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Unnecessary medical care is harming patients physically and financially (2015)

newyorker.com

61–70 of 256 posts

Re: Unnecessary medical care is harming patients physically and financially (2015)

#61
post #47
post #5

Sounds like another one of those "this is what happens when money (as opposed to patient wellbeing) becomes a driving factor in health care." I remember I tried to find a PCP once and I showed up for my intake appointment and the young, rushed doctor said they wouldn't enroll me as an official member unless I had two intake visits. They were gaming the insurance system.

Did you read the article? It was a very nuanced look at how to provide medical care and the reasons caregivers and people either under-treat or over-treat and the high levels of uncertainty about the efficacy of any given medical procedure. Certainly financial issues are a large part of the equation but certainly not the only one. Really an excellent read overall.

You're right. There are multiple factors. Probably some CYA type behavior thrown in there as well.

Re: Unnecessary medical care is harming patients physically and financially (2015)

#62

Earlier quoted context omitted.

I slightly disagree - what's missing is price transparency inviting competition. Through competition the payment and cost side of things will be added to the equation and shift incentives to cut waste and increase quality of service. That includes all aspects of the healthcare services.

It is probably both. The primary reason for healthcare cost growth is price not utilization (refer to work from IHME, others), but there also have to be appropriate incentives in place such as exist in ACOs to ensure quality care is delivered cost effectively. Agree that value based care by itself may not be the answer, just look at the way drug companies claim to price medications based on value such as Gilead’s Sov…

[deleted]

Re: Unnecessary medical care is harming patients physically and financially (2015)

#63
post #6

This article makes it sound like medical costs in the US could be halved if everyone understood this problem, and did their own research on proposed procedures.

So... it would be impossible to halve medical costs? People, in general, are pretty dumb. Sick people, in general, are more so.

I don't think your mother is dumber than the general population if she has cancer though.

Re: Unnecessary medical care is harming patients physically and financially (2015)

#64
> A third patient had undergone surgery for a lump that was bothering him, but whatever the surgeon removed it wasn’t the lump—the patient still had it after the operation.

One wonders how the constantly trotted out panacea of making patients pay more out of pocket would help with a case like this.

Re: Unnecessary medical care is harming patients physically and financially (2015)

#65
post #10

Earlier quoted context omitted.

Yeah lets get rid of laws and regulations, that will fix health care prices!!! /s

It actually would. No need for sarcasm on that comment.

It really, really, really would not.

Re: Unnecessary medical care is harming patients physically and financially (2015)

#66
post #4

It sounds like in the "free market healthcare" system hospitals are incentivized to get the patient to spend as much as possible. That's aside from other bad incentives of such a system such as hospitals not wanting to be transparent with their prices, insurance companies not wanting to take patients with pre-existing conditions, also wanting to cover as few conditions as possible, Big Pharma being incentivized to as…

At least you're living in a free country with free healthcare and not some socialist shithole with universal healthcare.

Literally no other country on Earth has USA-model healthcare. The choice isn't USA vs USSR healthcare (I would pick USA even with the debt issues, and I've actually lived in a socialist shithole), it's USA vs anywhere else.

Re: Unnecessary medical care is harming patients physically and financially (2015)

#67

Earlier quoted context omitted.

Sounds like a typical American family doctor's office? All of them in my area have long waiting lists. You don't just show up at the front door like it's an auto mechanic's shop, you call to schedule your annual physical. They're typically booked solid for a few months in advance. Calling to book an appointment requires being a registered patient or member of that office. If you want to change your primary care physi…

that would be anarchy Yet it's exactly what we can do in the UK, I remember needing to see a doctor whilst on Holiday in Scotland, I just phoned the local GP and got an appointment the next day.

A huge percentage of the US population lives within a 10 minute drive of an urgent care facility. Same day appointment, billed similarly to a GP office visit.

Re: Unnecessary medical care is harming patients physically and financially (2015)

#68
post #14

Earlier quoted context omitted.

Nice idea, but how realistic is it? Most patients are not scientifically-literate, some are flat out incapacitated. For all the stories about heartless insurance companies denying to pay for things, perhaps they should actually be more strict. As in, refuse to pay for anything unless there is 1) rock-solid (i.e. double-blind, placebo-controlled) evidence that it helps 2) for a specific, objectively verifiable indicat…

In the US system you agree to pay any bills the insurance will not cover prior to receiving treatment. Which is an obvious opportunity for improvement. When a giant hospital and a giant insurance company get in a knife fight over whether a procedure is covered, the patient shouldn't be the loser. (Maybe some sort of system where if the provider states that something is medically necessary then they are on the hook if…

>Maybe some sort of system where if the provider states that something is medically necessary then they are on the hook if insurance denies the claim

Not only should a provider be legally prohibited from trying to collect payment for unnecessary treatment, they should be held responsible for complications. Even unnecessary x-rays can cause cancer.

Re: Unnecessary medical care is harming patients physically and financially (2015)

#69
post #14
post #6

This article makes it sound like medical costs in the US could be halved if everyone understood this problem, and did their own research on proposed procedures.

Nice idea, but how realistic is it? Most patients are not scientifically-literate, some are flat out incapacitated. For all the stories about heartless insurance companies denying to pay for things, perhaps they should actually be more strict. As in, refuse to pay for anything unless there is 1) rock-solid (i.e. double-blind, placebo-controlled) evidence that it helps 2) for a specific, objectively verifiable indicat…

I wasn't claiming it was realistic or practical generally. Perhaps achievable for a well educated and motivated HN reader, certainly not for everyone.

Perhaps a startup could provide a service: should I [get some discs fused] (or whatever). Call it cybersecondopinion.com or something.

Re: Unnecessary medical care is harming patients physically and financially (2015)

#70
post #10

Earlier quoted context omitted.

Yeah lets get rid of laws and regulations, that will fix health care prices!!! /s

It actually would. No need for sarcasm on that comment.

Really, you think there's a market for healthcare?

Try walking into a hospital and asking how much something costs. I can tell you that you won't/can't get an answer in over 60%, specifically because the software they use does not show prices only billing codes! So the person providing care can not find out how much it costs... how are you supposed to choose?

Try calling billing once you have the correct code. I can tell you what happened in my case. I called 4 times and navigated a phone tree for 5 minutes each time waiting on hold. Why did I call 4 times... because they said that I needed to connect to a different number, but would not transfer me. Then the next person I talked to asked me to speak to yet another department. Then that department promised to send me the information (what I was being charged for code=treatment, and what the bill=$$ was for it) but after 4 weeks I hadn't received it. When I called back, I wouldn't leave until they actually looked it up and told me over the phone (which they could have done the first time).

Let's be clear, obfuscating medical costs for customers is a core insurance company competency (like hiring doctors outside of specialty to decline coverage for treatments of patients who's records they have not read- see Aetna investigation). So, if you want to know how much something is going to cost you for treatment, I recommend self-diagnosis. You can bill yourself what you want for it... then you can call the billing department and ask for every single code and figure out which ones should be required to reach your diagnosis and provide treatment. Then you can try to get them to tell you what value is assigned to each billing code. Then you can go to the hospital and tell the nurses and doctors exactly what they should do and what codes to use.

https://www.cnn.com/2018/02/11/health/aetna-california-inves...

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