The World’s Cheapest Hospital Has to Get Even Cheaper • Hacker News Board

Re: The World’s Cheapest Hospital Has to Get Even Cheaper

#11

Post by notyourday » Thu, Mar 28, 2019, 6:17 PM UTC

maxxxxx wrote: post #7

supahfly_remix wrote: post #6

Really interesting article. As always, the truth is probably somewhere in the middle. I wonder what would happen if a company known for affordable quality, like Toyota, could make an efficient assembly-line for health care.

I think applying methods that for manufacturing to healthcare is not a good idea. Manufacturing is generally very predictable whereas health care often isn't. We already have tried to manage software development like an assembly line. That didn't work for software and I don't think it will work for health care.

> I think applying methods that for manufacturing to healthcare is not a good idea. Manufacturing is generally very predictable whereas health care often isn't.

https://en.wikipedia.org/wiki/Fyodorov_Eye_Microsurgery_Comp...

Re: The World’s Cheapest Hospital Has to Get Even Cheaper

#12

Post by eitally » Thu, Mar 28, 2019, 6:20 PM UTC

smush wrote: post #2

Compared to high margin low volume surgeries in the US, this is low margin high volume. Its ingenious how the highest skilled individuals only step in for the trickiest part of the surgery, but the simpler tasks like getting to a heart are performed by lesser doctors or nurses. Some things make sense like having medical machines maintained in house. Other things, like sterilizing and reusing IV lines seem pretty risk…

This happens in the US, too. (my daughter just had open heart surgery at a top tier research hospital.) It's very common for a resident surgeon to open the patient and prep the detailed surgical site as part of their practical work (residency, fellowship). This usually happens under direct supervision of the attending, but not always. But, in the case of cardiac surgery, "getting to the heart" is a very quick process -- a couple of incisions, some clamps & drainage, and there's a heart right in front of you. The time-consuming early part is getting the anesthesia work done (not just sedation, but installing all the necessary ports, tubes and catheters) and hooking them up on a heart/lung bypass.

I can't comment on your second point.

Re: The World’s Cheapest Hospital Has to Get Even Cheaper

#13

Post by maxxxxx » Thu, Mar 28, 2019, 6:30 PM UTC

jolmg wrote: post #10

maxxxxx wrote: post #7

Earlier quoted context omitted.

I think applying methods that for manufacturing to healthcare is not a good idea. Manufacturing is generally very predictable whereas health care often isn't. We already have tried to manage software development like an assembly line. That didn't work for software and I don't think it will work for health care.

> We already have tried to manage software development like an assembly line. That didn't work for software What makes you say that? Assemblies like: - product owner writes detailed user stories from communications with client - developers pick them, implement them, and put them up for review - CI server runs automated tests - reviewers check the code for maintainability issues - QA folks check the feature from the p…

The usually the part that fails is this:

"- developers pick them, implement them, and put them up for review"

In quite a few cases it turns out that it's not so easy to implement what you thought first because there is a bug in some system you are using or some other component needs to be changed too and suddenly the whole plan falls apart. There is no amount of planning you can do to avoid this. Unexpected things come up all the time.

I am not saying that health care can't improve but by nature it's much less predictable than manufacturing a car.

Re: The World’s Cheapest Hospital Has to Get Even Cheaper

#14

Post by hinkley » Thu, Mar 28, 2019, 6:35 PM UTC

I applaud the ends but I'm not sure I'm comfortable with the means.

In circles where discipline is valued, rote tasks aren't worthless. Considering them to be beneath you can be a trap.

Those easy steps help keep you centered on your craft. They might even give you time to prepare for what comes after. Taken too far they can rob you of the time to pursue skill advancement, sure. But eliminating them completely? I think that will turn out to be a mistake in ways we can't anticipate (possibly very different from the concerns I already stated above).

Re: The World’s Cheapest Hospital Has to Get Even Cheaper

#15

Post by 8ytecoder » Thu, Mar 28, 2019, 6:46 PM UTC

notyourday wrote: post #9

rhombocombus wrote: post #8

Earlier quoted context omitted.

The difference here is not that we don't do surgeries efficiently, but that we are subject to the effects of regulatory capture, which stops any kind of price competition in its tracks and leads to $300 bags of saline.

I most am most likely going to need an ACL surgery in a couple of months so we will see how it goes. So far I found out that pretty much every "X is difficult" is a gospel peddled by lazy. This is my first relatively major incident so I'm running pretty blind -- I'm approaching it as I approach needing to do something in business. Instead of going to the ER ($2,500), I went to a walk in medical center ($120), got see…

What's the incentive for me to save all that money when my insurance pays for it anyway and my company pays for my insurance? Insurance is supposed to do this job - negotiate prices ...etc., but, people are so attached to their doctors that insurance usually caves giving hospitals a much higher bargaining power.

Re: The World’s Cheapest Hospital Has to Get Even Cheaper

#16

Post by arcticbull » Thu, Mar 28, 2019, 6:47 PM UTC

notyourday wrote: post #9

rhombocombus wrote: post #8

Earlier quoted context omitted.

The difference here is not that we don't do surgeries efficiently, but that we are subject to the effects of regulatory capture, which stops any kind of price competition in its tracks and leads to $300 bags of saline.

I most am most likely going to need an ACL surgery in a couple of months so we will see how it goes. So far I found out that pretty much every "X is difficult" is a gospel peddled by lazy. This is my first relatively major incident so I'm running pretty blind -- I'm approaching it as I approach needing to do something in business. Instead of going to the ER ($2,500), I went to a walk in medical center ($120), got see…

This sounds a lot like the Bitcoin Be Your Own Bank™ approach to healthcare. Being your own bank sucks. Being your own hospital is even worse. Socialized medicine can't come soon enough.

Re: The World’s Cheapest Hospital Has to Get Even Cheaper

#17

Post by bena » Thu, Mar 28, 2019, 6:49 PM UTC

notyourday wrote: post #9

rhombocombus wrote: post #8

Earlier quoted context omitted.

The difference here is not that we don't do surgeries efficiently, but that we are subject to the effects of regulatory capture, which stops any kind of price competition in its tracks and leads to $300 bags of saline.

I most am most likely going to need an ACL surgery in a couple of months so we will see how it goes. So far I found out that pretty much every "X is difficult" is a gospel peddled by lazy. This is my first relatively major incident so I'm running pretty blind -- I'm approaching it as I approach needing to do something in business. Instead of going to the ER ($2,500), I went to a walk in medical center ($120), got see…

How did you know it was an ACL injury?

Did you injure yourself and went to a medical center and they told you to go to a radiology center who then told you you had an ACL injury?

I ask because at the end, you said you searched for "sports medicine surgeons" which already looks like you have _some_ knowledge about what was going on.

Which is great. But part of the problem we have is education. Most people don't even know of other options available to them and don't have the vocabulary to effectively search for what they want.

"Torn ACL" is way more specific than "Knee hurts".

Re: The World’s Cheapest Hospital Has to Get Even Cheaper

#18

Post by DoubleCribble » Thu, Mar 28, 2019, 6:51 PM UTC

Some equipment is too expensive to be disposable and therefore requires enhanced cleaning protocols[0], but reusing as much equipment as possible just to save a few bucks seems penny wise but pound foolish. Why add unnecessary risk [1] if you can easily avoid it?

[0]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623380/

[1]https://www.scientificamerican.com/article/evidence-for-pers...

Re: The World’s Cheapest Hospital Has to Get Even Cheaper

#19

Post by notyourday » Thu, Mar 28, 2019, 6:53 PM UTC

8ytecoder wrote: post #15

notyourday wrote: post #9

Earlier quoted context omitted.

I most am most likely going to need an ACL surgery in a couple of months so we will see how it goes. So far I found out that pretty much every "X is difficult" is a gospel peddled by lazy. This is my first relatively major incident so I'm running pretty blind -- I'm approaching it as I approach needing to do something in business. Instead of going to the ER ($2,500), I went to a walk in medical center ($120), got see…

What's the incentive for me to save all that money when my insurance pays for it anyway and my company pays for my insurance? Insurance is supposed to do this job - negotiate prices ...etc., but, people are so attached to their doctors that insurance usually caves giving hospitals a much higher bargaining power.

High Deductible Plan. Takes care of big ass expenses, steep cost in the beginning.

Re: The World’s Cheapest Hospital Has to Get Even Cheaper

#20

Post by redisman » Thu, Mar 28, 2019, 6:56 PM UTC

notyourday wrote: post #9

rhombocombus wrote: post #8

Earlier quoted context omitted.

The difference here is not that we don't do surgeries efficiently, but that we are subject to the effects of regulatory capture, which stops any kind of price competition in its tracks and leads to $300 bags of saline.

I most am most likely going to need an ACL surgery in a couple of months so we will see how it goes. So far I found out that pretty much every "X is difficult" is a gospel peddled by lazy. This is my first relatively major incident so I'm running pretty blind -- I'm approaching it as I approach needing to do something in business. Instead of going to the ER ($2,500), I went to a walk in medical center ($120), got see…

The average case where people go to the ER they don't have a week to Google and research their options. More likely minutes to hours. You can definitely find some value in the US medical system if you have the time, like coupons for prescription drugs that aren't covered. But yes, don't go to the ER for non-emergencies and you'll save money and everyones resources. Hopefully that's basic logic to most people.