The bizarre calculus of emergency room charges

[c1ue]

Re: The bizarre calculus of emergency room charges

Do these numbers really help to understand healthcare...consider the populations and the homogenous make up of the population vs the United States.........statistics lie....

I'm curious as to what exactly you're trying to say.

Are you saying that having more people means less efficiency? Because normally it is the other way around: the larger you are, the better the economy of scale.

The point of dc's data was that the US spends ridiculously more than any other nation, both in absolute and percent per capita terms, but clearly does not achieve better results.

Whether the absolute results are worse or not in material terms can be argued, but the efficiency of health care spending is without question extremely poor in the US.

[lektrode]

Re: The bizarre calculus of emergency room charges

Oh, there's no doubt in my mind that you're correct. Still, how long can that simple fact continue to perpetuate a super-expensive, broken system? And how can anyone claim it's anything but broken when health care costs twice as much as everywhere else in the first world with no measurable increase in lifespan or wellness?

ok heres the numero uno question: how much does labor cost in the med sector, as a % of med service delivery operations cost in The US vs elsewhere? (facilities expense is another good comparison)

and whats the ratio of med labor to other sectors (say compared with mfg, (autos, jets, trains, , machinery, consumables, etc) construction, edu, (would ask about .gov% but then most of the other places the .gov (taxpayer base) pays for it, so how can it be separated?)

and how much more are US med people paid vs elsewhere?

would seem that merely comparing total costs isnt giving us a good feel for where all the money/difference ends up flowing to?

would think/hope jk would have some great insights on this?

[lektrode]

Re: The bizarre calculus of emergency room charges

Whether the absolute results are worse or not in material terms can be argued, but the efficiency of health care spending is without question extremely poor in the US.

and for the 400 billion thats skimmed off the top in 'profits' ???
one would think we'd get a little more in the way of 'results' too, eh?

why i think it would be interesting to break out the ops expenses by line item vs elsewhere - am hoping dc and jk can offer more on this - anybody else got data on personel, facilities, utilities, equipment costs, supplies, and malpractice/liability ins as a % of operational costs of the providers - as it pertains to US medical industry (and vs elsewhere too)

mr mesyn?

[jk]

Re: The bizarre calculus of emergency room charges

i used to think that the u.s. health statistics sucked [relatively speaking] because we really had 2 healthcare systems, one for those with money and insurance, and the other for the poor, and that the latter pulled down the outcome statistics. however, data shows that our statistics are worse than e.g. the u.k.'s, even for those with good insurance. i suspect this has more to do with nutrition, obesity, and so on than to medical care. however, it means that even those in the "good" u.s. system don't have better health outcomes. we just pay a lot more for it.

this also points out the power of the agribusiness sector. they shape the agriculture bills which are really disguised nutritional-policy bills. we subsidize corn, for example, so we get corn syrup, modified corn starch and so on in all the processed foods. we don't subsidize vegetables. the cheap calories are the subsidized calories, are the starchy obesity-causing calories, and thus the diabetogenic calories. conagra and adm et al are making money producing obesity and diabetes and raising health care costs.

i also used to think that high drug prices in the u.s. was the u.s.'s gift to the world, i.e. that we were paying for all the r&d costs to develop new drugs while the rest of the world got to buy the drugs for marginal cost. however, i've since learned that 85% of the r&d is to develop "me too" drugs and for patent extensions, not to develop anything really new. "me too" drugs can be useful, but that statistic is disheartening. so now i think we pay higher drug prices because pharma pays off the congress' billy tauzin's, pure and simple.

i think the only hope for seriously reforming the medical system will come from a kapoom that forces a radical rethink of all spending.

[Andreuccio]

Re: The bizarre calculus of emergency room charges

Our oldest had a bad ear infection on a Sunday morning.

Rather than have him continue in pain until Monday my wife took him to the Hospital Emergency Room on Sunday midday.

After a 2-3 hour wait my son was seen by an ER doc for approximately 2 minutes.

He was prescribed some antibiotics.

We were billed just over $1100US.

While we are fortunate to be able to afford it, it is simply insane.

The biggest issue we have is the complete lack of non-emergency options outside of bankers hours in the US.

In NZ we have numerous "24 hour surgeries" that are well equipped to act as after hours GPs and minor emergency care facilities and pharmacies to keep patients from going to the hig basis emergency rooms and are reasonably priced.

And NZ is a place with quite limited business/retail hours of operation and lower economies of scale compared to the US.


Where's the McDonald's of healthcare in the US?

Maybe not McDonalds, but we often use what might be the taco truck of helthcare. My wife's family are mexican immigrants, and through them we've found clinics that are very reasonably priced and provide good care, at least for some things.

For $30 or$40 we can see a doctor any day if the week until 9 pm. Some of them will make housecalls for $100 at all hours. For minor issues, like ear infections, we get the rx quickly and at a reasonable price. For more major issues, they'll let us know what they think it is and what tests they recommend. We then either wait to see our primary care through the insuranse or, if urgent, go to the er.

In general, we like the doctors better than the hmo docs. If we could get tests they ordered paid through the hmo we would use them exclusively.

[shiny!]

Re: The bizarre calculus of emergency room charges

Maybe not McDonalds, but we often use what might be the taco truck of helthcare. My wife's family are mexican immigrants, and through them we've found clinics that are very reasonably priced and provide good care, at least for some things.

For $30 or$40 we can see a doctor any day if the week until 9 pm. Some of them will make housecalls for $100 at all hours. For minor issues, like ear infections, we get the rx quickly and at a reasonable price. For more major issues, they'll let us know what they think it is and what tests they recommend. We then either wait to see our primary care through the insuranse or, if urgent, go to the er.

In general, we like the doctors better than the hmo docs. If we could get tests they ordered paid through the hmo we would use them exclusively.

This is very interesting. My insurance out-of-pocket is so high I haven't gone to the doctor for anything in a year, except for prolotherapy which isn't covered anyway. I live in an area with a lot of Mexican immigrants. Maybe I should check out some of the clinics in their neighborhoods.

[lakedaemonian]

Re: The bizarre calculus of emergency room charges

Maybe not McDonalds, but we often use what might be the taco truck of helthcare. My wife's family are mexican immigrants, and through them we've found clinics that are very reasonably priced and provide good care, at least for some things.

For $30 or$40 we can see a doctor any day if the week until 9 pm. Some of them will make housecalls for $100 at all hours. For minor issues, like ear infections, we get the rx quickly and at a reasonable price. For more major issues, they'll let us know what they think it is and what tests they recommend. We then either wait to see our primary care through the insuranse or, if urgent, go to the er.

In general, we like the doctors better than the hmo docs. If we could get tests they ordered paid through the hmo we would use them exclusively.

Interesting concept.....I can imagine the possibility of general practice configured vehicles combined with modern telecommunications to allow a network of physician assistant/nurse practitioners connected with GPs in a central office to provide a reasonably good level of care for low(er) cost leveraging off of a smaller number of GPs.

It fits into the inflation thru lower quality/quantity theme discussed here before(supermarket goods repackaging less content for the same old price), but it could fit into a "good enough, cheap enough" round peg, round hole.

[lakedaemonian]

Re: The bizarre calculus of emergency room charges

Interesting concept.....I can imagine the possibility of general practice configured vehicles combined with modern telecommunications to allow a network of physician assistant/nurse practitioners connected with GPs in a central office to provide a reasonably good level of care for low(er) cost leveraging off of a smaller number of GPs.

It fits into the inflation thru lower quality/quantity theme discussed here before(supermarket goods repackaging less content for the same old price), but it could fit into a "good enough, cheap enough" round peg, round hole.

I don't know if telemedicine will be more of a product(the infrastructure that makes it happen) or a service(the mid level health care provider working under the remote direction of high level providers like GPs and specialist MDs)...but I suspect this space will become quite busy in the coming decade or two.

Relentlessly increasing healthcare costs combined with ubiquitous telecommunications bandwidth smells like some real opportunity to shake things up and create some new or highly revised business models.

I can see the mid-level care provider(physician assistant and nurse practitioner) being an area of considerable job growth in the coming decade or two.

Having just started a remote medical practitioner program it seems like telemedicine has considerable potential for high growth no matter how challenging the economic climate. I wonder if a challenging economic climate might even help accelerate the field and provide a bit of a tailwind.

[jiimbergin]

Re: The bizarre calculus of emergency room charges

Oh, there's no doubt in my mind that you're correct. Still, how long can that simple fact continue to perpetuate a super-expensive, broken system? And how can anyone claim it's anything but broken when health care costs twice as much as everywhere else in the first world with no measurable increase in lifespan or wellness?

Perhaps it would be useful to play another mind game. Let's swap out deciding to buy a vehicle for deciding what sort of health care system to have.

That's like paying $60k for a Toyota Camry because your friend works for Toyota. Plus other mid-size cars are scary - what if they break down? You've never driven a Taurus. Better to pony up the $1,200 per month payment on the devil you know, you think...

When you think of it this way, what we do is almost the definition of irrational. Yet here we are. And if SCOTUS strikes the whole law down, the trend over the last couple of decades will definitely hold, because nothing will have changed. Prices are doubling every 20 years even in times of relatively low overall inflation. Already it costs twice as much for the same basic thing (a midsize car or healthcare system) than anybody else pays. How long can ideology and special interests win over the pocketbook and lifestyle of American citizens? How much of average compensation can go towards health insurance before we hit the breaking point? These are good questions, to which I don't know the answer.

I do know that the healthcare system in the U.S. makes us less competitive for industry. It adds a lot to the hiring cost. Shouldn't there be enough lobbyists on that side to balance the see-saw by now? Or do they just not care and build a plant in Hamilton, ON instead? Who knows. But I know that these numbers don't speak so highly for the American system:

There are many problems with the above table. Forbes has an article that explains part of the problem. First of all life expectancy is a terrible way to measure health. Besides many of the problems mentioned in the Forbes article linked below, the very definition of life varies by country. In some countries a baby who is born "alive" but dies shortly thereafter (up to 30 days in some areas of the world) are not even counted as ever being alive, which can dramatically change the life expectancy calculation. Fatal accidents, of which we are king, greatly reduce life expectancy, and they have little, if anything, to do with health. There are many other reasons some of which are in this article and the other articles mentioned.

http://www.forbes.com/sites/aroy/201...fe-expectancy/

Please read the article.

[Shakespear]

Re: The bizarre calculus of emergency room charges

If it's about anything it is about money and most certainly not the people.

The US has a nice money making machine and those making profits from it don't want it to change. I hear so many Canadian friends say that their system is not perfect but it is good enough for them not to run them to the poor house if they get sick. Well not so in the US. All that high tech does not make Americans any healthier and most certainly makes them poorer.

The Food Preparation Machine churns out food full of chemicals/sugar/salt that when I come in from Europe can not but notice the difference. The results are seen on the sidewalks.

Now these "prepared" people are ready to get serious health problems and need to "enter" the Health Care Machine which when it is done with them there is nothing left in their pockets.

It is a racket as bad as the Prohibition. Some have had enough and are in the fortunate position to leave the Machine.

http://www.commondreams.org/headline/2012/04/07-1


Wow to those that can not.

[bpr]

Re: The bizarre calculus of emergency room charges

even if you are paying thousands of bux/year for 'insurance' one still is left with the idea that when it really matters, the only way one gets what one is paying for is to threaten legal action.

There are three ways, and, having handled inbound (angry) calls for health insurers, they take threats in degrees of severity:

1. Legal threats: "You'll be hearing from my lawyer..."
2. Regulatory threats: "I'm going to get in touch with the state insurance board."
3. Publicity threats: "I'm going to Call Bob Spersky who does Spersky's Scams every week on the local news and he's going to expose your fraud..."

I worked for the largest health insurer in the country ten years ago, and here was the protocol for handling these calls:

1. Legal threats: Promptly give them the address and phone number of the appropriate in-house lawyer (with name) and address that their lawyer should contact. Ask if there's anything else you can help with and politely end the call.

2. Regulatory threats: Promptly give them the address, phone number and email address of the state regulatory agency they should contact. Ask if there's anything else you can help with and politely end the call.

3. Publicity threats: Assure the caller that we will be able to help them. Agree with them. Calm them down, and keep them on the phone. Assess their need and ask if they can hold while you contact a supervisor...

Publicity threats were taken more seriously than anything. Even more seriously than homicidal threats ("I'm going to drive a truck full of C4..." and yeah, we got those, too).

Spersky's Scams casting light on the fraud is a lot scarier than legal threats that can be buried by lawyers to these companies that operate in the shadows.

[Thailandnotes]

Re: The bizarre calculus of emergency room charges

3. Publicity threats: Assure the caller that we will be able to help them. Agree with them. Calm them down, and keep them on the phone. Assess their need and ask if they can hold while you contact a supervisor...

Publicity threats were taken more seriously than anything. Even more seriously than homicidal threats ("I'm going to drive a truck full of C4..." and yeah, we got those, too).

This is why I keep coming back here. Thanks.

In Thailand there is still a lot of transparency with healthcare. You can shop doctors and hospitals and know what you will get and how much it will cost.

I recently renewed my health insurance here. I’m 56 w/o pre-existing conditions. The insurance costs 1,250 US $ per year. The deductibles are low and the policy covers me for up to 7 weeks if I travel to the states. Procedures here remain so inexpensive I often don’t file. Major procedures like colonoscopies cost 500 dollars instead of 5,000. Tests are done here on state-of-the-art equipment by well-trained doctors and nurses. Last month, fearing I was developing pneumonia, I had an EKG and chest x-ray, reviewing the results with a doctor. Total price was 45 US dollars.

Ten years ago, my wife fainted in LAX. We were forced by airport officials to exit the airport in an ambulance. The bill for the ride was a bit over 10,000 dollars.

[Dave Stratman]

Re: The bizarre calculus of emergency room charges

Why does this seems like a Sci-Fi story?



http://www.latimes.com/health/la-me-...6799675.column

I think there is reason behind all this madness. It comes down to a matter of social control; that is, people in the U.S. are made more dependent on their employers and more insecure in their lives than people in other industrialized countries by the absence of single payer/socialized medicine. While insurance costs add to the costs of production for U.S. manufacturers, the overall higher level of social insecurity in the U.S. tends to keep wages and thus costs down. Companies such as GM, which one would expect would benefit directly from socialized medicine as a means of controlling costs, still have opposed it. For an interesting discussion of the issue, see John Spritzler, "Market-Driven Health Care And Social Control"

[c1ue]

Re: The bizarre calculus of emergency room charges

I don't know if telemedicine will be more of a product(the infrastructure that makes it happen) or a service(the mid level health care provider working under the remote direction of high level providers like GPs and specialist MDs)...but I suspect this space will become quite busy in the coming decade or two.

Telemedicine in the teleoperative sense has a large number of both structural and societal/economic limitations:

1) Unless there are large percentages of doctors sitting around with nothing to do, it is quite unclear how the ability to project skills across the Internet is going to help with supply. Far more likely is that you'll see "doctor franchises" like you see with famous chefs.

2) The existing provider networks already limit medical practice both for public safety and for job security - how would teleoperated medicine fit in with that? Just imagine how the AMA would react to foreign doctors practicing in the US via the internet

3) Cost of equipment. A full teleoperative setup is likely 7 or 8 digits in cost, plus significant maintenance. A hospital's operating expenses aren't just the capital depreciation of its MRIs and what not, but also the ongoing building, supply, sanitation, disposal, and so forth.

4) The actual doctor's fees in many operations seems to be insignificant; I know my own $35K operation - the one doing the operating got paid $1200. So how does teleoperative medicine help then?

I do think teleoperative medicine may have some benefits for rural areas where population density is too low to support a full medical infrastructure, but I equally doubt that is the market being targeted.

As for teledirection - I don't see this working at all.

Just consider the ramifications of malpractice insurance in the context of a non-certified practitioner working under the direction of a certified practitioner. If something goes wrong, who gets sued and for what? Does this mean the certified practitioner must now also insure the non-certified practitioner for malpractice? How do non-certified practitioners perform the subconscious exercise of skill sets which they don't have - i.e. noticing things wrong besides what the patient says?

What about things like prescriptions? Do non-certified practitioners get to dispense prescriptions? How do you control the non-certifieds from writing prescriptions not dictated by the certified?

As someone who has been involved with packet type communications for 25 years, the idea of practicing medicine in the face of 'internet lag', DDoS, trojans, viruses, OS incompatibilities, Internet browser updates or lack thereof, HTML protocol updates and lack thereof, and so forth is quite unappealing.

[Master Shake]

Re: The bizarre calculus of emergency room charges

Here's an easy solution that doesn't require Congreff passing a bill thousands of pages long that nobody read. Instead they can pass a much shorter bill stating that the amount paid by any uninsured person for a specific service will equal the actual average amount paid by the insurers for that service for the prior 12 months.