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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

#61

Post by 29athrowaway »

The problem with healthcare is that inefficiency and lack of transparency is profitable.

The government has deep pockets, and everyone is trying to get as much money as they can from it. Pharmaceutical industries, insurance providers, healthcare facilities, etc.

Pharmaceutical research is important and expensive, but there must be a way for that research to happen without doing stupid shit like making insulin expensive.

Labor costs in healthcare are high, but there must be a way to not make a bag of water with salt not cost $500.

People pay for costs that are completely unrelated for the products and services they are receiving.

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

#62

Post by nitwit005 »

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...

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

#63

Post by 238475235243 »

triceratops wrote: post #51
238475235243 wrote: post #40

Earlier quoted context omitted.

Or we could make it legal to open hospitals, or charge differential pricing based on the time of day... you know, basic stuff? Most people have no idea how captured healthcare is. There's no competition, indeed most healthcare is government granted monopolies already. Having lived in countries with "free" healthcare, that isn't all it's cracked up to be either. A good example of cost cutting: just make the disease il…

The rest of your post I agree with but > just make the disease illegal, like ADHD in the UK What in the world are you talking about?[1] 1. https://www.nhs.uk/conditions/attention-deficit-hyperactivit...

You need a psychiatric evaluation for diagnosis, which is exceptionally hard to get. So there's a nice shiny website and then there's the reality. Getting the diagnosis and then medication can literally take years, and it looks like this is on purpose.

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

#64

Post by laputan_machine »

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…

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 then go onto train for another 5 years as a junior doctor.

There is a _lot_ of training for UK doctors.

[0] https://www.manchester.ac.uk/study/undergraduate/courses/202...

[1] https://www.healthcareers.nhs.uk/explore-roles/doctors/train...

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

#65

Post by triceratops »

jimnotgym wrote: post #48
whiddershins wrote: post #23

Earlier quoted context omitted.

I believe it takes longer in the US, when all is said and done. It’s hard to casually verify this because each country uses different terms and has a different track but I think, when you include the various phases of training, starting from the bachelors degree, the US one is more total years. Edit: So for example the UK and France don’t appear to require any sort of bachelor’s degree as a prerequisite for medical.…

Citation definitely needed here And just to be sure, 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. I note this Wikipedia article that suggests 4 years messed school plus 1 year internship could get me a license in the US. That sounds like Western Europe to me. Or India... https:/…

> 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", then 4 years of med school. That's from the article you referred.

1. https://en.wikipedia.org/wiki/Medical_school_in_the_United_K...

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

#66

Post by bilbo0s »

HEmanZ wrote: post #16
syops wrote: post #3

Earlier quoted context omitted.

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.

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…

I don't know how residencies could not be profitable for hospitals.

If it helps, think about it this way,

how does the malpractice work?

There are a lot of indirect costs around residents. For example, staffing mandates. Think what implications there are to regulations that say, for instance, no more than 4 patients for each RN on duty. That said, there are a lot of indirect funding sources too. The problem is, of course, sometimes the funding doesn't equal the costs depending on where you are.

And now we come to the rub. Which of the MDs are willing to do their residences in places where everything matches up nicely to support a lot of residents? Keeping in mind that those places may not be Sarasota, or Tampa, or Charlotte, but rather places in Alaska, a small desert city in New Mexico, or some small place on the tundra of North Dakota.

If you're asking, does the US government give enough funding? You can get an answer that's "Yes" if you consider nothing else.

Does that funding cover every regulatory cost of having a provider on staff? Not likely, depending on the rules in the state you're in.

Does that funding get to where MDs want to practice? Rarely at all does that happen.

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

#67

Post by tephra »

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…

Only accepting doctors who went to medical school in the u.s or Canada is not the same as having higher standards (necessarily).

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

#68

Post by trosi »

whiddershins wrote: post #23
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…

I believe it takes longer in the US, when all is said and done. It’s hard to casually verify this because each country uses different terms and has a different track but I think, when you include the various phases of training, starting from the bachelors degree, the US one is more total years. Edit: So for example the UK and France don’t appear to require any sort of bachelor’s degree as a prerequisite for medical.…

I'll bring an example for the sake of comparison. In Italy the path to becoming a physician involves a six year degree focused entirely on medicine (so not a bachelor), followed by a specialized degree of variable length (4-6 years depending on the chosen specialty) during which you practice in a hospital and study for exams at the same time, mostly the former. Entrance exams are required at both levels and acceptance rates are very low. Also, many students end up needing 1-2 extra years to complete it all.

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

#69

Post by heymijo »

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…

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 general practitioners/family doctors e.g. see patients, prescribe medicine, etc. They can also specialize.

[0] https://www.thepalife.com/physician-assistant-stats/

[1] https://www.aanp.org/about/all-about-nps/np-fact-sheet

[2] https://en.wikipedia.org/wiki/Physicians_in_the_United_State...

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

#70

Post by hpoe »

KoftaBob wrote: post #44
whowe1 wrote: post #18

So how do they plan on getting private capitalist enterprise to start implementing reforms that would lower their profits? Because by definition administrative cost to the consumer is profit for the company.

The majority of hospitals in the US are non-profit. They don't benefit from passing administrative costs to patients.

Non-profit doesn't mean that people aren't making money from it, it just means that the excess funds aren't used to drive stock growth and the organization "doesn't exist for the purpose of making money", but if the Administrators in the hospital find a way to slash the budget by $5 million there's nothing saying they can't then give themselves a raise for doing such a good job.
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