No system is perfect. The goal is to figure out how to help as many as possible, in the most cost effective way. That comes with compromise.
As it stands, we have a two tiered system, the best in the world and third world. Medical debt is the leading cause of bankruptcy in the US, at over 60% and roughly half of those are insured.
Even if you have good insurance, it can take months to be seen, and then you get 5 minutes from many doctors and a complete inability to comprehend nuance.
There are definite issues in Canada but that shouldn’t deter the US from finding some kind of alternative to what we have now. Waiting months for appointments and surgery is already happening right here - as is the difficulty finding a doctor that will see you. And I live in MA where the health care is good - I can’t imagine the challenges facing Americans where access is limited.
Recommendation: Colorectal Cancer: Screening | United States Preventive Services Taskforce – see figures 1 and 2 at the bottom to compare benefits and harms of each screening method, as well as estimated lifetime colonoscopies and other tests of each screening method. The latter can be used for cost comparison. Colonoscopy as primary averts about 7-8% more deaths than FIT, but also means more complication risk.
Yep, and much of this is due to the patients behaving as customers in what is a highly competitive industry. Healthcare entities and providers have to satisfy their patients/customers, because their facilities, services, bedside manner, etc. are being publicly rated by them. These ratings can correlate to greater money/revenues going to the entity, e.g., Medicare STAR ratings, growth in customer numbers, etc. Here’s one study: https://patientengagementhit.com/news/online-reputation-provider-reviews-tied-to-hospital-revenue
So, all of that leads to fancy hospitals and buildings with amenities, and HCPs saying yes to patient/customer requests for MRI for back pain, or elective C-section, or antibiotics to treat a virus, or a faster surgery date, or any of thousands of other things. Not sure that genie is going back in the bottle.
It can be easy for providers to accommodate when it means more revenue for them…
You have to wonder if those patients remember any high school biology… or realize that antibiotics can be unpleasant (digestive issues due to disruption of gut bacteria).
Until 2015 only 20% of hospital beds in Montreal area hospitals had air conditioning. Patients’ families could not bring in portable AC units because the hospital’s electrical system could not handle the extra demand. The opening of two new hospitals has raised the rate of air-conditioned rooms to 50%.
Is that what Americans would tolerate?
I am not familiar with USPST and whether insurers (including Medicare) adopt their recommendations. The data in figures 1 and 2 show exactly why I will stick with colonoscopies. If one chooses lighter sedation during the colonoscopy I expect the risks decrease (but don’t have supporting data to share).
Given how warm they keep medical offices and hospitals inside*, it seems surprising that air conditioning is needed.
*Patients tend to skew older, and older people prefer warmth, plus people may be undressing for examination etc…
Risks of sedation may decrease, but there are still risks of colon perforation during colonoscopy.
I agree, and this factor will persist in a single payer system. Physicians (depending on their employment situation) will still be paid to do procedures (and be publicly rated on their ‘skill’), and hospitals will still be paid when their MRI machine is used, just to take two examples.
It does get hot in Montreal in the summer with frequent heat waves of 90 degree plus temperatures.
‘This has been a nightmare:’ families slam hospitals with no A/C amid deadly heat wave | CTV News Temperatures in this article are in Celsius.
Would it be that we if everyone paid cash? I don’t think so. It got that way because we’ve been shielded from the true cost, and it’s now coming back to haunt us.
Sedation! That is a big one. People choose to get put out for a root canal or steroid joint injection. Had both with just local numbing and can say did not feel any serious discomfort. Sedation would have added $2k to that joint injection (had to call the clinic to take it off the bill even though it was insurance, not me paying).
Of course, that depends on everyone saving up to cover the risk of medical bills… Employers, unions, and the government (for Medicare) offered insurance because people did not save up to cover the risk of medical bills.
Higher deductible insurance could theoretically impose some market discipline for lower cost medical needs, but it seems that even those deductible amounts are beyond what many people will save to cover medical bill risk, hence the frequency of medical bill bankruptcy even among those with insurance.
Exactly…more customer behaviors/desires/demands that cost big bucks.
Maternal request (aka elective) pre-labor C-sections are actually cost effective. What is expensive is unplanned (aka emergency) C-sections. This is because unplanned C-sections involve both the costs of the labor PLUS the costs of the C-section which is more likely to be complicated as it occurs on an urgent basis with the fetus already partly into the birth canal, plus higher risk of adverse neonatal outcomes (low overall percentage, but extremely expensive when they do occur.) Trying to save money by lowering the C-Section rate is penny wise pound foolish as the UK “Campaign for Normal Birth” has revealed.
Yes, in some cases. However, most customers would not know that a joint injection can be done with sedation. It was offered to me by the doc. I refused. A few local shots did the trick.
Nope.
Every party in the medical system has culpability for spiraling healthcare costs.
However, patients are an important party in the medical system. They also share responsibility and that usually isn’t brought up.
There is a subset of US patients who treat the healthcare system like an all you can buffet with no regard to cost and unnecessary waste of resources.
They disdain generalists and will only seek specialists. They will not take generic medications. They have researched the internet and know exactly what they want as soon as they enter the door. And they are upset when they do not get their way.
For some, preventive care is not a priority. They are not compliant with their medications, their follow-up appointments, and they do not listen to their doctor’s advice.
There are patients who doctor and hospital shop for only the “best.” They equate better care with ordering more tests, especially expensive tests. They want things done quickly and are not willing to wait.
There are young, healthy patients who want their doctor to order MRIs for their recent history of low back pain or headache. They want a CT scan to evaluate their gastroenteritis. They want the dermatologist to biopsy a stable mole that has been there for 20 years. They want an expensive antibiotic prescribed for a cold. They want an X-ray for an obvious ankle sprain. There are also patients who think nothing of calling 911 to have an ambulance bring them to the hospital when they have a minor ankle sprain.
Providers and healthcare organizations are graded by various consumer reviews such has online ratings and Press-Ganey scores. They also have to respond to patient complaints and are often motivated by the fear of litigation for any undesirable outcome. Unfortunately, the old adage, “the customer is always right” is often applied even when the customer is clearly wrong.
100% true! It’s largely because we aren’t paying the actual cost though. How many of us would demand “the best” if it was 5% better, but would cost us 2000% more?