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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

#201

Post by laurencerowe »

google234123 wrote: post #143
laputan_machine wrote: post #64

Earlier quoted context omitted.

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.

There is a weird discontinuity in the data for 2020 which your quote - it was 12.3% the previous year according to https://lginform.local.gov.uk/reports/lgastandard?mod-metric...

This is also a proportion of students who take A levels which is already filtering down to about 38% of the population in that age group (766k 18 year olds in U.K. so about 643k in England of which about 250k take at least one A level.)

So in a normal year that 12.3% of A level students getting 3 A’s is only 4.8% of the age cohort.

Edit: I should add that medicine is about the hardest subject to get into in U.K. (other than vet med which has so few places) and one of the only ones where they expect you to demonstrate suitability beyond academic performance, e.g. work experience in a caring setting. (Source: shared a house with a med student in undergrad.)

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

#202

Post by StanislavPetrov »

DonnyV wrote: post #29

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. No one ever talks about what is the value all these Health Insurance companies bring? The whole point of their existence when they were created was to control costs. Obviously they have failed miserably. Medicare For All handles lowering or eliminating student loans fo…

>It regulates costs for pharmaceuticals and medical equipment.

This is an underappreciated requirement if we want to significantly lower costs. Drug patents, medical device patents and illogical government regulations imposed by corrupt and incompetent regulators lead to massive costs for patients. Allowing drug to charge hundreds or thousands of dollars for a dose of a drug that costs .50 cents to manufacture is an atrocity. This is doubly true since a large portion of medical research that these patents rely on is done by publicly funded research at universities and research clinics. Patent laws need to be completely rewritten to allow for a decent return on investment while disallowing price gouging.

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

#203

Post by phobosanomaly »

opo wrote: post #180
rscho wrote: post #152

Earlier quoted context omitted.

The question is not "when do you leave school?" it's actually "when are you employable as an independent practitioner?". In my personal experience, it's _much_ easier to get an attending/private practice position in the US at a younger age. Just because the country is huge and lots of places lack docs, probably. Of course, that's my experience and I could be wrong.

Just because there is a Dr shortage in the US due to having a limited number of medical schools, there are still thousands of students who get their degree and can't find a residency: >.... The matching challenge comes as the U.S. faces a physician shortage. The nation could be short as many as 139,000 physicians by 2033, according to the Times, which cites Association of American Medical Colleges data. Despite this…

That must be understood in the context of the number of applicants to U.S. residency programs from Caribbean medical schools (which are well-known to be a little predatory).

From that article you cited: International medical graduates in particular have low match rates for residency programs. American medical students have a 94 percent match rate, according to the Times, which cites information from the National Resident Matching Program. However, Americans who study at international medical schools have a match rate of 61 percent."

Kids from the U.S. get sold on a Caribbean M.D. school, and spend thousands and thousands of dollars only to find out that things get really complicated when it comes time to do clerkship rotations or apply to residency.

An M.D. or a D.O. from a school on U.S. soil is definitely not useless, and your chances at matching a residency are extremely high, as cited above.

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

#204

Post by phobosanomaly »

alistairSH wrote: post #148
JamesBarney wrote: post #83

Earlier quoted context omitted.

-> 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.

Practicing medicine must be lucrative because it costs an individual student around $240,000 in tuition for the M.D. itself, excluding cost of living.

Doctors are made out to be predatory vultures, but unless they come from money they must undergo massive debt burdens that they are not able to even begin paying down the principal on until they're well-into their thirties. Imagine the feeling of taking out half-a-million dollars in student loans to cover both undergrad, and graduate-level training. After that look forward to your 80-hours a week of residency making below hourly minimum wage. [1]

Make medical school free, and you'll have people lining up the door to practice for low-cost. Make it half-a-million pay-to-play, and you'll have people desperately clawing their way out of debt so that some day they can have a family and own a home after a decade of hellish training.

Cut the docs some slack. They're taking on unimaginable debt burdens for a job that often isn't in the same universe of cushiness as something at FAANG (inspecting that anal fissure in the ED at 3am with perks including, well, hospital food), but involves an tremendous service to society.

[1] https://www.mdlinx.com/physiciansense/is-it-better-to-be-a-d...

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

#205

Post by noahtallen »

andrewlgood wrote: post #175
DonnyV wrote: post #97

Earlier quoted context omitted.

The government would act as an insurer, that is all. All hospital services stay private. And having all medical services have to go through one system to get paid would streamline it SIGNIFICATLY.

Like the IRS has streamlined taxes and the US postal service has streamlined mail delivery?

That’s interesting, because your latter example is pretty excellent. USPS can deliver to anyone in the country (unlike the private companies) and I’d say it’s pretty streamlined. The IRS is definitely in a bad position, but there are two problems: firstly, they’re only enforcing the tax code written by Congress. They can’t just streamline the tax code. Secondly, there are private companies lobbying to prevent the IRS from being as good as it could be. And that will obviously be the same with health care.

As a country, we’ve decided it’s in everyone’s best interest to be able to get mail. Private enterprises cannot solve global access problems because they have no incentive to go the extra mile for the last few people the system can’t reach. (Which is why internet is so shitty in rural parts of the country.)

So why not health care as well? To me, it seems like the problem are solvable.

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

#206

Post by perlgeek »

smnrchrds wrote: post #165
ju-st wrote: post #154

Earlier quoted context omitted.

I pay 759€/month for my German public health insurance while in the US according to Google the average cost of platinum insurance (the best?) is $750/month.

Is it calculated as a percentage of income? In that case, it is effectively a tax, and like any progressive taxation, higher income individuals pay more.

Yes it is.

Also of note: when you're insured with a public health insurance in Germany, a spouse and kids without income of their own are automatically insured as well, without extra cost.

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

#207

Post by legulere »

smnrchrds wrote: post #165
ju-st wrote: post #154

Earlier quoted context omitted.

I pay 759€/month for my German public health insurance while in the US according to Google the average cost of platinum insurance (the best?) is $750/month.

Is it calculated as a percentage of income? In that case, it is effectively a tax, and like any progressive taxation, higher income individuals pay more.

Your wage is payed from that insurance, so it makes sense that you pay accordingly to what you earn.

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

#208

Post by Smithalicious »

jac241 wrote: post #190
someguydave wrote: post #182

Earlier quoted context omitted.

The AMA also argues against prescription rights for other health professionals like pharmacists (who often have much more in-depth education on drugs)

What do you have to do before you prescribe a drug? Make a diagnosis, which is what is taught in medical school and not in pharmacy school. Pharmacists are frequently embedded in care teams in hospitals and primary care clinics where they make medication recommendations and know how to get drugs approved by insurance companies (sad that this has to happen...).

It's totally possible to have one party diagnose and another prescribe.

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

#209

Post by djdjdjdjdj »

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…

In Germany the grades you need to study medicine is really high. You need the best grade of 1.0. you can wait if you just have something like 1.3

Do you have sources which shows your argument?

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

#210

Post by djdjdjdjdj »

google234123 wrote: post #144
lr1970 wrote: post #99

Earlier quoted context omitted.

> 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?

Global market?

It's much easier for an us citizen anyway as it is easier for an employee.

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