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Researchers chart path to drastically lower administrative costs of health care

med.stanford.edu

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Re: Researchers chart path to drastically lower administrative costs of health care

#121

Post by swearwolf »

EvanAnderson wrote: post #32
HEmanZ wrote: post #16

Earlier quoted context omitted.

I don't know how residencies could not be profitable for hospitals. Hospitals receive something like $120k/yr per resident, then work residents 80+ hours/week at $50k/yr pay, amounting to right around minimum wage (for my city). Residents do a tremendous amount of work in supporting the hospital, so much so that a single resident getting deathly ill and needing to stay home (e.g a surgery resident getting covid, whic…

The residency slots are so limited right now because the AMA lobbied hard against expanding them in the 1990s (fearing a "glut" of doctors). Edit: Every time this comes up I go down a rabbit hole of looking for an article from the mid-to-late 90s where a medical lobbyist spoke about how doctors would be forced to leave the profession and do "mundane" jobs like driving cabs if the residency slots weren't capped. It di…

Is it this one?

https://www.baltimoresun.com/news/bs-xpm-1997-03-01-19970600...

Or maybe this one?

https://www.nytimes.com/1986/06/14/us/ama-board-studies-ways...

Re: Researchers chart path to drastically lower administrative costs of health care

#122

Post by IG_Semmelweiss »

dublin wrote: post #105
IG_Semmelweiss wrote: post #46

Earlier quoted context omitted.

all those immigrant physicians went thru the same programs as the non-immigrants. In fact, I hear this is continuously a problem for well qualified , practicing, and established physicians to migrate to the US. They are fed up with their own home countries lack of security, opportunities for their children, freedom etc, but they cannot imagine going back to medical school to be accredited to practice in the US. This…

No, they most certainly did not. I've spent a large chunk of my career in healthcare technology, and one thing I can say for sure is that with very few exceptions, foreign doctors are no where close to the knowledge and capability of those educated in the US. I'm not going to specify to avoid slamming particular countries, but I would definitely refuse to be treated by doctors from several major countries that crank…

I disagree.

I've spent my own career in healthtech and at actual clinics.

While I won't dispute the fact that medical care abroad can be hit or miss, we are certainly not strangers to substandard doctors ourselves.

The difference between your experience and reality, is that the bad US doctors get put in corners where you have not been looking.

You should read marty makary's book unaccountable.

So, while your heuristic may be valid for someone living in a large metro area with tons of options, I would make a safe bet that it wouldn't be as useful in rural, underserved areas where the bad doctors end up.

Re: Researchers chart path to drastically lower administrative costs of health care

#123

Post by Ericson2314 »

Considering how enmeshed everything is at Standard is with private sector businesses, and how many of these businesses can prosper due to these inefficiencies, I am quite skeptical.

Even if the particular businesses these professors work with stand to gain from such reform, this sort of approach that thinks we can technocrat our way around the antagonism that is precisely why things like medicare-for-all are so difficult seems incredibly politically naive.

Re: Researchers chart path to drastically lower administrative costs of health care

#124

Post by nradov »

bilbo0s wrote: post #75
nitwit005 wrote: post #62

Even fairly mundane steps like assigning people uniform medical record numbers, so that every single organization doesn't need its own system, is a heated political issue in the US: https://ehrintelligence.com/news/house-votes-to-overturn-nat...

That's because companies like Epic exist. Their entire business is fixing impedance mismatches. Your implicated solution is to eliminate impedance mismatches. Do you think the major med tech firms will be for or against that? What do you think their lobbyists will recommend?

Epic and their competitors never lobbied to retain the national patient identifier ban. The political opposition to national identifiers was based on concerns about patient privacy and federal government overreach.

Re: Researchers chart path to drastically lower administrative costs of health care

#125

Post by dantheman »

pessimizer wrote: post #80
trentnix wrote: post #60

Earlier quoted context omitted.

> Worthless paper, administrative costs is only a piece of the many issues with US "Healthcare". Medicare For All is the better and cheaper way forward. As frustrating and arcane as the current system may be, the government fully in charge for the provisioning (rationing) and financing will only increase 'worthless paper, administrative costs'.

This is clearly not the case with Medicare. The only guaranteed savings with M4A is in administrative costs. edit: even the researchers in the linked article doesn't claim to reduce administrative overhead as much as M4A, they claim to be able to get most of the way there.

It's really simple to lower administrative costs, just spend more money and don't look for fraud.

Re: Researchers chart path to drastically lower administrative costs of health care

#126

Post by rscho »

HDMI_Cable wrote: post #33
rscho wrote: post #13

Earlier quoted context omitted.

> For example, the US has extremely high standards restricting who can practice medicine compared to the rest of world Rest of the world, yes. Rest of the developed world, not at all. The major difference is that becoming a doc in the US is much more expensive than pretty much anywhere else. You could also argue it's proportionally harder because of the more numerous competitors. But on an absolute level of knowledge…

It really is harder in the US. The standards are much higher in the US than anywhere else. The US only accepts doctors who went to Canadian or American medical schools. And then on top of that, it is much harder to get into a medical school here in NA than practically anywhere else, except maybe India. I know that in the UK you can go directly from high school, meanwhile in the US & Canada you need a 515 MCAT, 3.7 GP…

I'm european, never set foot in a us or canadian medical school but worked in Boston. So no, it's not as set in stone as you think it is.

Re: Researchers chart path to drastically lower administrative costs of health care

#127

Post by neartheplain »

benlivengood wrote: post #110

I worked in a hospital for 13 years. The economic incentives for the current system are quite perverse. The FDA has no cost constraints and so maximizes safety instead of QALYs. Medical equipment and drug manufacturers maximize profit and so fill the highest margin niches first instead of maximizing QALYs. Radiology and lab services are lucrative and separate themselves from clinical providers to maximize profits ins…

For anyone else who didn't know, QALY stands for "Quality-adjusted life year."

Re: Researchers chart path to drastically lower administrative costs of health care

#128

Post by kingsuper20 »

creaghpatr wrote: post #47
kingsuper20 wrote: post #28

Earlier quoted context omitted.

I'm not much for the genius of government to correct things, but you really can make a strong argument for the standardization to a small number of insurance plans with stated rules, third party arbitration, etc. You would definitely see more of a free market by producing fungible products with (hopefully) a bit less obfuscation. The insurance companies would still do their best to not cover a claim of course, so thi…

Yes, I'm bullish on the potential savings of standardization, of course in healthcare the devil is in the details so it matters what they mean by those things.

Exactly right. I hate even having an opinion on this kind of thing. Software people tend to be filled with concepts on the way-things-oughtta-be-why-are-people-so-stupid usually without any domain knowledge and it's good to watch out for that tendency.

Medicine is like tax law, there's a whole lot to it. Some historical, some arbitrary, some greed, some altruism.

Re: Researchers chart path to drastically lower administrative costs of health care

#129

Post by EvanAnderson »

nradov wrote: post #103
EvanAnderson wrote: post #32

Earlier quoted context omitted.

The residency slots are so limited right now because the AMA lobbied hard against expanding them in the 1990s (fearing a "glut" of doctors). Edit: Every time this comes up I go down a rabbit hole of looking for an article from the mid-to-late 90s where a medical lobbyist spoke about how doctors would be forced to leave the profession and do "mundane" jobs like driving cabs if the residency slots weren't capped. It di…

The AMA is actively lobbying for more residency slots. https://www.ama-assn.org/press-center/press-releases/ama-fun...

They are now. They weren't back in the 90s.

Re: Researchers chart path to drastically lower administrative costs of health care

#130

Post by bialpio »

kaesar14 wrote: post #102
bialpio wrote: post #89

Earlier quoted context omitted.

> Why? An apples-to-apples comparison would be to see how long it takes to become a general physician after completing secondary school. Because if the requirement in the US is indeed "bachelor's degree required, any will do", then it exists solely for gate-keeping and says nothing about the standards of education. Edit: looking at wiki, the requirements are actually a bit more reasonable, but it does seem strange th…

Of the people who attempt the pre-med track not all will make it. Forcing students to get an actual Bachelor's degree gives students some fallback. I think really it's just the system was built this way and nobody's going to change it now.

> Forcing students to get an actual Bachelor's degree gives students some fallback.

That may be one reason, but seems to me that it doesn't really raise the standard of education. So it doesn't really help with proving that "US > the world" in this aspect.

I imagine you could still fall-back from medical college to undergrad & get credit for the completed coursework that is relevant towards the Bachelor's degree you fall-back to. This way, you don't incur unnecessary costs on folks who succeed.

> I think really it's just the system was built this way and nobody's going to change it now.

Channeling my inner cynic: nothing's going to change given that the decision-makers benefit financially from the system being set up like this.

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