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Why doctors pay millions in fees that could be spent on care

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Re: Why doctors pay millions in fees that could be spent on care

#71

Post by dqv »

francisofascii wrote: post #52
triceratops wrote: post #24

Earlier quoted context omitted.

How is the government restricting the supply of HIPAA-compliant software?

I suspect HIPAA-compliant software is needlessly complex, such that only a few large companies can afford to supply it. Like the tax code.

It's really about who is willing to sign a business associate agreement and take the fall if something bad happens. Complexity just varies based on the implementing-companies aversion to risk. Bigger companies (appear to) have more to lose and therefore (might) implement more robust and complex solutions. A smaller company might flout more best practices than you're willing to accept - and then you can pretend to be ignorant rather than asking for an explanation about their infrastructure and hope it doesn't bite you in the ass (since you're still responsible for vetting companies even when you've initiated a business associate agreement). Both are "HIPAA-compliant", but the smaller company probably isn't HIPAA-compliant in the way one might hope.

Of course, there are people who are very afraid of what might happen if they don't take HIPAA seriously even at smaller companies. I suppose those companies turn into big expensive companies pretty quickly.

Not sure how big rsync.net is, and no I'm not advertising, but their pricing is reasonable and I trust that they really are HIPAA compliant in the way that I'm willing to accept. So this isn't a strict rule, but I do think that there are a lot of situations where you have a non-compliant product that is more compliant than the "HIPAA-compliant" product.

Re: Why doctors pay millions in fees that could be spent on care

#72

Post by alexpotato »

codegeek wrote: post #22
Vvector wrote: post #20

Earlier quoted context omitted.

Imagine if we had "food insurance". Your grocery store is "in network", but the butcher sends you a bill because he is out-of-network. No prices on anything, because your insurance carrier has "negotiated" a price for you, which you only find out after the fact.

Or imagine you had Car Insurance butting in everything including an Oil change and dictating which shop you can use for the oil change. I bet it won't be a $20-$30 oil change anymore and your premiums will be much higher than it already is. Btw, don't give the Food industry these ideas :). It would suck if we now have "Food Insurance"

> Or imagine you had Car Insurance butting in everything including an Oil change and dictating which shop you can use for the oil change.

This kind of already exists with insurance and car repair.

If I damage my car, I take it to an approved repair shop and they give me an estimate. It's in the car repair shop's best interest to provide a quick estimate and good repair. If they don't, I can raise the issue with my insurer who might even lose me as a customer. The repair shop would then potentially lose out on repeat business from the insurance company.

Granted, this is a better example of a not-so-free market working vs the "locked in market" of healthcare but I think it's good to provide some counter examples to "it's ALWAYS bad to have insurers with preferred vendors"

Re: Why doctors pay millions in fees that could be spent on care

#73

Post by alexpotato »

bombcar wrote: post #37
codegeek wrote: post #22

Earlier quoted context omitted.

Or imagine you had Car Insurance butting in everything including an Oil change and dictating which shop you can use for the oil change. I bet it won't be a $20-$30 oil change anymore and your premiums will be much higher than it already is. Btw, don't give the Food industry these ideas :). It would suck if we now have "Food Insurance"

"Food Insurance" does exist in some places and cases; many colleges charge for "room and board" if you live on-campus, so you're paying for meals even if you don't eat them that day, or at all.

My university used to have "X meals per week" plans.

People hated them b/c: - you couldn't use a meal twice in the lunch period e.g. have a late breakfast at 11am and and early dinner at 3pm

- you lost all of your meals at the end of the week

They then switched to "Y meals per semester" and people loved it.

- you could get an extra takeout meal for later (or a friend)

- you could eat three times a day on the weeks you were at school and less if you were away for a trip etc

- they actually released a price for lunch($6) and dinner($11( so you could arbitrage getting a cheap lunch vs buying dinner somewhere else

Re: Why doctors pay millions in fees that could be spent on care

#74

Post by za3faran »

offsky wrote: post #69

I was recently at a museum and I had two choices to buy a ticket. Buy a paper ticket from a real person or use a self-service kiosk which emails me a ticket for a $5 electronic delivery fee. Why?? I am always baffled by fees for electronic delivery of anything.

You're paying for convenience. Why go wait in line for God knows how long when you can pay a fee and get it immediately? Otherwise I agree that the charges can be exorbitant.

Re: Why doctors pay millions in fees that could be spent on care

#75

Post by dv_dt »

qwytw wrote: post #67
dv_dt wrote: post #66

Earlier quoted context omitted.

In terms of total expenditure per capita the picture is a little different, https://ourworldindata.org/grapher/annual-healthcare-expendi... I wouldn’t dismiss a comparison vs percentage GDP, but it is a little different than absolute expenditure and abstracts the some aspects out differently. Absolute per capita expenditures if nothing else seems a little less volatile.

That chart only goes to 2019, though. Switzerland has been spending exactly as much as Germany since covid started: https://data.oecd.org/chart/79Yf But I don't agree about comparing absolute spending. Of course there are caveats when using GDP but you really can't expect countries where salaries and other costs are much higher like Switzerland to not spend quite a bit more than poorer countries (and this doesn't rea…

PPP is a fair consideration, but Covid I think threw a lot of gdp relative measures out of whack for 2020-2022. And of course as mentioned in other threads, many of the national healthcare systems have significant regulation of procedure and drug prices. Switzerland also iirc has enough public hospital services that it serves as an additional anchor to check private pricing.

Re: Why doctors pay millions in fees that could be spent on care

#76

Post by tredre3 »

za3faran wrote: post #74
offsky wrote: post #69

I was recently at a museum and I had two choices to buy a ticket. Buy a paper ticket from a real person or use a self-service kiosk which emails me a ticket for a $5 electronic delivery fee. Why?? I am always baffled by fees for electronic delivery of anything.

You're paying for convenience. Why go wait in line for God knows how long when you can pay a fee and get it immediately? Otherwise I agree that the charges can be exorbitant.

But he said he was at the museum. At this point a paper ticket is the more convenient option, rather than have to find your smartphone and open your emails.

Re: Why doctors pay millions in fees that could be spent on care

#77

Post by senectus1 »

no_wizard wrote: post #21

Medical Billing is ripe for disruption, but of note, I don't know of any startup that has made significant inroads into this market. Anyone know why its so tough to break?

oh yes, lets apply gig economy thinking here.

demand scaling prices and share doctoring.

Re: Why doctors pay millions in fees that could be spent on care

#78

Post by bombcar »

alexpotato wrote: post #73
bombcar wrote: post #37

Earlier quoted context omitted.

"Food Insurance" does exist in some places and cases; many colleges charge for "room and board" if you live on-campus, so you're paying for meals even if you don't eat them that day, or at all.

My university used to have "X meals per week" plans. People hated them b/c: - you couldn't use a meal twice in the lunch period e.g. have a late breakfast at 11am and and early dinner at 3pm - you lost all of your meals at the end of the week They then switched to "Y meals per semester" and people loved it. - you could get an extra takeout meal for later (or a friend) - you could eat three times a day on the weeks yo…

This is the kind of example where a small change for the “company” greatly increases “customer” happiness.

I feel there’s a ton of room for that in healthcare.

Re: Why doctors pay millions in fees that could be spent on care

#79

Post by profile53 »

jimbob45 wrote: post #61
deniz_tekalp wrote: post #23

The comments so far miss the point. Off-the-shelf software is not HIPAA compliant. Government restricts supply through regulation, monopolists collect rent. If HIPAA were to be relaxed, off-the-shelf software can be used and fees would plummet. Don't blame "insurers", "middlemen", "capitalism" etc; blame well-intentioned / poorly designed regulations.

It's a great time to repeal HIPAA anyway. I suspect that if you surveyed Americans, most would believe that their health information has already been leaked to the point of making HIPAA obsolete anyway. The Europeans were doing just fine without HIPAA right up until the GDPR anyway. I seriously doubt people would choose HIPAA over the savings they could have if it was to evaporate.

That’s a terrible idea. Legally your doctor’s office owns your medical records and HIPAA is the only reason why the ER/a new doctor/urgent care/etc can access your medical history.
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