Why Did My Patient Leave Me? • Hacker News Board

Re: Why Did My Patient Leave Me?

#71

Post by ThomPete » Sat, Apr 15, 2017, 2:02 PM UTC

cortic wrote: post #46

ThomPete wrote: post #24

Earlier quoted context omitted.

I do question the sustainability of the french system though and that of many other european systems. Its important to remember that in a state economy where healthcare is free or semi free it's operated as a cost center and thus has budgets that are politically mandated not determined by market demand at least not directly. This leads to a number of limitations on what kind of care patients can get what machines the…

I do question the morality of the US system, and the sustainability of inflated prices it creates. Its also important to remember that in for - profit healthcare, its operated as a profit center and thus has profit margins that are corporately mandated and not determined by need, at least not directly. This leads to a massive inflation of price and decrease of quality of service, medicine, machines etc. Not saying th…

I am unconvinced any of the systems are sustainable.

The US system isn't better it's different. The inflated prices aren't due to it being more privately driven but because of lobbying which can be dealt with.

Re: Why Did My Patient Leave Me?

#72

Post by jacquesm » Sat, Apr 15, 2017, 2:02 PM UTC

ThomPete wrote: post #70

jacquesm wrote: post #44

Earlier quoted context omitted.

Yes, those poor people with recreational broken legs really should pay for their own work. That's only about 25K or so in a bad case without further complications... /s

Please read what I actually wrote instead of just knee-jerk reacting to your own prejudice. I said MOST people should pay MOST of the bill. Do you really think I am talking about those with least amount of money.

You wrote:

> most people pay most of the cost for normal healthcare costs like going to the doctor for a checkup, most of the cost for one of things like a broken leg

Most people are poor. Wealthy people are the exception and most people would not be able to pay for even the simplest procedures.

They typically can't pay for a new washing machine if their current one breaks down.

Re: Why Did My Patient Leave Me?

#73

Post by nullstyle » Sat, Apr 15, 2017, 2:04 PM UTC

DanBC wrote: post #37

tomohawk wrote: post #30

Years ago, I had a truly great primary care doctor. She had her own practice, which was typical at that time. She was caring, but above all, extremely competent. After she retired, I've yet to come across a situation remotely as good. I think she was so good because she was allowed to be directly engaged with her patients and that resulted in some sort of feedback loop where she was always striving to stay on top of…

> Just look at how many doctors no longer will prescribe medicine for pain due to the war on drugs. They're scared of losing their license. The collateral damage is the poor people who need strong pain management but find it increasingly hard to get it. Doctors haven't stopped prescribing opioids because of the war on drugs. They've changed prescribing because opioid meds are not effective to treat long term pain, an…

> Doctors haven't stopped prescribing opioids because of the war on drugs. They've changed prescribing because opioid meds are not effective to treat long term pain, and certainly not effective in the way they were being prescribed.

Watch the documentary "Dr. Feelgood" (http://www.imdb.com/title/tt5192362/) for a couple of very extreme, living and breathing refutations of that claim. It's not nearly cut and dried one way or the other.

Re: Why Did My Patient Leave Me?

#74

Post by cmdrfred » Sat, Apr 15, 2017, 2:04 PM UTC

surgeryres wrote: post #65

theoneone wrote: post #61

Earlier quoted context omitted.

So 3000$ for a biopsy: ticket to Greece and back to USA : let's say 1000€. Biopsy procedure if it's ultrasound guided around 300€. Lab fee for examining the biopsy:around 200€ max, maybe less. Hotel room for 2-4 days in Thessaloniki 120€-150€ in a decent hotel. Total:1500€ or even less. All these can be done by highly and well educate medical doctors, treatment in private clinics is very good(since you are paying in…

So are you going to fly back when the biopsy is positive for your surgery or chemotherapy?

Chemo is often every week or month for a period of time, but the surgery is probably a one off. I'd go for it if I was able.

Re: Why Did My Patient Leave Me?

#75

Post by ThomPete » Sat, Apr 15, 2017, 2:05 PM UTC

DanBC wrote: post #43

ThomPete wrote: post #24

Earlier quoted context omitted.

I do question the sustainability of the french system though and that of many other european systems. Its important to remember that in a state economy where healthcare is free or semi free it's operated as a cost center and thus has budgets that are politically mandated not determined by market demand at least not directly. This leads to a number of limitations on what kind of care patients can get what machines the…

> and thus has budgets that are politically mandated not determined by market demand at least not directly. Why is market demand a good thing? In the US the government spends more per capita than France, but gets worse health outcomes.

It's neither a good or a bad thing.

The US system isn't the only way a marketdriven system can be and a lot of it's problems are lobby and politics related.

Market demand is a good thing in the sense that it creates better allocation of resources.

The US doesn't have a healthcare market driven by market demand. But the fact is that the US system has more advanced treatment methods.

The problem is that it's not evenly distributed.

Re: Why Did My Patient Leave Me?

#76

Post by ThomPete » Sat, Apr 15, 2017, 2:07 PM UTC

XorNot wrote: post #36

ThomPete wrote: post #24

Earlier quoted context omitted.

I do question the sustainability of the french system though and that of many other european systems. Its important to remember that in a state economy where healthcare is free or semi free it's operated as a cost center and thus has budgets that are politically mandated not determined by market demand at least not directly. This leads to a number of limitations on what kind of care patients can get what machines the…

Ah yes, because the "market" for healthcare operates so well ...

It's really sad that it's impossible to discuss healthcare without people jumping into their pigeonholes.

Healthcare isn't perfect anywhere in the world whether private or public.

And even the US healthcare system isn't really market driven.

Re: Why Did My Patient Leave Me?

#77

Post by ThomPete » Sat, Apr 15, 2017, 2:12 PM UTC

maxerickson wrote: post #42

ThomPete wrote: post #24

Earlier quoted context omitted.

I do question the sustainability of the french system though and that of many other european systems. Its important to remember that in a state economy where healthcare is free or semi free it's operated as a cost center and thus has budgets that are politically mandated not determined by market demand at least not directly. This leads to a number of limitations on what kind of care patients can get what machines the…

Much of the US has certificates of need which impose limits on who can operate certain machines or have a hospital. And Medicare makes funding decisions based on what sort of care hospitals provide to patients. Critical access hospitals get higher reimbursement; maintaining that certification means a short average for length of inpatient stays and not growing to meet demand.

This is not the market fault it's the political system and reimbursement rules which creates perverse incentives. Some hospitals have begun to get reimbursed based on how well the patients gets treated called value based treatment.

Re: Why Did My Patient Leave Me?

#78

Post by foobarian » Sat, Apr 15, 2017, 2:13 PM UTC

csydas wrote: post #35

josephorjoe wrote: post #33

The primary reason I have left healthcare providers has been the poor quality of their administrative staff. There are too many qualified doctors in the major metro area I live in to put up with ones where I can't quickly and efficiently make an appointment, can't get an appointment in a timeframe that is useful to me, and where their staff can't seem to successfully process routine insurance claims with major insura…

> Also, randomly billing me for stuff weeks or months after an appointment with cryptic explanations thoroughly pisses me off -- even it if is only $15.00 (going to get a new podiatrist over that one...). This part gets me a lot as well, and having experienced other pay-for healthcare systems, it's extremely frustrating remembering just how much I would pay in the US even when I had fair insurance through my employer…

I had a similar experience for a minor hand surgery. The thing is, when I called the insurance company (or was it the billing dept at the hospital? I don't remember) they went like, "oh, that's wrong" and like magic $5000 in bills disappeared. How many people just pay without asking? How many people don't care because it's the insurance co covering the bill? The whole system just seems rife with inefficiency.

Re: Why Did My Patient Leave Me?

#79

Post by ashark » Sat, Apr 15, 2017, 2:14 PM UTC

maxxxxx wrote: post #51

QSIITurbo wrote: post #34

Earlier quoted context omitted.

Another alternative that I've run into. Visiting a doctor friend of mine. She needed to deliver some papers to another room and summoned the nurse for that. I joked that why you can't do that yourself (omg) and she replied that the nurses start to complain if you do stuff that's earmarked to them. It might be that it's because they're in a union or it's a company policy. Who knows, I never asked. But the point was th…

That's a very american thing. I remember reading about engineers from Germany who worked with NASA engineers on a project. The americans were surprised that when something was wrong the germans just took a wrench to fix it where for the americans it was policy to call a technician. From my own experience the US is a weird mix of "can do" attitude on the one hand with strict hierarchies and enforced policies on the ot…

We're all terrified of doing something wrong and losing our livilihood, if not our freedom, over it. Or of doing something right but having something unfortunate happen anyway, and not having followed the proper blame-deflecting or blame-halting procedures, and so suffering for it. Seriously.

Re: Why Did My Patient Leave Me?

#80

Post by mhneu » Sat, Apr 15, 2017, 2:15 PM UTC

ThomPete wrote: post #32

jacquesm wrote: post #26

Earlier quoted context omitted.

Good point. I'm not too worried about France, they seem to have their priorities straight there, other countries are less stable. Especially in former Eastern European countries there are disasters happening right now, and many Western countries will have to come to terms with the cost of health care and attempting to take commerce out of it. NL had a very good system which got replaced by something much less efficie…

My personal suggestion for a good balanced system is that most people pay most of the cost for normal healthcare costs like going to the doctor for a checkup, most of the cost for one of things like a broken leg but that society pays for more serious and longer term situations like cancer, heart surgeries where you are supposed to stay at the hospital for a longer time. I.e. no one should be bankrupted because they g…

That article is from 2013 and predicts crisis in as little as 3 years. It's 2017.

Be careful with articles about single payer healthcare systems in the US. Most similar countries to the US have functional single payer plans. It's a false talking point pushed by conservative media that those systems don't work well. Conservative media pushes those falsehoods because the media is funded by the very wealthy and those who want to cut taxes to line their own pockets at the expense of most Americans.