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I see people here explain all this documentation requirements as a function of it paying private health care. While some of that is true, it is far from the wh

I see people here explain all this documentation requirements as a function of it paying private health care. While some of that is true, it is far from the whole explanation. I am a Norwegian we have what you guys call socialised health care. I've been treated in the US and Norway so I can compare. In the US there is a lot more paperwork related to disclaimers, suing, billing, insurance companies etc which we don't have to deal with. However when it it comes to the medical side of things, doctors here also sit and type at their computer while seeing their patient. They are also stressed out trying to make it all add up. Just because there isn't a profit motive doesn't mean there isn't a push to be more efficient from above. There is lots of political pressure from above to save money on health care. The core problem here isn't profit or not. I think the problem in common both in the US and Norway is the measurement and feedback based management. New Public Management or whatever you call it. Both in public sector and private those at the top want to be able to control and improve what is going on below and so they insist on massive amounts of feedback, so they can measure everything about how things are run. Of course they never consider the massiv cost of all this documentation. It is the same in schools here in Norway. Teachers have ended up spending a shitload of time documenting and measuring over the last decades. The paperwork load keeps adding up even though every successive government says they are all about cutting paperwork. IMO opinion the solution to this isn't to go public or private but to change our ideas about how things are managed and run.

lmm 11y ago
This has to be answered empirically. No doubt there is value in giving doctors or teachers the freedom to do what they think best - especially the best ones. But there is also a lot of value in standardization, accountability, and ensuring we know what went on. A patient may think they care more about how kind the doctor was, but if better notes make the difference in spotting a rare condition or simply catching a mistake - or, more subtly, enable data analytics that let us spot new correlations and develop improved treatments - then (with a limited amount of doctor's time available) that's a lot more important. What has the overall effect of these paperwork changes been on healthcare outcomes?
- ThomPete 11y ago
  One of the outcomes is that doctors spend up to 50% of their time making notes instead of seeing patients. Another issue is that by making these overly controlled environments you are basically being forced to higher more control people. I.e. you are getting more "cold hands" (administrators, controlllants, bureaucrats) than "warm hands" (doctors, nurses, caregivers) This at least has been one of the main issues in Denmark. Can't speak for Norway but my guess is the issue is the same. Denmark has fallen far down the list of the places with most effective care. It is however (mostly) "free". There is a real groundbreaking business hiding there. How to ensure control of whats going on without burdening the wrong people.
  - lmm 11y ago
    > I.e. you are getting more "cold hands" (administrators, controlllants, bureaucrats) than "warm hands" (doctors, nurses, caregivers) That's a good political talking point, but it just begs the question. How much good do those two groups do in terms of ultimate outcomes?
    - ThomPete 11y ago
      I would guess that no matter how you slice and dice it 50% of the time a doctor spend on reporting is 50% too much. The same goes for other types of caregivers btw. Of course there needs to be a control system but the problem with NPM is that it puts optimization over outcome and because getting the data is the only way they know how to optimize it basically ends up being the goal justifying the means. This has created layer upon layer of highly paid middle managers and is basically right now crippling the Danish healthcare system. It used to be one of the best in the world but have slipped down to 36 now.
  - Consultant32452 11y ago
    The next step is to get rid of most of those people and replace them with medical AI. I personally can't wait for Watson or whatever to come along and replace even my doctor with someone simply trained to perform whatever procedures Watson suggests.
ThomPete 11y ago
Agree. I am from Denmark free healthcare and same problem. The issue is as you say New Public Management.

lmm 11y ago

This has to be answered empirically. No doubt there is value in giving doctors or teachers the freedom to do what they think best - especially the best ones. But there is also a lot of value in standardization, accountability, and ensuring we know what went on. A patient may think they care more about how kind the doctor was, but if better notes make the difference in spotting a rare condition or simply catching a mistake - or, more subtly, enable data analytics that let us spot new correlations and develop improved treatments - then (with a limited amount of doctor's time available) that's a lot more important. What has the overall effect of these paperwork changes been on healthcare outcomes?

ThomPete 11y ago
One of the outcomes is that doctors spend up to 50% of their time making notes instead of seeing patients. Another issue is that by making these overly controlled environments you are basically being forced to higher more control people. I.e. you are getting more "cold hands" (administrators, controlllants, bureaucrats) than "warm hands" (doctors, nurses, caregivers) This at least has been one of the main issues in Denmark. Can't speak for Norway but my guess is the issue is the same. Denmark has fallen far down the list of the places with most effective care. It is however (mostly) "free". There is a real groundbreaking business hiding there. How to ensure control of whats going on without burdening the wrong people.
- lmm 11y ago
  > I.e. you are getting more "cold hands" (administrators, controlllants, bureaucrats) than "warm hands" (doctors, nurses, caregivers) That's a good political talking point, but it just begs the question. How much good do those two groups do in terms of ultimate outcomes?
  - ThomPete 11y ago
    I would guess that no matter how you slice and dice it 50% of the time a doctor spend on reporting is 50% too much. The same goes for other types of caregivers btw. Of course there needs to be a control system but the problem with NPM is that it puts optimization over outcome and because getting the data is the only way they know how to optimize it basically ends up being the goal justifying the means. This has created layer upon layer of highly paid middle managers and is basically right now crippling the Danish healthcare system. It used to be one of the best in the world but have slipped down to 36 now.
- Consultant32452 11y ago
  The next step is to get rid of most of those people and replace them with medical AI. I personally can't wait for Watson or whatever to come along and replace even my doctor with someone simply trained to perform whatever procedures Watson suggests.

ThomPete 11y ago

Agree. I am from Denmark free healthcare and same problem. The issue is as you say New Public Management.