of verification to allow access to internal networks. Today, biometrics — an individual’s unique physical traits — are emerging as an alternative.

At least a half-dozen banks in the United States ask their customers to verify who they are by reciting a two-second phrase to a computer over the phone, in addition to punching in their PINs. It could be as simple as “at my bank,” and a million customers could recite the very same phrase and still sound unique, according to Nuance Communications, a company based in Burlington, Mass., that makes the technology.

As mobile phones become bodily appendages for people worldwide, they too are emerging as instruments to verify identity. Google introduced its two-step process earlier this year. It sends a six-digit code to an application on a Google user’s cellphone to be entered, along with a password, when signing onto a Google account on a computer or tablet. The code can also be sent as a text message for those who don’t have smartphones, or it can be conveyed through a phone call.

The extra step is not mandatory, and the company will not say how widely it has been adopted. But as vulnerable as passwords are to theft and compromise, Google says, it is increasingly important for a user’s identity to be verified through another channel — a cellphone, in this case.

“I think we’ll start to see people using their mobile devices as their pervasive identifiers,” said Brendon Wilson, a security researcher at Symantec. “The password will no longer be the final arbiter that you are you. You will see layers on top.”

Article source: http://feeds.nytimes.com/click.phdo?i=30429f1c993ccdecca4f91dd99cd4ca5

Economix: ‘Middleweight’ Cities as Growth Engines

By 2025, 13 current Daniel Berehulak/Getty Images By 2025, 13 current “middleweight” cities will become megacities of 10 million of more, a McKinsey report says. Seven, including Shenzhen, are in China.

A new study by the McKinsey Global Institute has put a spotlight on a trend shaping the world: urbanization, in particular the shift toward emerging nations in Asia and Latin America.

Reports have long projected a vast increase in urban populations and megacities, as rural dwellers flock to cities in search of work and higher living standards. Some 60 percent of global gross domestic product is generated in just 600 cities around the world, with the bulk of them in developed economies like the United States and Europe, according to the institute, the economics research arm of the consulting firm McKinsey Company.

But the latest report, published by the institute last week, gives some nuanced — and perhaps surprising — assessments that could affect the strategies of companies seeking to tap into the global urbanization trend. It also provides fresh insights into the immense changes in the emerging world and China, in particular.

The world’s largest 600 cities will continue to account for about 60 percent of global G.D.P. by 2025, McKinsey said, but the composition of that group of cities will have changed dramatically.

One-third of cities in the most developed markets will no longer make the top 600 by 2025, and 136 new cities are expected to enter the top 600, all of them from the developing world and overwhelmingly from China, which will account for 100 of them.

“Over the next 15 years, the center of gravity of the urban world will move south and, even more decisively, east,” the institute said in its report. (That finding echoes a recent paper by an economist at the London School of Economics.)

Equally striking is the finding that it is urban “middleweights” (cities with populations from 150,000 to 10 million), rather than “megacities” (with a population of 10 million or more) that are increasing their share of global output most rapidly.

“It is a common misperception that megacities have been driving global growth for the past 15 years,” the McKinsey Institute said. “In fact, most have not grown faster than their host economies.”

Today’s 23 megacities will contribute about 10 percent of global growth to 2025, below their current 14 percent share of global G.D.P.

In contrast, by 2025, 577 middleweights are expected to contribute more than half of global growth, gaining share from today’s megacities.

By 2025, 13 cities that are current middleweights will probably have become megacities, 12 of which are in emerging markets (the exception is Chicago), with seven in China alone.

Companies wanting to capitalize on the urbanization trend had better take note. Focusing on developed economies and on emerging market megacities may no longer be enough — it’s the middleweights that are likely to deliver the biggest growth potential over the next decades, the McKinsey Institute said.

Article source: http://feeds.nytimes.com/click.phdo?i=34315771ef1d4c6a6b8c9ef6fd13b6ad