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Doctors, Revolt

nytimes.com

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Re: Doctors, Revolt

#171

Post by dominotw »

PeterisP wrote: post #170
dominotw wrote: post #168

Earlier quoted context omitted.

> The same reasons would apply elsewhere, they're not USA-specific, so they don't explain why it's not possible to do the same thing that's successfully done elsewhere. I 've never seen a chart with prices for hernia in the lobby , anywhere that I've lived( I am not from USA). Where has it been successfully done?

Well, it's not literally placed in the lobby (since the price chart is big and different locations/types/severities of e.g. hernia mean different types of operations, and the choice of which type of operation should be chosen is generally not made by you but by the consulting doctor) but it's conceptually the same in that the price list is publicly available and you know beforehand about what exactly you're going to…

> That's it, if your doctor recommends to do this operation, then if it's not covered by your insurance this is what you'll pay for the procedure followed by a standard per-day inpatient fee for however you're required to stay during recovery. It's up to the hospital how to split the amount among all the involved specialists labor, equipment, drugs and supplies required.

But this exactly the same in USA too. I got shoulder surgery in USA. Doctors office took my insurance information and called my insurance provider and told me how much my insurance covered and how much I am going to pay for it. I paid exactly that amount out of pocket post surgery.

Re: Doctors, Revolt

#172

Post by creep »

ScottBurson wrote: post #163
creep wrote: post #161

Earlier quoted context omitted.

The cranberry juice thing is inconclusive, but I still drink a lot of it as well! >Quite the contrary: doctors should know that that can happen. Okay, thanks for clarifying. This is how I felt. It was silly to me that I could have all the symptoms of a UTI, only to have everything written off because of a clean urine sample. I think it was hopeful thinking on the doctor's part-- she just wanted me out of the bed so s…

>> doctors should know that that can happen In fairness, I guess it really doesn't happen very often — the ER doc in my wife's situation commented that she had never seen it before. On the other hand, pulled muscles don't cause fever. I understand a little bit of reluctance to offer antibiotics, as they have been overused, but geez, you have a patient with a fever and in terrible pain, indeed with all the other sympt…

I think the best thing is to do another urine test. I'm also wary about antibiotics, but it doesn't hurt to keep the patient around for another hour or two to get a fresh sample and test it. But, the doctor assured me it was just a mechanical issue ¯\_(ツ)_/¯

Re: Doctors, Revolt

#173

Post by creep »

ScottBurson wrote: post #162
creep wrote: post #161

Earlier quoted context omitted.

The cranberry juice thing is inconclusive, but I still drink a lot of it as well! >Quite the contrary: doctors should know that that can happen. Okay, thanks for clarifying. This is how I felt. It was silly to me that I could have all the symptoms of a UTI, only to have everything written off because of a clean urine sample. I think it was hopeful thinking on the doctor's part-- she just wanted me out of the bed so s…

This is from memory, but it seemed like there was the better part of a year when it wouldn't be more than two or three weeks after she was over one that she'd get another one. Really, she should have been referred to the urologist a lot sooner.

That must have been hard, it's good she's on regular antibiotics now. Mine seem to be occurring once a year, almost to the day.

I had issues with bedwetting as a child and into my late teens. I went to sleep specialists, urologists, and psychologists but nobody could say anything about it. I think it's somehow related to what I've been experiencing lately but I don't know what to do about it. I was always getting infections as a kid too (ears, eyes, bladder, kidney) but not really flu or colds (despite not being vaccinated). Has your wife experienced any of these things in her youth?

Re: Doctors, Revolt

#174

Post by PeterisP »

dominotw wrote: post #171
PeterisP wrote: post #170

Earlier quoted context omitted.

Well, it's not literally placed in the lobby (since the price chart is big and different locations/types/severities of e.g. hernia mean different types of operations, and the choice of which type of operation should be chosen is generally not made by you but by the consulting doctor) but it's conceptually the same in that the price list is publicly available and you know beforehand about what exactly you're going to…

> That's it, if your doctor recommends to do this operation, then if it's not covered by your insurance this is what you'll pay for the procedure followed by a standard per-day inpatient fee for however you're required to stay during recovery. It's up to the hospital how to split the amount among all the involved specialists labor, equipment, drugs and supplies required. But this exactly the same in USA too. I got sh…

As far as I understand, the insurance-negotiated system works more or less fine in USA, the major problems seem to be with uninsured rates; I have no first-hand experience from USA but the discussion about the health system claims that often they're either not able to obtain such information (especially if they'd be shopping to obtain a quote from multiple providers) or, alternatively, get hit with significant "surprise" extra bills from different additional providers. Of course, the issue may be exaggerated, but that's the impression I've got from media.

Re: Doctors, Revolt

#175

Post by kwhitefoot »

chimeracoder wrote: post #127
mikecsh wrote: post #120

Earlier quoted context omitted.

And this certainly isn't the case in the NHS in the UK where doctors have no financial incentives interfering with their clinical decisions (barring saving the service money). What you describe is a pitfall of private medicine.

> And this certainly isn't the case in the NHS in the UK where doctors have no financial incentives interfering with their clinical decisions (barring saving the service money) This meme really needs to die. The NHS has massive financial incentives that impact clinical decisions. In fact, you literally go on to mention as such in your next sentence. It turns out that having an incentive to "save the system money" res…

> which is why the NHS does rather badly on complicated and chronic conditions like treating cancer compared to the US and other countries).

It might be true that the NHS has poorer outcomes but I doubt that this is necessarily the cause. I live in Norway and have considerable recent first hand experience of the health system. I'm confident that they have incentives to save money too. In fact my wife's cancer nurse when explaining why there was a delay in starting the day's treatment said that preparations like Avastin would not be ordered from the pharmacy until the patient was both present and prepared for treatment because they could not afford to throw it away when the patient didn't turn up or turned out to be too ill for chemotherapy.

It is broadly speaking the same idea as the UK NHS but apparently has better outcomes for diseases like cancer. There are fees to pay, similar to an insurance excess or what the US calls co-pay; but those fees are affordable and capped to a couple of hundred pounds a year.

Re: Doctors, Revolt

#176

Post by motohagiography »

HillaryBriss wrote: post #104
motohagiography wrote: post #59

The health sector is the Afghanistan of the tech business. It's entire history is of empires arriving to solve its problems, and after a decade and massive losses, they leave, mystified at how something so contained could be so intractable. The only people who survive there are the ones who don't try to change it. When you can send your diagnostic images to get a consult from 2 clinics in India and an expert system f…

not sure where your confidence comes from, though i hope you are correct. i don't see it yet though. in the US healthcare market the payment model will have to change before Indian healthcare market prices have an impact. in other words, US legislation that takes money away from the current system of providers would need to be passed. (i mean, why doesn't the US medicare/medicaid system take advantage of the lower co…

Tell me more of your impregnable fortresses and unsinkable ships.

I agree that the barriers you mention are real, but those are in the domain or class of solvable problems. Apps like Figure1 are a good example of how doctors are moving around this.

To borrow from Nial Ferguson's new book, the big CMS/EHR players (nightingale and another one here) control the integration points and hierarchical relationships, but I think they are vulnerable to networks.

Re: Doctors, Revolt

#177

Post by bawana »

gregw134 wrote: post #96
adventured wrote: post #84

Earlier quoted context omitted.

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 hi…

Last time I was out the hospital they had robots running around to just to pick up towels. Robots are great and all, but that's a symptom of not managing costs.

thank you all for your input. The hospital you linked in Asia. It seems that SE Asia has leapfrogged us in the concept of capitalism and the free market. Indeed, it is a 'free-for-all' in terms of lack of regulation, but certainly it is not 'free care for all'. Here in the US, The medical-industrial complex has seen how other industrial complexes deal with our government and are trying to mimic that gravy train. I still remember articles about the $500 hammer, and $2000 toilet the Navy had purchased in the thousands.

We need to get back to our roots. A free market where people can buy what they want when they want it. Health care insurance is an oxymoron. Everyone gets sick. There is no probability of someone NOT using the system. The minute you try to amortize the costs over time or large populations to provide services, there is infinite demand.

Insurance would make sense for events that are RARE. House fires, automobile accidents, gun accidents, etc. (BTW, why isnt gun insurance mandatory? That way everyone could be happy- you could still buy a gun as long as you paid your $5000 premium. The insurance companies could make more money, there would more 'gun control', and the money could go to the emergency rooms that take care of shooting victims. But OH NO! Hospitals would figure out a way to spend that money too and it would never be enough!! Maybe the gun insurance premiums could be given to the victims !)

Anyway, there is no easy fix until we start to force our politicians to GET OFF THEIR ASSES. It particularly annoys me that they offer 'thoughts and prayers' after each mass murder and do nothing else. They should be in Florida digging the graves. Representing their constituents properly.

Re: Doctors, Revolt

#178

Post by bawana »

PeterisP wrote: post #174
dominotw wrote: post #171

Earlier quoted context omitted.

> That's it, if your doctor recommends to do this operation, then if it's not covered by your insurance this is what you'll pay for the procedure followed by a standard per-day inpatient fee for however you're required to stay during recovery. It's up to the hospital how to split the amount among all the involved specialists labor, equipment, drugs and supplies required. But this exactly the same in USA too. I got sh…

As far as I understand, the insurance-negotiated system works more or less fine in USA, the major problems seem to be with uninsured rates; I have no first-hand experience from USA but the discussion about the health system claims that often they're either not able to obtain such information (especially if they'd be shopping to obtain a quote from multiple providers) or, alternatively, get hit with significant "surpr…

no it doesnt work. the insurance companies restrict reimbursement even for those people who pay premiums. I have seen deductibles now in the $5000 to $10000 range. The costs and fees have been inflated beyond reality to facilitate their profit numbers for their EPS ratios.
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