The profit-obsessed monster destroying American emergency rooms • Hacker News Board

Re: The profit-obsessed monster destroying American emergency rooms

#121

Post by musicale » Sat, Oct 05, 2024, 6:41 PM UTC

> Meanwhile, to minimize costs, private equity-owned staffing firms often replaced more expensive physicians with nurse practitioners and physician associates. It was a move likely to worsen patient care: While these professionals do highly skilled work in a variety of clinical settings, the emergency department is one place where care outcomes are more likely to suffer if a doctor isn’t involved.

Using more PAs and NPs seems like it could potentially be beneficial, since 1) they are cheaper than physicians (this could be attractive to patients if it lowered the bill for treatment), 2) the supply of physicians is more constrained (due to limits in med school and residency slots to avoid "oversupply", as well as longer training time), and 3) NPs and PAs may be well positioned to take care of many non-emergency patients in the ER, urgent care, non-life-threatening cases, etc. What might be helpful is a higher tier of ER-specialist NPs and PAs, as well as an adequate supply of ER physicians to treat the emergency patients in the ER who really need them.

Re: The profit-obsessed monster destroying American emergency rooms

#122

Post by raincom » Sat, Oct 05, 2024, 6:49 PM UTC

JamesBarney wrote: post #97

ninalanyon wrote: post #96

Earlier quoted context omitted.

> But there are countries that have systems similar to ours Really? Which ones are they?

Israel, Switzerland, and the Netherlands all rely on private insurance as well and still have vastly better systems than our own.

US population is 300M, whereas Israel/Switzerland/Netherlands population is about 10M.

Re: The profit-obsessed monster destroying American emergency rooms

#123

Post by hakfoo » Sat, Oct 05, 2024, 7:07 PM UTC

404mm wrote: post #18

I live in north Texas, and the situation here is pretty much on par with the article. Urgent Care & Emergency Room combos are here on every corner. It’s a lucrative business, so it makes sense that private equity firms are gobbling it up. But I think the more interesting problem here is one level up. Why are there so many of them? I see two possible reasons: 1. Anytime one of my family members gets sick, it’s rather…

Triage is hard. People may be mis-judging which is the appropriate service provider for their needs. If they don't know what's wrong they may worry that they stumble into a GP, and he just calls the ambulance/steers you to the ER anyway.

Re: The profit-obsessed monster destroying American emergency rooms

#124

Post by ghaff » Sat, Oct 05, 2024, 7:09 PM UTC

phil21 wrote: post #89

ryandrake wrote: post #79

Earlier quoted context omitted.

It's kind of silly they tie these together. Why can't I also open an HSA if I'm on a traditional PPO plan? Or if I have no health insurance as all.

Because a healthcare plan isn’t insurance. You used the correct term. If you want a prepaid healthcare plan that’s fine, just stop calling it insurance since it’s not. Totally agree it should be available for cash pay.

It's insurance in the sense you have annual out-of-pocket maximums--which is really the key feature for a lot of people. I can cover $5K or $10K for a year but not, say, $100K or more.

Re: The profit-obsessed monster destroying American emergency rooms

#125

Post by ghaff » Sat, Oct 05, 2024, 7:10 PM UTC

cameldrv wrote: post #114

ghaff wrote: post #28

Earlier quoted context omitted.

You also have Insta-clinic in chains like CVS. Not sure it's a bad thing. Came back from a trip with minor but persistent cough symptoms that were a LOT like the time I had COVID even though I tested negative. Got an appointment the next day at a clinic with a nurse practitioner who prescribed me an inhaler and said it was a "virus" after listening to my chest, etc. I think I maybe had a $40 bill. Told my primary car…

For some reason these all seem to be closing down. I don't think there any of the CVS Minute Clinics left in California. They used to be in every third CVS or so.

There are still plenty in Massachusetts. Maybe there's some regulation in CA that makes them financially unattractive.

Re: The profit-obsessed monster destroying American emergency rooms

#126

Post by mutatio » Sat, Oct 05, 2024, 7:12 PM UTC

hintymad wrote: post #105

A key question is why the free market does not work in this case. Many business are "profit obsessed", yet it does not mean they won't provide quality products or services at increasingly lower prices. What's different in the health care?

Likely because some core components of health care cannot be comoditised via technology, there's still vast human involvement from diagnosis to surgery, all the way to social support of the aged. Everything is getting stretched at the edges by aging populations in most of the developed world meaning medical and technological advances don't even touch the sides.

I'm in the UK (NHS), I don't see a bright future for systems like the NHS or mostly private systems like the US. There's an extreme core cost which "systems" cannot make disappear.

Re: The profit-obsessed monster destroying American emergency rooms

#127

Post by atombender » Sat, Oct 05, 2024, 7:13 PM UTC

raincom wrote: post #122

JamesBarney wrote: post #97

Earlier quoted context omitted.

Israel, Switzerland, and the Netherlands all rely on private insurance as well and still have vastly better systems than our own.

US population is 300M, whereas Israel/Switzerland/Netherlands population is about 10M.

You would expect healthcare cost to scale pretty linearly with population size, I think? Number of doctors, hospitals, drug prescriptions etc. are entirely population-driven.

Medications also don't cost more or less based on population size. Although in a single-player market monopoly, I suspect a larger country should have greater cost negotiation power, so this should actually benefit a larger country like the U.S.

A greater factor than population size may be demographics. Countries with older and less healthy citizens would have a larger cost burden.

A poorly designed government structure could also disadvantage a large country like the U.S. This has been observed in the U.K., where successive Conservative governments have centralized the healthcare system over the last two decades, reducing efficiency and increasing cost. Not sure about Switzerland, which is also a federation of states (cantons).

Re: The profit-obsessed monster destroying American emergency rooms

#128

Post by watwut » Sat, Oct 05, 2024, 7:26 PM UTC

ryandrake wrote: post #74

swatcoder wrote: post #40

Earlier quoted context omitted.

3. Demand for immediate care is high. The next "one level up" might explore how much is because the community is quite morbid and unwell, because modern culture has displaced traditional home/self care with consumerized services, or because of other things. There are people I know who are largely healthy and who consult paid medical services many times per year for everyday disturbances, and others who take decades t…

> traditional home/self care Not sure what you mean by this? If I have a broken bone, I'm not going to set it myself at home and take a few aspirin. Same if I'm puking my guts out. If you just mean getting exercise and eating healthy then I fully agree with you. But, when you're actually sick, and need to see a professional, that is the right time for "consumerized services".

They mean you take aspirin and hope it goes away.

Re: The profit-obsessed monster destroying American emergency rooms

#129

Post by giantg2 » Sat, Oct 05, 2024, 7:34 PM UTC

yumraj wrote: post #65

giantg2 wrote: post #36

Earlier quoted context omitted.

In the US you can have similar labs done at Labcorp or Quest. Prices are similar or slightly higher. MRIs are prescription only and higher priced. One main difference is that most labs here require a prescription, which means you need to go to a different provider just to get the piece of paper and pay them. Of course these providers are both massive chains. Not sure if either are PI owned.

Quest and Labcorp have started doing many tests for a direct fee. You just pay upfront and get it done, no prescription/insurance needed. It’s not all the tests I think, but many.

Exactly what I was saying. The majority of tests still need a prescription, but there a a few dozen out of the few hundred total.

Re: The profit-obsessed monster destroying American emergency rooms

#130

Post by BugsJustFindMe » Sat, Oct 05, 2024, 8:02 PM UTC

dingnuts wrote: post #113

AlphaSite wrote: post #48

Earlier quoted context omitted.

You really need to look at how the employer funds it but often those are cheaper no matter what.

not if you have a chronic illness. my wife hits her deductible every year just getting the annual MRI she's required to get.

My high deductible maximum out of pocket is lower than the available other plan's premiums+deductible with equivalent care policies. I save money on a high deductible plan no matter what happens to me medically.