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The Cost of an ACL Injury

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Re: The Cost of an ACL Injury

#161

Post by dclowd9901 »

rayiner wrote: post #116
dclowd9901 wrote: post #114

Earlier quoted context omitted.

Overall costs: 2.291 Trillion $7,638 per person per year. That just can't be right. I and 90% of the people I know haven't made a significant trip to the dr or hospital in years. Where the fuck is that money going?

Sick people, rather than people who are not sick, are responsible for the majority of healthcare spending: News at 7. See: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361028 (Table 3). 80% of your lifetime healthcare expenditures will be after age 40.

Incredible! Even more important, I suspect nowadays, most people live more years after 40 than before. Maybe a goal should be figuring out ways we can push back that age.

Re: The Cost of an ACL Injury

#162

Post by Komodo9 »

jwr wrote: post #10

For comparison, the full cost of a hernia repair ( http://en.wikipedia.org/wiki/Inguinal_hernia_repair ) in a private hospital in Poland is below $1500. Sure, this is a much simpler procedure than the OP's one, but still -- it involves an operating room, a surgeon, an anesthesiologist, assistants/nurses, and 2 days of hospital care. I don't imagine the materials are much different to the ones used in the US. Even acc…

I don't know the statistics overall, but in my case the comparison of the inguinal hernia repair is even more damning: I'm positive it was more costly, but to add insult to injury, it (my hernia repair) was done as an outpatient procedure.

Although I am not a doctor (just a patient), if anyone tries to pitch you this as a good idea, run. The effective recovery time was insane, and not to mention the pain/temporary disability (also insane). An inpatient stay wasn't even offered, but in hindsight it shouldn't have even been optional.

By contrast, an unrelated abdominal surgery a few years later, despite being a much more involved procedure, had a much faster recovery. (10 day inpatient stay + probably 5 days of that with some physical therapy.)

Health care costs are a secondary issue to me, right behind health care quality. Unfortunately, I don't think either can be fixed unless they are entirely divorced from each other.

Re: The Cost of an ACL Injury

#163

Post by dragonwriter »

angersock wrote: post #131
dragonwriter wrote: post #127

Earlier quoted context omitted.

> 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. The kind of errors made by a Linux admin who is more familiar with emacs using vi don't have as much likelihood of ending up with dead customers and massive liability for the Linux admin and/or his employer as the kind of error…

"But somehow I don't think letting surgeons choose the tools used for a particular surgery based on their own expertise and understanding of the needs of the particular surgery, rather than having one standard kit used for all surgeries regardless of the specific details of surgeon and patient, is the difference." In isolation, your intuition is correct. But, with thousands and thousands of surgeons performing hundre…

> It's perhaps not the main difference, but I'm willing to wager it is at the least a symptom of whatever the underlying problem is.

I doubt its even a symptom: because I don't think the other OECD countries that spend less for broader access and equal or better outcomes use one-size-fits-all-surgeries standardized equipment kits, either. But even if it was a symptom, it would be better to treat the underlying problems.

Re: The Cost of an ACL Injury

#164

Post by woobar »

kriro wrote: post #158
rogerbinns wrote: post #120

Earlier quoted context omitted.

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.

Insurance company will not pay >60K. It will be <10K. Typical insurance pays around 80%, patient 20% of the 'negotiated rates'.

Re: The Cost of an ACL Injury

#165

Post by pyre »

rexreed wrote: post #137
pyre wrote: post #133

Earlier quoted context omitted.

Can (some of) the ballooning costs be attributed to the costs / time investment in medical school? When Ron Paul went to medical school how much did it cost (adjusted for inflation)? How much more knowledge are doctors expected to have now than then?

Maybe, but not any significant part. As evidenced by this post, only a small portion of the costs are attributable to the work performed by the surgeon. The majority of costs are allocated to facility costs (whose increases in price are not related to tuition costs) and equipment. Indeed, if there was such a direct correlation between the two, the easiest way to control healthcare costs would be to reduce doctoral sc…

To be fair, comparing the costs of ACL surgery to Ron Paul's costs for 'making house calls' isn't exactly an apples-to-apples comparison either.

I'm merely pointing out that this is a complex beast with many contributing factors:

- The money/time investment to become a medical professional.

- The increase in the number / complexity of procedures over the years. Our medical knowledge keeps increasing we keep getting more and more ways to fix things.

- Comparisons without details. For example, people like to compare how cheap MRIs are in Japan, but the MRIs that people get in Japan aren't as powerful/accurate as the ones that are charged for in the US. Does this justify the cost difference? Maybe, but maybe not.

Re: The Cost of an ACL Injury

#166

Post by DanBC »

jordan0day wrote: post #67
DanBC wrote: post #30

So, I have a few questions. > Going in, I had anticipated that doctors would take the lion’s share of the costs. I was surprised when the facilities ended up being the dominant cost; over 40% of the total. Is that because you're paying for the cost of nurses here, rather than breaking that cost out elsewhere? > This centimeter-wide cutting machine cost $900 according to the price sheet. That seems to be a bit much. I…

> So why don't insurance companies seem to be driving the costs down? They are driving down costs -- as the OP mentions elsewhere in this thread, while he was billed nearly $49k for facilities/equipment, the insurance company only paid $15k. There certainly are a lot of rich doctors and hospital executives who are being paid ludicrous amounts of money (especially considering the hospitals themselves are billed as not…

That feels, and I'm not sure what the right word is, "corrupt"?

Re: The Cost of an ACL Injury

#167

Post by rexreed »

pyre wrote: post #165
rexreed wrote: post #137

Earlier quoted context omitted.

Maybe, but not any significant part. As evidenced by this post, only a small portion of the costs are attributable to the work performed by the surgeon. The majority of costs are allocated to facility costs (whose increases in price are not related to tuition costs) and equipment. Indeed, if there was such a direct correlation between the two, the easiest way to control healthcare costs would be to reduce doctoral sc…

To be fair, comparing the costs of ACL surgery to Ron Paul's costs for 'making house calls' isn't exactly an apples-to-apples comparison either. I'm merely pointing out that this is a complex beast with many contributing factors: - The money/time investment to become a medical professional. - The increase in the number / complexity of procedures over the years. Our medical knowledge keeps increasing we keep getting m…

When an ACL costs $68k in California and $20k in Illinois and $32K in Delaware, you know that it's not an issue with simply the cost of getting medical training. Something else (I agree, something a lot more complicated than simply the cost of education or differencies in country-specific medical practices) is at work.

I think we actually agree here - the dramatic rise in health care costs doesn't have a single root cause, or even perhaps a readily identifiable root cause. It's systemic, rather than simplistic. Education is a factor, but a small one. Insurance and health liabilities are probably an equal factor. But neither explain disparities in cost within the US (no need to look at comparisons between Japan for that). See my [1] reference two comment posts up for the chart on cost disparities intra-US.

It's quite possible that medical suppliers are using information asymmetry to overcharge in some instances and properly charge in others. Could it be as simple as that? Why is it that the same procedure with the same equipment using similarly trained staff in similar hospitals with similar liability exposures would have such different costs? The only thing I can think of is that medical purchasing is sufficiently complex and with such little visibility and transparency between different establishments that medical suppliers and providers can get away with pricing them "as much as the market can support". But that's just an unsubstantiated theory and maybe there is a reason why the same procedure is cheaper in another state, county, or city.

Re: The Cost of an ACL Injury

#168

Post by larrys »

yummyfajitas wrote: post #126
larrys wrote: post #81

Earlier quoted context omitted.

"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…

You pay $100 for preventative care now to avoid paying the $5,000 deductible down the line.

"care now to avoid paying the $5,000 deductible down the line."

Does not answer the question of what to do with people who don't have a pot to piss in. You aren't going to deny them medical care. That's the problem. Just like you can't say "if you smoke we won't fix your lung cancer" (forgetting even if the link could be clearly established).

Bottom line: You have to prevent people from their folly. Although certainly some people would respond to the incentive in your example.

Re: The Cost of an ACL Injury

#169

Post by pyre »

rexreed wrote: post #167
pyre wrote: post #165

Earlier quoted context omitted.

To be fair, comparing the costs of ACL surgery to Ron Paul's costs for 'making house calls' isn't exactly an apples-to-apples comparison either. I'm merely pointing out that this is a complex beast with many contributing factors: - The money/time investment to become a medical professional. - The increase in the number / complexity of procedures over the years. Our medical knowledge keeps increasing we keep getting m…

When an ACL costs $68k in California and $20k in Illinois and $32K in Delaware, you know that it's not an issue with simply the cost of getting medical training. Something else (I agree, something a lot more complicated than simply the cost of education or differencies in country-specific medical practices) is at work. I think we actually agree here - the dramatic rise in health care costs doesn't have a single root…

It's difficult to see which factors are contributing without a similar breakdown for a similar procedure from somewhere else.

Are doctor's costs more expensive in CA due to the increased cost of living? Ditto for administrators, driving up the hospital costs? Is it due to a scarcity of hospital beds / operating tables that the hospital charges 'what the market will bear' in more densely populated regions?

Re: The Cost of an ACL Injury

#170

Post by DanBC »

dredmorbius wrote: post #150
DanBC wrote: post #30

So, I have a few questions. > Going in, I had anticipated that doctors would take the lion’s share of the costs. I was surprised when the facilities ended up being the dominant cost; over 40% of the total. Is that because you're paying for the cost of nurses here, rather than breaking that cost out elsewhere? > This centimeter-wide cutting machine cost $900 according to the price sheet. That seems to be a bit much. I…

I'm presuming CJD refers to Creutzfeldt–Jakob disease. Sometimes it's preferable to spell out acronyms. Especially obscure ones, likely unfamiliar to the readership of a given site.

Yes, you're right. I'll remember for next time!
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