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Health care anecdote

edited June 2014 in Everything Else
A couple of weeks back I fell off my bike. All my fault nothing to be done. Arm hurting like hell.

Next day went to doctor, phoned in the appointment in the morning, got a time at 10, 10:15 was on my way to the hospital for delicious x-rays. At hospital I had to wait 20 minutes and the staff was apologetic for the waiting time (it was lunch hour). Doctor #2 takes x-rays, says there is a long cue (== wait until the next day) for the analysis but will see what she can do about fast tracking me because it is an acute trauma.

Same afternoon doctor #1 calls with report (maybe broken) says go to trauma clinic. Arrive at trauma clinic, am told there'll be at least a half hour wait but I can go get something to eat at a nearby restaurant and not lose my place in line. Go to deli, eat, get back. Doctor #3 takes a look at arm, twists, pulls, pinches and declares a verdict of not broken but much fluid in joint therefore severe pain and restricted movement.

Three different hospitals/clinics, three doctors, x-rays, no paper work, walk in walk out, just show my driver's licence. Week later get bill in the mail:

29.90 euros.

Never been so happy about paying taxes!
Post edited by Dr. Timo on

Comments

  • In related news, I'm now looking up immigration info for Finland as well as Norway.
  • The American version of your story is mostly the same except no one takes your ACA insurance.
  • HMTKSteve said:

    The American version of your story is mostly the same except no one takes your ACA insurance.

    Uh, no, more like they take your insurance, but the insurance company refuses to pay.
  • HMTKSteve said:

    The American version of your story is mostly the same except no one takes your ACA insurance.

    Uh, no, more like they take your insurance, but the insurance company refuses to pay.
    Nope. My ex recently fell and fractured her upper arm. First stop was the urgent care center (they did accept her bronze plan). People there were great and there was very little waiting. Might be due in part to the center being located in an upper middle class area? After xrays it was time to go to a second location to see an orthopedic doctor.

    Arrived at the orthopedic office to find out that they do not accept ANY of the exchange plans. Paid about $300 out of pocket for the visit and a sling. After talking to the front desk we found that the nearest orthopedic office that takes the bronze insurance is about 50 miles away. Dr was willing to reclassify office visits to lower the cost since she would be paying cash.

    Office recommended two visits a week for rehab at $100 per visit over a two month period.

    The other problem is that she went from $5 a week for company plan with a low deductible to $100 a month for a high deductible plan. Compounded by reduced hours at work (over 30 hours a week and company has to provide old $5 plan) she now has insurance she has to pay a lot more for with a deductible so high it provides very little benefit.

    Last week the insurance company sent her a letter about a rate increase. In the letter they worded it to the effect of: "we are raising your rates bit since you get a subsidy to pay for it you won't be paying that much more..."

  • When I had my scooter accident I had to go to the after hours clinic. They gave me a brace and some crutches for my knee. $90 with insurance.
  • HMTKSteve said:

    HMTKSteve said:

    The American version of your story is mostly the same except no one takes your ACA insurance.

    Uh, no, more like they take your insurance, but the insurance company refuses to pay.
    Nope. My ex recently fell and fractured her upper arm. First stop was the urgent care center (they did accept her bronze plan). People there were great and there was very little waiting. Might be due in part to the center being located in an upper middle class area? After xrays it was time to go to a second location to see an orthopedic doctor.
    Let me offer another anecdote. Person I know with non-ACA insurance -- in fact, it's a military insurance plan (TRICARE to be specific) that he pays out of pocket for. Said person got nailed with a $13,000 bill because the insurance refused to pay for certain treatments for his wife.
  • Is your friend forced to buy tricare or face a government imposed penalty?
  • HMTKSteve said:

    Is your friend forced to buy tricare or face a government imposed penalty?

    Well, TRICARE or any other qualifying insurance program, obviously.

    The problem is that the health insurance system in this country is broken. The ACA is a band aid, but it's not a very good one.
  • Why can't it work like car insurance? If something gets broken I pay my deductible and then the insurance company covers everything after that until the fix is repaired. They then increase my premium based upon how much of the incident was my fault.

    "What's that, broke your leg? $500 and we cover the rest."
    "Mr Johnson? Well according to our records you broke your leg six months ago because you were drinking and thought you could fly? I am afraid we will have to raise your premium or deductible due to your stupidity and risky lifestyle."
    OR
    "Mr Johnson? Well according to our records you broke your leg six months ago when you were injured at a work related accident. After an investigation it was determined that you were not at fault. This incident will not be a factor in calculating the cost of your insurance."

    Health insurance isn't broken the high cost of medical care is broken.
  • Why can't everyone just have medicaid and then buy a la carte plans?
  • Part of the reason why medical care is so expensive is the broken insurance industry. The ACA put a cap on how much money the insurance industry can waste on things other than paying out benefits, but the cap is still relatively high at 15%. Compare that to the socialized medical systems in countries like the UK and Canada, where "administrative expenses" for their health care systems are about 5 and 6%, respectively.
  • Why can't everyone just have medicaid and then buy a la carte plans?

    BECAUSE EVIL SOCIALISM!!!
  • edited June 2014
    Medical care is not medical insurance.

    The cost of car insurance has zero impact on the cost of car repairs.

    Part of the problem is our own technological improvements in the medical field. If a generic version of a drug costs $0.10 and the name brand costs $1 why do we buy the name brand when it is not ten times better than the generic? When we buy computer parts we look at the value and often choose what meets our needs and provides the best performance at the price. We don't pay $1,000 for a graphics card that is only 20% better than the $400 one.

    If the $10,000,000 super medical machine is only 25% better than the $100,000 super medical machine why not stick with the cheaper one until the prices drop?
    Post edited by HMTKSteve on
  • edited June 2014
    HMTKSteve said:

    Part of the problem is our own technological improvements in the medical field. If a generic version of a drug costs $0.10 and the name brand costs $1 why do we buy the name brand when it is not ten times better than the generic? When we buy computer parts we look at the value and often choose what meets our needs and provides the best performance at the price. We don't pay $1,000 for a graphics card that is only 20% better than the $400 one.

    If the $10,000,000 super medical machine is only 25% better than the $100,000 super medical machine why not stick with the cheaper one until the prices drop?

    Because purchasing computer parts doesn't involve people dying.

    First, let's address the generic vs. brand name drug. A properly made generic drug is 100% chemically identical to the brand name, at least with regards to active ingredients. Therefore, a generic drug is a perfectly legitimate one-for-one substitute for a brand-name drug as it will be just as effective as the brand name drug. Heck, my existing insurance pretty much mandates generics when they are available and I have no problem with that. In addition, even when buying over-the-counter drugs, I almost always go with the generic/store brand ones unless I have a coupon or some other discount on the brand name that makes the brand name version cheaper. Generic drugs, when appropriate and available, are a good manner of keeping medical costs down.

    Now comparing computer parts to medical machines/procedures is not a good comparison at all. If I buy the $400 video card instead of the $1000 video card that you mentioned in your example, the worst that can happen is that I can only reach 48 frames per second instead of 60 frames per second in the latest FarCry or something like that. 48 FPS is probably still playable and, even if it's not, the card will probably still be fine for a significant number of high quality yet less demanding games. Not being able to play the latest FarCry is not a life or death situation.

    Going back to the medical machine, if 25% better means that my chances of living are also 25% better, then hell yeah, I want to use the better medical machine. With the computer parts, not paying more for a fancier video card effectively only means I may not be able to play some of the most bleeding edge games. In the case of medical equipment, not paying more for fancier machines potentially means I'm more likely to die. I can live without playing the latest FarCry. I can't live if I'm literally dead.

    That said, if the difference between the two medical machines is that the more expensive one is better at treating/diagnosing certain ailments than the cheaper machine but there is a common subset of ailments where both machines are equally effective, then yeah, there is no need to go with the more expensive machine when the cheaper one can handle my particular ailment just as well. However, if I happen to have one of the ailments that the more expensive machine is better at dealing with, then it's worth it to use the more expensive machine in order to avoid death or disability.
    Post edited by Dragonmaster Lou on
  • Yes, 25% better chance to live would be worth it. However for most cases the issue is not that simple.

    It could be an imaging machine. The one that costs 10x may provide a statistically negligible benefit to 99% of the people the machine is used on with only 1% having a true 'need' for the technology. The 99% would be served just fine using the 1x cost machine. However the medical facility does not see a point in having both machines so they opt for the 10x one and EVERYONE pays more.

    We are moving in the right direction with urgent care facilities vs ER visits but due to the issue of medicine having a life or death component (even when not present in a particular case) we as people do not want to use the old tech when the new tech is sitting over there especially when we are not accustomed to paying the true cost because of insurance. If the 10x machine costs me the same as the 1x (thanks to insurance) why would I choose the 1x?

    Insurance is a two edged sword. It's great not going bankrupt after a hospital visit but it is also terrible that costs have risen so high that a hospital visit can bankrupt you!
  • edited June 2014
    Another thing is those "administrative costs" might be subsidizing things like pencils and paper for the H&D, differentials, and other stuff. We have the existing technology right fucking now that hospitals and even primary care facilities could be completely digital with no problems. A doctor could walk into your room with a tablet (pucker factor of those things being pretty fragile notwithstanding) with your file already up, put in your symptoms, and have a program that lists possible diagnoses. Why don't they do that? Probably because initial equipment and service costs of setting that kind of a system up would be high, and too many doctors today were trained on the old way of writing everything down (hell students today are still being trained to do that).
    Post edited by Jack Draigo on
  • edited June 2014
    Could be HIPAA rules.
    Post edited by HMTKSteve on
  • edited June 2014
    Again, I stated that if all other things are equal, I'm fine with using the less expensive machine as opposed to the pricier machine if the end result will be the same.

    One thing I've noticed is that a lot of places that practice socialized medicine seem to use what can best be described as "escalating diagnostic procedures." Essentially, based on a combination of what symptoms you first present and the possible severity of the ailment, they'll use less expensive diagnostic equipment first and only work their way up to the fancier stuff as necessary. For example, if you injured your foot, they'll do some range of motion tests and whatnot to determine the likelihood of a sprain as opposed to a break before even bothering to ask for X-rays. If it looks like you only have a sprain based on these initial tests, then they'll tell you to treat the injury as a sprain and to call your doctor if it hasn't gotten better in a couple of days. At that point, if it hasn't gotten better, then they'll order up X-rays as the odds are greater that you have a small break and progress from there. The worst case result in this situation is that you'll have a sore foot for a couple more days than you would if you got treated for the break right away. The more severe/life threatening/etc. the situation, of course, the more fancy the equipment/techniques they'd use off the bat, as appropriate.

    The reason why we don't see this so much in the US is twofold: 1, doctors often order up the uber-techniques ASAP as a CYA move to avoid malpractice suits. 2, doctors often get paid more for recommending more expensive procedures, even if cheaper procedures would be sufficient. Issue 2 can easily be fixed by changing doctor compensation to a salary as opposed to the current "fee for service" model (some prominent hospitals, like the Cleveland Clinic, have already done this). 1 is much trickier as there is a need to hold doctors who legitimately screwed up accountable, but we don't want to do it in such a way that it hurts the entire medical profession as well as makes costs ridiculously high for all involved. Going back to the injured foot example above, it was actually something I personally experienced at the local urgent care. It was an American facility, but the doctor who saw me said he was using a Canadian cost control technique, with my informed consent. I agreed to it, knowing that the worst that could happen in this case was a few more days of a sore foot, and it turns out he was mistaken -- I did have a minor break that only showed up on X-rays. Did I choose to sue? No, because it was a minor error that had no long-term consequences for me. However, if it was a major error that resulted in my foot having to be amputated due to his screw up, then yeah, I'd be tempted to sue. That's the crazy malpractice balancing act patients and doctors have to deal with (though some patients will look for the smallest reasons possible to sue, hoping to make a big pay day. I happen to not be one of them).
    Post edited by Dragonmaster Lou on
  • edited June 2014
    Out of curiosity, how do the socialized medicine countries deal with malpractice?
    Post edited by HMTKSteve on
  • edited June 2014
    HMTKSteve said:

    Out of curiosity, how do the socialized medicine countries deal with malpractice?

    That is a very good question. England apparently does allow malpractice lawsuits, but they have some pretty strict rules as to what actually constitutes negligence and malice (which are the only things you can sue for, apparently). If the doctor's actions were the actions that any reasonable doctor would have taken in the same situation, no matter the result, then there was no malpractice, for example. They also apparently give some leeway in situations were you'd be just as screwed even if the doctor didn't screw up. However, I am not a lawyer, let alone one with knowledge of English tort law, so take this with a grain of salt.

    New Zealand's approach, however, seems to be a no-fault compensation system, whereas if something happened to you because a doctor possibly screwed up, then you'll be fairly compensated, but no fault will be found with the doctor. Presumably they'd also have some way of tracking if a doctor frequently screws up and that would result in loss of his/her license or something.
    Post edited by Dragonmaster Lou on
  • edited June 2014
    Good luck getting that to happen in the US. The trial lawyers pretty much shit a brick when fee shifting was brought up regarding patent reform. Suffice to say that portion of the new patent law was scrubbed.

    There are far too many "slip and fall" type lawyers working medical malpractice in the US.
    Post edited by HMTKSteve on
  • HMTKSteve said:

    Good luck getting that to happen in the US. The trial lawyers pretty much shit a brick when fee shifting was brought up regarding patent reform. Suffice to say that portion of the new patent law was scrubbed.

    There are far too many "slip and fall" type lawyers working medical malpractice in the US.

    Indeed, and that is part of the problem. One other thing to keep in mind is that malpractice cases are decided by a judge in England, whereas (as far as I know) they are decided by a jury in the US. I've heard way too many stories about malpractice and personal injury lawyers awarding large amounts of money to the plaintiffs just because they wanted to "stick it to the man" (i.e. the defendant), ignoring just how at fault the defendant was. An example I heard of from a former co-worker from when he was on jury duty was a case where a fellow juror wanted to award the plaintiff in an automobile accident case "a million dollars" simply because "she felt like she deserved it." Never mind that the facts of the case were that many of the plaintiff's injuries were caused by her not wearing a seatbelt at the time of the accident. Fortunately, there were enough smart jurors, including my former co-worker, that the defendant was only penalized proportionately to how much he was actually at fault as opposed to what the emotional sentiments were of the less intelligent members of the jury.
  • edited June 2014

    Again, I stated that if all other things are equal, I'm fine with using the less expensive machine as opposed to the pricier machine if the end result will be the same.

    You didn't read my post at all. Where does the doctor walking in with a tablet as opposed to a file full of paper play into any of that?
    Post edited by Jack Draigo on
  • Again, I stated that if all other things are equal, I'm fine with using the less expensive machine as opposed to the pricier machine if the end result will be the same.

    You didn't read my post at all. Where does the doctor walking in with a tablet as opposed to a file full of paper play into any of that?
    I don't think he replied to you.

    I suspect that HIPAA rules and regulations may have something to do with what you are asking about.

  • Again, I stated that if all other things are equal, I'm fine with using the less expensive machine as opposed to the pricier machine if the end result will be the same.

    You didn't read my post at all. Where does the doctor walking in with a tablet as opposed to a file full of paper play into any of that?
    I didn't mention it because I didn't disagree with you in principle there. Also, none of my doctors seem to use all that paper you mentioned (although I'm not sure switching to digital would necessarily be cheaper -- paper and pencils are pretty damned cheap compared to fancy electronics). They don't use tablets, per se, but all my doctors either have networked computers in all the examination rooms or bring in a WiFi-enabled laptop (either on its own or on some sort of cart along with other diagnostic/treatment equipment) into the room when examining you. If they don't already have my records up when they walk in, the first thing they do is log in and look them up. Personally, I think a laptop or desktop in the room is superior to a tablet in most cases since typing on a tablet is a freaking pain in the ass; I'd hate to have to type in multiple symptoms using a touch screen keyboard. Tablets are good alternatives to clipboards so long as all you're doing is checking things off a checklist or reading data, but they suck for data entry.

    Also, don't knock writing things down on paper. In some ways it's still faster, easier, and more efficient than any digital technologies we have today. Maybe, with a decent note taking app and a high-quality stylus, a tablet approaches the functionality of paper, I'll give you that.
  • Come to think of it, the urgent care clinic my ex went to did use tablets rather than paper and pencils.

    There still were plenty of papers to fill out by the patient but the workers were carrying tablets not clipboards.
  • edited June 2014
    HMTKSteve said:

    There still were plenty of papers to fill out by the patient but the workers were carrying tablets not clipboards.

    Papers for the patients makes sense from the standpoint of providing something that is usable by the lowest common denominator (i.e. people who, due to age and/or socioeconomic status don't know how to use a tablet or computer) and preventing theft or damage of expensive devices by the patients. Workers have no real excuse for not using some sort of electronic device for most of their activities. Paper works best for rapid note taking, especially if it involves drawings or characters that cannot be easily typed using a standard keyboard. Paper works better for rapid note taking than tablets for text-heavy note taking too, but that's because touch keyboards suck, as I said earlier. I'm also assuming that said note takers are also at least competent typists where they can type at least as fast as they can write with a pen.
    Post edited by Dragonmaster Lou on
  • HIPPA might have something to do with it yeah. I'm not up on the regulations, but I don't think it'd be too hard to encrypt and password protect the data. I suppose it shouldn't be too hard to make a good note taking app for a tablet, and again someone might want to design a more rugged type for that kind of use.
  • Well, as I said, all my doctors and hospitals around here, while not using tablets, do use fully electronic systems with laptops and desktops, so it's "close enough" for your purposes.

    The main problem with note taking on a tablet, even with a good app, is that it still feels kinda clunky. Typing is the main problem as tablet keyboards are just about useless for rapid typing. The other issue is touch screen sensitivity. It seems like all touch screens seem to expect you to touch them with your fingers, meaning that if you need to include a diagram in your notes it's like drawing with finger paint. This even seems to apply to using a stylus, although maybe it's just cause my stylus sucks (admittedly, it was stupid cheap). One of these days I need to try a better stylus to see if it makes a difference. Even then, I don't think it still would be quite as nice as paper if only because I tend to leave my hand on the paper when drawing or writing and I can only imagine that would confuse the heck out of the touch sensors on the screen.
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