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The Economies With the Most and Least Efficient Health Care

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Re: The Economies With the Most and Least Efficient Health Care

#31

Post by rectang »

maxxxxx wrote: post #23
frockington wrote: post #19

Earlier quoted context omitted.

I agree with you, I'm saying we should learn from the mistakes and iterate on the current instead of fighting for extremes that will never work or be passed

One thing the Republicans could have done was to iterate on Obamacare instead of trying to repeal it for 8 years and now that they are in power they show that they have no ideas and no interest in improving anything.

While I think there's something to your point here, I wish for the sake of avoiding flamewars per the HN guidelines you could put it in less partisan terms. (For example by avoiding naming specific political parties.)

I would have liked to see more experimentation on price transparency.

Re: The Economies With the Most and Least Efficient Health Care

#32

Post by brownbat »

Fernicia wrote: post #4

The methodology here is not good. All they're doing is comparing average health care cost vs life expectancy. They don't measure standard of care, accessibility of treatment, etc. This is especially important when looking at end-of-life care, which I speculate affects these both of these metrics the most. A hospice with private rooms, friendly staff, and social engagement will score lower than a hospital that keeps s…

To your point, the key drivers of the recent decline in US life expectancy seem to be suicides, alcohol, and opioids.

Some of these are definitely mediated by the quality of the health care system, but culture, public policy, and economics have impacts too.

https://www.webmd.com/mental-health/addiction/news/20180816/...

Re: The Economies With the Most and Least Efficient Health Care

#33

Post by rectang »

nabla9 wrote: post #30
Fernicia wrote: post #4

The methodology here is not good. All they're doing is comparing average health care cost vs life expectancy. They don't measure standard of care, accessibility of treatment, etc. This is especially important when looking at end-of-life care, which I speculate affects these both of these metrics the most. A hospice with private rooms, friendly staff, and social engagement will score lower than a hospital that keeps s…

Bloomberg analysis gives one point of view. OECD has published data where you can compares 5-year survival rates after major cancers, heart attack 30-day survival after hospitalization, stroke, ischemic stroke etc. They also keep track of infant mortality, maternal mortality etc. http://stats.oecd.org/index.aspx?DataSetCode=HEALTH_STAT# Data shows that Japan, South Korea, Israel and Nordics are have the best healthca…

In the US, we make services used by the poor inconvenient and ineffective in order to (ahem) motivate people to not be poor. Lousy results are to be expected for that segment of the population.

Re: The Economies With the Most and Least Efficient Health Care

#34

Post by bitxbit »

You look at the list of most efficient health care systems across the globe and they are not nearly as large as the US. They are typically small and homogeneous. I like the concept of single payor in the US but I do see big hurdles even if we get through the politics which is a big if. I'd point to heterogeneous population and a very wide range of care quality across the country and sometimes even within MSAs.

Re: The Economies With the Most and Least Efficient Health Care

#35

Post by brownbat »

nabla9 wrote: post #30
Fernicia wrote: post #4

The methodology here is not good. All they're doing is comparing average health care cost vs life expectancy. They don't measure standard of care, accessibility of treatment, etc. This is especially important when looking at end-of-life care, which I speculate affects these both of these metrics the most. A hospice with private rooms, friendly staff, and social engagement will score lower than a hospital that keeps s…

Bloomberg analysis gives one point of view. OECD has published data where you can compares 5-year survival rates after major cancers, heart attack 30-day survival after hospitalization, stroke, ischemic stroke etc. They also keep track of infant mortality, maternal mortality etc. http://stats.oecd.org/index.aspx?DataSetCode=HEALTH_STAT# Data shows that Japan, South Korea, Israel and Nordics are have the best healthca…

Some of it is different reporting requirements, but some of it is clustered in at-risk groups that are underserved.

http://www.nber.org/papers/w20525

Big recent declines are due to safer sleeping practices reducing SIDS / asphyxiation.

Education about safe sleeping is a factor, and also if you are in a household that can't afford a crib, that's going to have an impact too.

https://www-m.cnn.com/2018/01/04/health/infant-mortality-by-...

Re: The Economies With the Most and Least Efficient Health Care

#36

Post by ssambros »

maxxxxx wrote: post #29
ssambros wrote: post #24

Earlier quoted context omitted.

American Hospital Association: Underpayment by Medicare and Medicaid Fact Sheet, December 2017 Update [0] FINDINGS In the aggregate, both Medicare and Medicaid payments fell below costs in 2016: - Combined underpayments were $68.8 billion in 2016. This includes a shortfall of $48.8 billion for Medicare and $20.0 billion for Medicaid. -For Medicare, hospitals received payment of only 87 cents for every dollar spent by…

After having dealt with billing from hospitals for services they never delivered or obscenely overpriced I am inclined not to trust them on statements about their actual cost. In my view the billing practices of most hospitals are very dishonest and intentionally confusing and opaque.

"billing practices of most hospitals are very dishonest and intentionally confusing and opaque."

Is that even true? Personally I have my doubts.

Re: The Economies With the Most and Least Efficient Health Care

#37

Post by SketchySeaBeast »

ssambros wrote: post #24
maxxxxx wrote: post #20

Earlier quoted context omitted.

"Medicare currently pays less than what it costs to provide for a lot of services" Is that even true? Personally I have my doubts.

American Hospital Association: Underpayment by Medicare and Medicaid Fact Sheet, December 2017 Update [0] FINDINGS In the aggregate, both Medicare and Medicaid payments fell below costs in 2016: - Combined underpayments were $68.8 billion in 2016. This includes a shortfall of $48.8 billion for Medicare and $20.0 billion for Medicaid. -For Medicare, hospitals received payment of only 87 cents for every dollar spent by…

> For Medicaid, hospitals received payment of only 88 cents for every dollar spent by hospitals caring for Medicaid patients in 2016.

Is that the actual cost of the item or the obscene markup? Is medicare only paying $2.20 for the $2.50 saline bag, or are they only paying $176 of the $200 charge?

Re: The Economies With the Most and Least Efficient Health Care

#38

Post by NeedMoreTea »

bitxbit wrote: post #34

You look at the list of most efficient health care systems across the globe and they are not nearly as large as the US. They are typically small and homogeneous. I like the concept of single payor in the US but I do see big hurdles even if we get through the politics which is a big if. I'd point to heterogeneous population and a very wide range of care quality across the country and sometimes even within MSAs.

You look at any list of anything across the globe relating to countries and they are not nearly as large as the US.

For the very simple reason that most countries are smaller and more homogeneous than the US, so I don't think it really proves a lot. Unless you're suggesting US only compare itself to Russia and China in future?

Re: The Economies With the Most and Least Efficient Health Care

#39

Post by DoofusOfDeath »

rectang wrote: post #33
nabla9 wrote: post #30

Earlier quoted context omitted.

Bloomberg analysis gives one point of view. OECD has published data where you can compares 5-year survival rates after major cancers, heart attack 30-day survival after hospitalization, stroke, ischemic stroke etc. They also keep track of infant mortality, maternal mortality etc. http://stats.oecd.org/index.aspx?DataSetCode=HEALTH_STAT# Data shows that Japan, South Korea, Israel and Nordics are have the best healthca…

In the US, we make services used by the poor inconvenient and ineffective in order to (ahem) motivate people to not be poor. Lousy results are to be expected for that segment of the population.

That strikes me as an overly simplistic view, largely because it implies a unity of motivation across the various persons involved in U.S. healthcare policy-making and delivery.

If you're sure of your statement, it would be helpful to cite some supporting evidence.

Re: The Economies With the Most and Least Efficient Health Care

#40

Post by maxxxxx »

rectang wrote: post #31
maxxxxx wrote: post #23

Earlier quoted context omitted.

One thing the Republicans could have done was to iterate on Obamacare instead of trying to repeal it for 8 years and now that they are in power they show that they have no ideas and no interest in improving anything.

While I think there's something to your point here, I wish for the sake of avoiding flamewars per the HN guidelines you could put it in less partisan terms. (For example by avoiding naming specific political parties.) I would have liked to see more experimentation on price transparency.

Totally agree about price transparency. Everybody but the people in the medical system who benefit from opaque pricing should be able to agree with this.

I don't think my comment was partisan but it was a description of the last 10 years. Republicans voted to repeal Obamacare several times a year but never introduced anything for improving it. And now that they are in power they seem have no idea how to proceed.

I am not saying that Obamacare was a good law. Actually it was pretty half assed but it could probably be made to work with some changes. I would have loved it opponents of it would have introduced steps for improvement but they never did.

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