Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Researchers chart path to drastically lower administrative costs of health care

med.stanford.edu

Post reply on HN
Print view View original

141–150 of 221 posts

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

#141

Post by ameister14 »

bialpio wrote: post #89
triceratops wrote: post #65

Earlier quoted context omitted.

> I would like you to start from the beginning of the person's medical training and not include the gatekeeping bit of having to get a bachelors in a random subject unrelated to medicine. Why? An apples-to-apples comparison would be to see how long it takes to become a general physician after completing secondary school. In the UK or India it's something like 5.5-6 years.[1] In the US it's 3-4 years of "pre-med", the…

> 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…

Some universities in the US offer a 7 year undergrad and medical degree. Those usually have an extremely high GPA requirement but it's possible to do just that.

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

#142

Post by [deleted] »

tryptophan wrote: post #112
heymijo wrote: post #69

Earlier quoted context omitted.

I just realized Physician Assistants (PAs) and Nurse Practitioners (NPs) have been forgotten in this equation. 126,000 practicing PAs [0] 325,000 licensed NPs [1] 985,000 practicing physicians (MDs and DOs) [2] I know that nurse practitioners are not under the same artificial residency constraints of MDs/DOs. I'm not sure about physician assistants. For someone not in the U.S., NPs and PAs often do the same role as g…

PA/NA education is a complete joke compared to what your average MD gets. They are not qualified to practice as general doctors at all. However, they are really cheap, which is why corporations are pushing them so hard. Substandard care in the name of profits.

[deleted]

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

#143

Post by google234123 »

laputan_machine wrote: post #64
HDMI_Cable wrote: post #33

Earlier quoted context omitted.

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…

You are either deliberately misleading people or are ignorant of the UK education system. Highschool in the uk ends at 16, you graduate with GCSEs. After this there are 2 extra years of education (compulsory in England), you start university at 18 (at the youngest). Medical schools are competitive and require strong a-level results, typically 3 As (the second highest grade, after A*) [0]. It's a 4 year degree, you th…

22.5% of students get 3 As or better so that doesn't sound very impressive to me. US med schools are much more competitive than that.

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

#144

Post by google234123 »

lr1970 wrote: post #99
HDMI_Cable wrote: post #33

Earlier quoted context omitted.

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…

> The US only accepts doctors who went to Canadian or American medical schools. This is factually incorrect. There are tons of doctors that graduated from European, Indian and Chinese medical schools. To practice medicine in the USA they need to pass the ECFMG tests (US graduates take similar USMLE tests) and then complete medical residency. The last part is the hardest, for the medical residency admission offices ar…

Why shouldn't domestic medical students have priority over foreign medical graduates?

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

#145

Post by google234123 »

ameister14 wrote: post #141
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…

Some universities in the US offer a 7 year undergrad and medical degree. Those usually have an extremely high GPA requirement but it's possible to do just that.

They typically have acceptance rates in the low single digits too.

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

#146

Post by kaitai »

syops wrote: post #3
jostmey wrote: post #2

I agree with the three issues they identify driving up costs. But I fear “Medicare for All” won't fix all the issues, which go much deeper. For example, the US has extremely high standards restricting who can practice medicine compared to the rest of world, limiting the supply of doctors and artificially driving up their demand. There is a need for standards, but perhaps the AMA has too much political influence. Like…

The bottleneck is not the number of people with an MD. The bottleneck is the number of residency programs. These are funded by Medicare and I believe they are not profitable for hospitals.

This is correct and needs to be upvoted more. The number of residency slots is artificially capped and already fails to serve the number of medical school graduates in the country. The Balanced Budget Act of 1997 is the basic vehicle for this cap. In Dec 2020 the first expansion in decades was passed, adding a whopping 1000 residency spots.

Look up Graduate Medical Education program for more info. For more key words, see this document from the U of California system that has an agenda (increase capacity) but also effectively lists salient points: https://www.ucop.edu/federal-governmental-relations/_files/f...

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

#147

Post by kurthr »

milliondollar wrote: post #109

Their solution in the TFA is to focus on straight-through billing through standardization of payment mechanisms, arguing that each physician is paying $100K / year. Of course, this also puts the lie to the insurance companies, who are the other side of the transaction and essentially add another 20% in cost just to pay the bill! (Their loss ratios due to medical costs are about 80%.) Insurance companies are basically…

One of the big lies is that Insurance Companies have an incentive (aligned with the customer) to lower costs.

In fact Insurance Companies have an incentive to pay no more than competition, but for costs to rise. Due to regulated %overhead this is one of the few ways they increase profits every year.

To maintain current inflation adjusted stock valuations (based on earnings and growth) Insurance companies need prices to rise and they are incentivized to produce this outcome. Surprise!

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

#148

Post by alistairSH »

JamesBarney wrote: post #83
alistairSH wrote: post #58

Earlier quoted context omitted.

The US only accepts doctors who went to Canadian or American medical schools. That's absolutely not true. Foreign medical graduates do have to take the US board exams, complete a US-based residency, and possibly take additional courses to fill educational gaps, but they absolutely can practice in the US with a foreign medical degree.

-> complete a US-based residency This is the kicker. There are incredibly difficult to get, they are incredibly stressful, and it's another 3-5 years of your life. If you allowed any non-us developers to practice in the US but you made them work a 5 year 80hr/week internship for 1/6th of what professional developers made first, that basically bans non-us developers from writing code in the U.S.

Absolutely. And that's due to AMA lobbying in the 90s. It doesn't have anything much to do with stringency of US medical licensing or ensuring quality and everything to do with existing MDs protecting their lucrative practices.

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

#149

Post by saiya-jin »

perlgeek wrote: post #79
legulere wrote: post #15

We have standardized health care billing in Germany, both for the around 100 public health insurances and the private ones. We still have a relatively expensive health care system when compared with other European countries.

... and much cheaper than the US, currently.

Everything is cheaper than US. Even Switzerland.

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

#150

Post by JamesBarney »

DonnyV wrote: post #93
JamesBarney wrote: post #78

Earlier quoted context omitted.

There are two issues in healthcare. Efficiency and and access. Medicare for all solves the access problem, but it doesn't do anything for the efficiency problem.

Do you know why efficiency is such a problem? Its because people put off going to the doctor because THEY CAN'T AFFORD IT!. Thats why vists sky rocket when people become eligible for Medicare. https://www.uclahealth.org/u-magazine/u-s-ranks-near-bottom-...

Your link doesn't have any analysis on how preventive care is the cause of increased costs.

But there are lots of ways that are obviously not related to preventative care that drive up costs.

Our doctors and nurses make way more money than doctors and nurses in other countries.

We spend more money on questionable, or low yield procedures that have low returns that other countries don't.

Not to mention medicine just isn't that good at preventative care. The only real preventative medicine are diabetes medications and cardiovascular medications.

Post reply on HN