I'm the author. A question I have is: how did so many prices ever get negotiated in the first place? What kind of systems are in place to do this kind of micro-negotiation?
My understanding (not an expert by any means) is that we basically have two tiers of negotiation - the fed. govt. has way more leverage but also some amount of corruption that goes into pricing, then afterwards individual hospitals and "networks" of providers will negotiate with the insurer - sometimes after the procedure has already happened - to figure out the final price. The end result is that you might end up wi…
> To make it worse we also have laws preventing healthcare providers from providing prices upfront, out of a fear that people will forego necessary care they can't afford.
What are these laws? This seems so backwards - I know personally I have put off medical care in my past because I had high deductible insurance, and no guarantee that the bill I'd get wouldn't wipe me out, and no way to price shop. Paralysis of unknown.
The article mentioned CSV files, it seems more like a reflection of what a huge bureaucracy the US healthcare system is. I liked their suggestion that the government should have created the database as part of the law, done the processing on the raw data, and made it more accessible.
Someone with the right connections should call up Google Cloud and ask them to ingest the data into BigQuery as an example dataset like the NY taxi trips. It would be a great way for them to show off the capabilities of the engine and helpful for everyone wanting to do analysis on it. https://cloud.google.com/bigquery/public-data
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Who said anything about owning it? Just making it available for processing through their platform too.
My current assumption is that private healthcare/insurance is to blame, because countries without that or with less generally have better outcomes at less cost. Looking for evidence to the contrary
As two quick examples, both Switzerland and France have private healthcare providers and insurers. I think that’s enough to falsify your assumption :)
How much do you think it costs to maintain all these negotiated contracts VS just having a single payer system with the same price for all procedures?
It's very expensive, carriers have an economic incentive to simplify it and this is still where they end up. There are a long tail of provider circumstances that the single-payer model will need to figure out. Some examples: * Small hospitals in low-density, underserved areas have to make up for underutilized equipment and personnel costs. They raise prices on unrelated, common procedures to break even (This is very…
What do you think about how Kaiser has handled the whole thing? The insurance company employing the doctors and just paying them a standard salary seems to create all the right incentives.
Someone with the right connections should call up Google Cloud and ask them to ingest the data into BigQuery as an example dataset like the NY taxi trips. It would be a great way for them to show off the capabilities of the engine and helpful for everyone wanting to do analysis on it. https://cloud.google.com/bigquery/public-data
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Sometimes people do a thing where they see certain keywords in combination and reflexively respond without regard to the meaning those words are expressing. For example, it's what happens if I use a word like "welfare" near that one uncle at Thanksgiving. The signature feature is a very strong negative reaction but with content that doesn't seem related to what the previous person was saying, except that it involves certain keywords.
I think that's maybe what happened here. You saw "Google," "data," and "ingest," and your sentiment analysis report came back positive, and it triggered a response.
I'm the author. A question I have is: how did so many prices ever get negotiated in the first place? What kind of systems are in place to do this kind of micro-negotiation?
The US healthcare system is wildly complicated and inefficient because it is a double-bureaucracy; pubic and private. The government bureaucracy makes a bunch of rules and also provide healthcare through Medicare/Medicaid. The private bureaucracy compete with each other, and hospitals, and pharma companies, ect. Many of the private health providers are for-profit and lobby against rule changes that would reduce compl…
> Many of the private health providers are for-profit and lobby against rule changes that would reduce complexity and save the system money.
This is almost certainly an anti-competitive move. By keeping many rules and regulations, you need more staff to deal with them - and smaller insurers have fewer patients to amortize those salaries over.
I'm the author. A question I have is: how did so many prices ever get negotiated in the first place? What kind of systems are in place to do this kind of micro-negotiation?
I would assume these get negotiated as a large list with each payer so if you have 500 services, and 4 payers, you probably and up with 1k-2k unique prices?
I'm author of Hacking Healthcare for O'Reilly, 20 year health system executive, blah, blah. It's very easy for people to forget the scale of the US "health system", we are talking 1/5, maybe more, of the entire US economy. If US healthcare spending were a country, it would have the third largest GDP in the world. Accidents of history and the massive federal beauracracy created the crazy monster of ICD/CPT codes that…
Do you consider the amount that the US spends per capita on healthcare relative to other countries for the same standard of care a "failure" of the healthcare industry? Or is there some other reason healthcare "just costs more" here? Also wondering what you think a solution is - single-payer for better and simpler price negotiations, or some other approach? My main concern is if we're spending 20% of GDP on something…
Healthcare is such a base layer of the economy, I find comparisons to be extraordinaly difficult between countries. On the most basic level our pathway to becoming a healthcare provider of all sorts is dramatically more expensive and limited than other countries, what healthcare providers are paid is dramatically more than other countries, we invest many times per capita what other countries put into basic medical research, the way are population is taxed is very different than other countries, our patient population is very different from other countries, our expectations are very different from other countries, our scale is dramatically different than other countries, and so on. The US is a singular animal politically in that it is a compact of individual states that especially in regards to healthcare, the federal goverments powers (though it may not seem so at times) are actually quite limited. It's all but impossible to come up with reasonable numerators and denominators for comparison.
My current assumption is that private healthcare/insurance is to blame, because countries without that or with less generally have better outcomes at less cost. Looking for evidence to the contrary
Across the board price controls seem to be a common to the various European health care systems. It is my understanding that upper limits are set for the cost of medicine.
There is quite a bit of variety across Europe - U.K. is 100% government run, France is a public/private mix, Germany is similar to Obamacare in some ways, others are single payer, apparently some are private, also. But I've read that they all have cost controls.