The question is why is it 20 times more costly here than in India, for example? Or Germany? People all over the world have this condition and are treated at lower cost than here.
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Their solutions aren’t magical, just extremely pragmatic.
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“The Indian hospitals transfer responsibility for routine tasks to lower-skilled workers, leaving expert doctors to handle only the most complicated procedures…[…]…Compare that to the U.S. system, where the first cost-cutting move is often to lay off support staff, shifting more mundane tasks such as billing and transcription onto doctors overqualified for those duties — precisely the wrong kind of task shifting.”
Yep. I do my own billing, type my own notes, print out endless required forms, hand-hold patents as they schedule follow-ups, oh the list goes on! These are tasks that others used to do, but the EMR has shifted them onto doctors. I spend maybe 1/3 of my time being a doctor, and 2/3 of my time being a secretary. It is extremely inefficient.
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If you were working in India, there probably would be a lot less overhead and paperwork for you, since the article says patients pay 60-70% of healthcare costs out of pocket.
Yes, I would be doing less paperwork, but I would also be very stressed because the poor people there just can’t afford care and end up dying.
Personally, I would like to work in a country with universal coverage. I don’t care which model (e.g. Canada, UK, Germany etc) as long as there is universal coverage. I would not care if I got paid less (I have spent many years of my career at a safety-net clinic getting paid <1/2 of market rates.) I would even continue to put up with all the crappy paperwork. I just wish healthcare in the US was more equitable. At its best, US healthcare is extremely high quality. But what does that benefit a person if they don’t have access to that?
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The cost problem in our healthcare system can never be solved if there is no price transparency, no matter who pays. To me, that’s where we need to start. Opacity benefits the few with inside knowledge to the detriment of many outside the system. This isn’t limited to healthcare. In any high margin/cost business, insiders always fight for the preservation of this information asymmetry to benefit themselves.
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Then what you are advocating for is a single payer system. If there are potentially hundreds of payers in the US, each paying a different amount including
differing amounts to different healthcare organizations because of negotiated settlements, transparency is practically impossible. There is also the issue of the uninsured. How do you handle patients who don’t pay? Who eats the charge?
I consider myself relatively well informed, but medical bills are practically the only things that I can never figure out. If there’s more than one payer, there needs to be standardization among all of them, along with all service providers. From my perspective, the lack of standardization seems purposeful.
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Every insurance company does things differently. You have the issue of in-network vs out-of-network. You also have the issue of the co-pay and deductible… Insurances plans will cover certain treatments and not cover others. Some insurance plans cover a % of the usual customary fee. Others pay a flat free. Others pay a multiple of Medicare’s reimbursement schedule. It’s very complicated. In the meantime, healthcare organizations adjust their listed charges to take into account what they know they should expect to receive from their payers, so that they can stay in business and hopefully make a profit.
Yes, we need to reduce complexity, which also benefits the insiders. Complexity and opacity go hand in hand.
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I agree. And based on my efforts trying to figure them out I concluded that most patient/customer-facing employees don’t understand them either. I have so many examples of complete ineptitude that I will not bother recounting them. Byzantine describes the situation well. Monty Pythonesque also.
Clearly some serious external pressure to keep healthcare costs low….
“ Indians on average bear 60% to 70% of health care costs out of pocket….”
My friend’s daughter is a PCP at Kaiser. She is just overwhelmed by the volume of patients Kaiser assigns her to see everyday. She’s been there 5 years and she has 2500 patients in her care. One of the PCP just left and it added another 500 new patients assigned to her.
She is expecting her second baby and is seriously thinking of quitting patient care entirely after her maternity leave. It’s really a shame that she feels so completely exhausted by patient care followed by email responses, telephone callbacks and electronic medical records etc.
Sorry to hear that. Many providers are demoralized by their work. They feel like they are being treated like cogs in the wheel and are powerless to do anything about it. Many providers are employees of large healthcare systems who are getting progressively squeezing them to increase their productivity and to lower the system’s own costs.
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I’m sorry to hear this as well, and Kaiser in many ways is one of the better run insurers. They just announced this year they lost $4.5B in 2022. A pretty hefty sum. They can absorb a loss like that, but are facing many headwinds as outlined here Request Rejected
From that Kaiser report, it seems like many of those factors causing financial losses affect medical care in general.
“Factors that drove higher annual operating expenses included increased care volume — in part due to care deferred over the 3 years of the pandemic, higher costs of goods and services, additional outside care costs in contracted hospitals, an increase in labor costs due to a highly competitive labor market, and increased COVID-19 care and testing.”
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Wouldn’t that increase earnings?
Kaiser did have an increase in total revenues, but costs rose much faster. So, if the increase care volume was for care given at a breakeven or loss (for whatever reason), then no, that will not increase net earnings.
They say “in part due to care deferred” due to Covid. People delayed their care, and now present sicker/with more advanced disease. That’s more expensive to treat.
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This is what I mentioned earlier about Kaiser’s tendency to rely on hospitals outside their system (eg Stanford) to treat the most challenging cases. That means you couldn’t simply apply Kaiser’s way of operating on a universal basis without figuring out how to make provision for those cases.