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The Cost of an ACL Injury

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Re: The Cost of an ACL Injury

#151

Post by Jach »

chudi wrote: post #145
sp332 wrote: post #113

Earlier quoted context omitted.

How can you guarantee the health of a person? Doesn't that incentivize risky activities? If someone else will pay to stitch you up if you get injured, or cover your drugs if you get sick, or keep you going in your old age if you make terrible long-term lifestyle choices: wouldn't that skew the overall population toward cheaper, more convenient, or more fun decisions at the expense of the state?

I think that getting hurt or sick has enough pain or tragedy for itself and thats why people dont want to feel it. If you hurt yourself and someone patchs you up, its not the same, my reconstructed knee will never feel the same as the other. I think that you pose people that whant to benefit as much as they can from the state, and I think that I know noneone that does that, at least in health care, nobody wants to go…

http://en.wikipedia.org/wiki/M%C3%BCnchausen_syndrome

Now whether the people with this syndrome are sizable enough to make it unacceptable to just bear their cost is another story...

Re: The Cost of an ACL Injury

#152

Post by ck2 »

I dunno about the surgery time which is probably the only overpriced thing worth the money if done right but WTF is this?

   First 30 minutes in the post-anesthesia care unit  $2,057
   Additional time in the post-anesthesia care unit   $3,894
What exactly cost $6000 ? Laying in a room? Seriously? Like you have a choice - which is probably why.

Re: The Cost of an ACL Injury

#153

Post by jrabone »

angersock wrote: post #101
dragonwriter wrote: post #86

Earlier quoted context omitted.

> 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 enou…

I guess part of the one-off nature is that post-op sterilization isn't cost effective; perhaps you simply can't remove the bits of the previous patient from the tool cheaply enough or without degrading it in some way) to justify not just opening another one.

Another point is that this tool (to take an example) offers one huge advantage over a scalpel; it will make both cuts simultaneously, reducing the margin of error. I wouldn't want to hear "Well, we messed up taking the first piece, so we need to do it again on the other side". It HAS to be right first time.

Re: The Cost of an ACL Injury

#154

Post by reeses »

jonknee wrote: post #119
reeses wrote: post #111

Earlier quoted context omitted.

This becomes readily apparent with medical care for animals. Your vet will send you home with bags of Ringer's, line, and a bunch of cannulae for $50. It's not as simple as insurance alone driving the cost, but having a throat to choke if something goes wrong does contribute to it. As has been mentioned elsewhere, random overhead is covered in weird places, as well.

And human medical procedures that aren't typically covered by insurance. LASIK for example, imagine what laser eye surgery would cost if it was billed like an ACL reconstruction. Instead you have to pay yourself and doctors compete, the entire bill (at a nice place) ends up being what a couple of ACL knives cost.

Gah, excellent point. Elective retail procedures such as vision improvement surgery and dental crowns, bonding, veneers, etc., all seem to top out around the average FSA limits of $5,000 or so. It's especially notable around the end of the year when advertisements encouraging people not to waste their FSA funds start picking up on the radio.

Now that the IRS has apparently imposed a limit of $2,500 on FSA deductions, I wonder if that's going to create pricing pressure on the "high end" procedures such as custom/wave/whatever LASIK here in the USA.

If I weren't a lazy sod, I'd look up capital equipment costs for medical procedures such as those and compare them to MRI, EKG, and other items used primarily for "need" based, insurance paid, procedures.

(Actually, I haven't used any fancyhands requests in a couple months. I'll be lazy and have someone google for me.)

Re: The Cost of an ACL Injury

#155

Post by jon-wood »

sp332 wrote: post #113
chudi wrote: post #39

Earlier quoted context omitted.

I got my ACL replaced in Argentina and the cost including rehab was about U$S 3000 having one of the best insurance companies (about 120 U$S a month). If I wanted to use the public care, it could probably cost almost nothing. It always amazed me that in the US the health of a person is not a right and if you get hurt doing anything you have to pay huge fees.

How can you guarantee the health of a person? Doesn't that incentivize risky activities? If someone else will pay to stitch you up if you get injured, or cover your drugs if you get sick, or keep you going in your old age if you make terrible long-term lifestyle choices: wouldn't that skew the overall population toward cheaper, more convenient, or more fun decisions at the expense of the state?

I live in the UK, so all my medical costs are covered by the state.

However, I still don't go base jumping. Even if the costs are covered, I still don't want to spend six months in traction after I break my back because the parachute didn't open. Similarly almost all the people I know either don't smoke, or want to stop smoking, because even if you can do it free of charge lung cancer just isn't much fun.

Re: The Cost of an ACL Injury

#156

Post by reeses »

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…

If an engineer or machinist used to working with SI tools goes to work somewhere using metric measurements, perhaps building equipment for space travel...

Oh wait.

Obviously, doctors can get things done under less than ideal circumstances. I'm sure every TV show has had an episode of someone doing an in-field tracheotomy with a swiss army knife and a biro cap.

A license is not necessary for a Linux admin to work (in general). Screwing up a service file isn't on average going to result in the CEO of his company having a meeting with the company's attorneys and practice review boards to determine how much to pay the victim of his edits.

Worst case based on negligence (maybe taking all the zones down for a DNS provider), the admin loses his or her job.

You're comparing something minor with something that has both a high risk of serious damage or death (throw the statistical average value of life in here) plus an environment (especially in the USA) where attorneys advertise on bloody public buses for people who were "harmed" by a doctor, and there's a lot of ass covering with best practice behavior.

The human body is not a car (there's the metric/SI thing again). Things are bigger, smaller, in a slightly different location, softer, harder, or any of a million other combinations of complications that make it safer to use appropriate customized equipment.

Re: The Cost of an ACL Injury

#157

Post by ry0ohki »

ohazi wrote: post #85
ry0ohki wrote: post #76

Earlier quoted context omitted.

>$60K were simply extorted from a person in pain. Or more specifically from all of us. The author only paid $2400. The whole system is designed to be opaque and non-competitive so they can just bill insurance companies for whatever. I wonder what it would have cost if he said he was paying in cash (hint: a lot less).

You'd think that it should be "a lot less" for someone paying cash, but this is almost never the case (in the U.S., anyway). Insurers can threaten to remove a hospital from their network if the prices get too high. The hospital doesn't want to risk losing the large stream of sick/injured patients from the insurer, and usually couldn't care less about one person deciding to have surgery else for reasons of cost (edit:…

I've never had major surgery so perhaps it's different for that, but I've found (through periods of no or crappy insurance) that doctors visits are significantly cheaper when you say you're paying in cash.

Re: The Cost of an ACL Injury

#158

Post by kriro »

rogerbinns wrote: post #120
defen wrote: post #42

Earlier quoted context omitted.

> The fraction of patients without insurance but with enough cash and motivation to fly to the UK purely to seek savings on medical treatment has got to be fairly tiny. Well, if my options are to spend 60 grand on an ACL repair in the U.S., or significantly less than that on a first-class ticket to London, some serious fun, and an ACL repair...I know which one I would choose.

Those weren't your options. As with most things health related in the US, someone else was paying (the "insurer" in this case). Given the choice between you paying $2,400 in the US (and the insurer paying an amount you don't see or care about), or you going to the UK and paying 3,000GBP plus accommodation and tickets, I'll bet you pick the former. It is in the insurer's interest for you to go somewhere cheaper as it…

If the insurance company pays the remainder i.e. >60k why don't they offer you this deal:

- No out of pocket cost

- Free all expenses paid one week trip to England with your surgery

Would cost them the 3k pounds+2.5k$ of your share+maybe another 3k for a good trip..I take it they simply can't get that 3k pounds deal as an insurance company.

Re: The Cost of an ACL Injury

#159

Post by rayiner »

thrownaway2424 wrote: post #144
rayiner wrote: post #82

Earlier quoted context omitted.

Medical liability costs are about $55 billion in the U.S., or about 2.4% of overall costs: http://www.hsph.harvard.edu/news/press-releases/medical-liab... . There are debates about how much "defensive medicine" adds to the cost, but those aren't all that relevant here since the costs presented are exclusive of additional tests, etc.

We know that liability is a non-factor, because in states with capped liability, health care costs have not responded.

Also, liability caps are the stupidest way of dealing with the potential for frivolous ligation. It punishes the people who were actually injured, not the ones who filed a nuisance suit hoping for a small payout. It's utterly non-sensical!

Re: The Cost of an ACL Injury

#160

Post by australis »

Interesting to read of a 'normal' person sustaining an ACL injury and the subsequent fixing thereof (especially detailed costing breakdown - thanks for the detailed analysis). There has been somewhat of an 'epidemic' of ACL injuries in the AFL[0] this year. So far at least 15 players, some of them quite well-known, have succumbed to a season ending ACL injury already[1], much more than previous years. The difference? They have access to a complete rehabilitation package of priority surgery and follow up physio program. Such is the professional sports industry I suppose...

[0] Australian Football League; http://en.wikipedia.org/wiki/Australian_Football_League

[1] http://www.abc.net.au/news/2013-04-29/afl-acl-injuries-2013/...

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