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The Cost of an ACL Injury

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Re: The Cost of an ACL Injury

#101

Post by angersock »

dragonwriter wrote: post #86
angersock wrote: post #47

Earlier quoted context omitted.

To be fair, you're doing exceedingly delicate machine and test equipment manufacture. The machine shops I know will buy new tools as needed, but reuse them on large job runs--and throw them out once they lose tolerance. Something like the $900 knife in the article is/could be a mass-produced stamped piece of metal, perhaps sharpened on-site or at the factory; unit cost for that should be easily less than $10.

> The machine shops I know will buy new tools as needed, but reuse them on large job runs--and throw them out once they lose tolerance. Hospitals aren't machine shops, though, so it would be a significant additional cost to equip and staff them to evaluate tools for reuse. There's also particular costs around requiring additional handling of used surgical tools rather than disposing of them that may not exist to the…

Right, right--but the point here is that economies of scale have driven the cost of machine tools low enough that they can treat them as disposable for the type of work they're doing.

This whole thing seems more a collection of specialized widgets that offer only marginal utility over a stock scalpel, and which aren't priced to reflect the sheer triviality of their manufacture.

Maybe somebody finally needs to be enough of an asshole to say: "Look, we're done with stupid one-off tools. Shit doesn't scale."

It sounds like medicine is trying it's hardest to be the same sort of logistical nightmare as maintaining automobiles.

Re: The Cost of an ACL Injury

#102

Post by harryh »

The insurance company didn't pay that much.

This article is silly.

Our health care system certainly has lots of problems but at least know how it works before sharing commentary on it.

Re: The Cost of an ACL Injury

#103

Post by milesskorpen »

angersock wrote: post #61
epmatsw wrote: post #59

Earlier quoted context omitted.

The issue with that is that no hospital is willing to be the first. Hospital: We're going to lower costs by not letting doctors choose their equipment. Talented surgeons: Welp, don't want to work there. Patients: Why would I go to the hospital that doesn't have any of the good surgeons?

So, have a deal that says "Hey, if you want to be able to receive Medicare/Medicaid payments, you have to standardize tools." All the hospitals will say "Wow, holy shit, alright", and the surgeons will have to play ball--because a surgeon without a proper OR is basically just a butcher or barber. EDIT: Please explain why this is a bad idea instead of just downvoting.

This kind of thing leads to ridiculousness like the "death panel" meme. The American healthcare system prizes choice and expansive options at the cost of, well, almost everything else. This means that wealthy people can receive a higher standard of care, but does make things very very very expensive.

Re: The Cost of an ACL Injury

#104

Post by harryh »

larrys wrote: post #81
dr_ wrote: post #37

Interesting read, and a valid criticism of the costs associated with ACL repair in the US. It would be nice to know, however, how much your insurance company actually paid for the procedure. There's probably a large discrepancy there. My own thoughts are that if there were a true free market for healthcare, with insurance only for real medical emergencies, the costs of a lot of these services would drop, including ph…

"with insurance only for real medical emergencies" You then have people putting off preventive care, tests etc and then you have to cover a bigger problem down the line. I'll give you an example. You are a landlord with a tenant and you tell the tenant "you have to take care of minor repairs I will cover anything major". As a result they don't do normal maintenance either because they forget, don't care, who knows. T…

That is an interesting hypothesis. There is, however, very little evidence to support it.

Re: The Cost of an ACL Injury

#105

Post by milesskorpen »

angersock wrote: post #100
drdoc wrote: post #96

Earlier quoted context omitted.

As an anesthesiologist, this is a bad idea for various different reasons. There are a numerous reasons why a physician needs the tools that he needs. The type of procedure, the type of patient and the familiarity of the equipment. I routinely intubate patients with a particular type of tool because that is what I feel most comfortable with and I have trained with. Yes, I can intubate with the myriad of other devices…

If I dropped a Linux admin off at a shop which didn't have emacs on their boxen and he refused to work because he might accidentally screw up a config file, he'd be laughed out of the joint. If I dropped a plumber off at a job site and she didn't have a particular type of ergonomic monkey wrench she'd grown accustomed to and said she couldn't do the job, she'd be mocked endlessly. If I dropped a line chef off at a ki…

In all your examples, you aren't dealing with a person's health or (potentially) life. The risk-benefit calculation changes (and people become, understandably, somewhat irrational) when the stakes get that high.

Re: The Cost of an ACL Injury

#107

Post by MPSimmons »

ISL wrote: post #8

Excellent read. One point on disposing of fancy, potentially reusable, tools: We do more than a little precision machining in our lab. When a job matters, the shop buys new tooling. It's lower in cost, especially time, than verifying that a tool is sharp and correct. At first, it seems wasteful to throw away a once-used tool, but if all you do is critical work, you must be certain that your tools are reliable and cor…

In the case of medical equipment, the gold standard to prevent contamination from previous patients' biomatter is to use new equipment each time. There's a demonstrably lower rate of infection than even if the equipment is cleaned to approved standards. I believe I should be able to find the paper I read discussing a while back, if you'd like.

Re: The Cost of an ACL Injury

#109

Post by reeses »

angersock wrote: post #47
ISL wrote: post #8

Excellent read. One point on disposing of fancy, potentially reusable, tools: We do more than a little precision machining in our lab. When a job matters, the shop buys new tooling. It's lower in cost, especially time, than verifying that a tool is sharp and correct. At first, it seems wasteful to throw away a once-used tool, but if all you do is critical work, you must be certain that your tools are reliable and cor…

To be fair, you're doing exceedingly delicate machine and test equipment manufacture. The machine shops I know will buy new tools as needed, but reuse them on large job runs--and throw them out once they lose tolerance. Something like the $900 knife in the article is/could be a mass-produced stamped piece of metal, perhaps sharpened on-site or at the factory; unit cost for that should be easily less than $10.

A quick search on ebay turns up, for example, a set of 4 for $35.

They're plastic with (I hope) steel blades.

In general, though, the cost is certification (+ liability insurance) and documentation of provenance. Basically, every time it's touched by a human, add $100, because the person has to be "trained", they have to log any actions they've taken with it, and they have to make sure the certificates go with the tool wherever it goes.

Plus, random upcharge.

Re: The Cost of an ACL Injury

#110

Post by kqr2 »

larrys wrote: post #81
dr_ wrote: post #37

Interesting read, and a valid criticism of the costs associated with ACL repair in the US. It would be nice to know, however, how much your insurance company actually paid for the procedure. There's probably a large discrepancy there. My own thoughts are that if there were a true free market for healthcare, with insurance only for real medical emergencies, the costs of a lot of these services would drop, including ph…

"with insurance only for real medical emergencies" You then have people putting off preventive care, tests etc and then you have to cover a bigger problem down the line. I'll give you an example. You are a landlord with a tenant and you tell the tenant "you have to take care of minor repairs I will cover anything major". As a result they don't do normal maintenance either because they forget, don't care, who knows. T…

The idea is to have the right incentives in place. The premium for medical emergency insurance would go down as you are more proactive in your healthcare.

For example, by having an annual physical, maintaining your weight, etc. you would get a discount.

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