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Doctors, Revolt

nytimes.com

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Re: Doctors, Revolt

#81

Post by savanaly »

bawana wrote: post #67

Hospitals should post prices of their procedures in the lobby. A surgeon gets $500 to repair a hernia and the hospital pulls in $5k for the ancillary services. The surgeon has to see the patient,make the diagnosis, provide the treatment, provide the aftercare and be the 'face'. The hospital-insurance complex has managed to create this fantasy world with complicated rules and somehow have sequestered themselves from t…

It's not like hospitals are wildly profitable to run though? I think the inflated costs are due to the little understood phenomenon of "cost disease" rather than owners of hospitals extracting outrageous rent for themselves as I think you are implying.

Re: Doctors, Revolt

#83

Post by adventured »

GiorgioG wrote: post #42
maxerickson wrote: post #37

Earlier quoted context omitted.

Gee I wonder why I used the exact phrase organized as non profits . But hundreds of millions in executive salaries at companies that pay billions in insurance claims isn't the thing driving health care costs. It barely registers.

Administrative overhead in 2014 accounted for 25% of US hospital spending. http://www.commonwealthfund.org/publications/in-the-literatu... Overall the administrative overhead is 8% for healthcare in the US, more than double global average (3%) http://money.cnn.com/2017/01/11/news/economy/healthcare-admi...

And further to that point, the admin side of US healthcare costs have massively expanded - similar to what has occured in education - over the last 30 years.

That 25% share, is about double what it is in Canada (although a few are equally high, the Netherlands is at 20%).

The famous chart showing the US growth in admin vs physicians since 1970: https://i.imgur.com/lnIcjo2.jpg

Re: Doctors, Revolt

#84

Post by adventured »

savanaly wrote: post #81
bawana wrote: post #67

Hospitals should post prices of their procedures in the lobby. A surgeon gets $500 to repair a hernia and the hospital pulls in $5k for the ancillary services. The surgeon has to see the patient,make the diagnosis, provide the treatment, provide the aftercare and be the 'face'. The hospital-insurance complex has managed to create this fantasy world with complicated rules and somehow have sequestered themselves from t…

It's not like hospitals are wildly profitable to run though? I think the inflated costs are due to the little understood phenomenon of "cost disease" rather than owners of hospitals extracting outrageous rent for themselves as I think you are implying.

You're correct about the spread of cost disease, it has essentially reached every corner of US healthcare. The part that hospitals are particularly guilty of, is unnecessary admin expense inflation. The US education system has seen an almost identical problem. Building buildings that aren't needed, hiring 10x the admin staff that the system had 30 or 40 years ago, etc. It's the system rewarding itself, bureaucrats hiring more bureaucrats, playing lords as they go on building sprees that aren't needed. There are very few readily available levers in the US healthcare system, that can be used to properly pull back against such cost spirals and spending behavior.

Re: Doctors, Revolt

#85

Post by nitwit005 »

aaavl2821 wrote: post #43
OliverJones wrote: post #21

Let's be careful about nostalgia for the "good old days" of medical practice. Keep in mind that standardizing medical care process has done more to get physicians to WASH THEIR HANDS than all kinds of exhortations about relationships, partnerships, and healing. And washing hands has, since Semmelweis's discoveries 150 years ago, been known as the easiest way to promote healing that medical people don't do. Why do the…

That may be true, but one aspect of the "good old days" (at least in the common cultural imagining of the "good old days") is that you could get more attention from doctors outside of a hospital setting, even at home, and that doctors had more time overall to spend with each patient All the procedures you describe seem like very important improvements in quality of hospital care, but there is (or should be) more to t…

You can still get a doctor to show up at your house. It just costs a lot, so people don't.

Re: Doctors, Revolt

#86

Post by maxerickson »

adventured wrote: post #83
GiorgioG wrote: post #42

Earlier quoted context omitted.

Administrative overhead in 2014 accounted for 25% of US hospital spending. http://www.commonwealthfund.org/publications/in-the-literatu... Overall the administrative overhead is 8% for healthcare in the US, more than double global average (3%) http://money.cnn.com/2017/01/11/news/economy/healthcare-admi...

And further to that point, the admin side of US healthcare costs have massively expanded - similar to what has occured in education - over the last 30 years. That 25% share, is about double what it is in Canada (although a few are equally high, the Netherlands is at 20%). The famous chart showing the US growth in admin vs physicians since 1970: https://i.imgur.com/lnIcjo2.jpg

Is there one that shows dollar amounts instead of growth?

If a dollar amount chart showed the same effect it would do a better job of making the point that chart is intended to make. But I think it is pretty likely that the 1970 administrative baseline is tiny (because in 1970 there were lots of small hospitals run by 1 doctor).

Re: Doctors, Revolt

#89

Post by alsetmusic »

andmarios wrote: post #64
kbenson wrote: post #10

Earlier quoted context omitted.

> Friend's mother was recently in hospital, multiple doctors thru a single day, each one had to completely relearn what was going on. What's the alternative? 24 hour shifts for the doctor and the new doctor each day needs to relearn everything? Having to relearn everything might be a problem, depending on what it actually means, but as long as we want a normal human being as a doctor, they will cycle over time as peo…

Is there really a need for 24 hour doctor visits most of the time? No. Doctors can have mostly normal 8-hour workdays, 5 times per week. Nurses administer drugs and monitor the patients. If a problem arise, they can call the doctor in charge of the patient or bring the doctor doing the night —or weekend— shift.

This is what you responded to:

>> Friend's mother was recently in hospital, multiple doctors thru a single day, each one had to completely relearn what was going on.

> What's the alternative? 24 hour shifts for the doctor and the new doctor each day needs to relearn everything?

This is from your response:

> Is there really a need for 24 hour doctor visits most of the time?

The exact situation described is hospitalization. Pointing out that most treatment may not be on a 24h basis is not relevant here.

Re: Doctors, Revolt

#90

Post by arkades »

BurningFrog wrote: post #56
mikecsh wrote: post #13

Earlier quoted context omitted.

In addition to this, many doctors want to re-take the history from the patients and re-examine them for themselves, rather than rely on a brief handover or potentially sub-optimal notes from another doctor. Clinical signs can be subtle, as can points in a patient's history that may point to a diagnosis. I see patients often frustrated at being asked the same questions by each doctor they see, but most of the time thi…

Each doctor also has an incentive to re-examine the patient so they can bill for that examination.

No, they don’t.

Most patients get admitted under a DRG, which is a lump sum payment. It’s true that doesn’t apply to every patient, but enough of them that doctors habits aren’t going to be shaped by the minority.

For that matter, you can come in and see a patient without asking the same history as the guy before you, if you’re just checking a box for a billing.

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