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Health care anecdote
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!
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
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..."
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.
"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.
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?
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.
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!
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).
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.
There are far too many "slip and fall" type lawyers working medical malpractice in the US.
I suspect that HIPAA rules and regulations may have something to do with what you are asking about.
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.
There still were plenty of papers to fill out by the patient but the workers were carrying tablets not clipboards.
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.