4 ms·

Just want to point out that making routine/preventative care an out-of-pocket cost is probably one of the worst things you can do. I expect there's a reason man

Just want to point out that making routine/preventative care an out-of-pocket cost is probably one of the worst things you can do. I expect there's a reason many companies emphasize and encourage their employees take advantage of 100% free preventive care under their insurance plans. You can save a ton of money later by catching and treating issues early, and even a small personal cost can encourage people to ignore warning signs and not seek aid until the problem has become severe and expensive.

aetherson 10y ago
Yeah, this is deeply off-topic, but my reading of the evidence is that preventative or diagnostic care is typically not cost-effective or even outcome-enhancing, with a few specific exceptions like vaccinations.
- bryondowd 10y ago
  Interesting. I'd love to see support for this view. Everything I've heard suggests the opposite. Especially if you consider worker productivity in addition to healthcare costs.
  - aetherson 10y ago
    http://www.nejm.org/doi/full/10.1056/NEJMp0708558 http://www.nejm.org/doi/full/10.1056/NEJMp0708558 http://www.reuters.com/article/us-preventive-economics-idUSBRE90S05M20130129 http://www.reuters.com/article/us-preventive-economics-idUSB... http://www.statcan.gc.ca/pub/82-003-x/2015012/article/14295-eng.htm http://www.statcan.gc.ca/pub/82-003-x/2015012/article/14295-... http://www.thehoopsnews.com/effectiveness-of-mammograms-vastly-overestimated-study-6622 http://www.thehoopsnews.com/effectiveness-of-mammograms-vast... It's a complex subject, and a few articles aren't the final word one way or the other. My opinion is based on various things I've read over the past couple of decades (most of which I can't summon up right now) and conversations with various medical professionals in my family and social circle, and my overall worldview (as anyone's must be).
    - bryondowd 10y ago
      Ok, this is interesting. Some of this fits my intuitions, and some was a surprise to me, so yes, this does modify my view, but only slightly. It seems there are preventative measures that are cost effective, and there are others that are not. So really, this indicates a need to determine a threshold. Perhaps we determine that we can afford to pay up to $50,000 per QALY, and cover any care that falls within that limit. So, we'd have coverage based on its efficiency rather than whether it is considered preventative or treatment or maintenance. The idea being to get the maximum amount of healthy years of life out of whatever amount of money we as society are willing to put toward healthcare. This could also be extended to programs outside of direct care, like some of those articles suggest, which encourage and support healthy activity in a way that still falls within the $/QALY target. Of course, I expect it would be a bear to fairly study every possible treatment and program to determine its efficiency, especially factoring in a changing environment which is bound to change the efficiency of any given treatment from year to year. Still, at a minimum, we should be grabbing those low-hanging fruits, where we can gain healthy years for a very low cost.
  - samscully 10y ago
    It does not exactly answer your question but this study [1] had some relevant results. [1] https://en.wikipedia.org/wiki/RAND_Health_Insurance_Experiment https://en.wikipedia.org/wiki/RAND_Health_Insurance_Experime...
- schmozz 10y ago
  I have heard this as well, but I think the point still stands. Things like annual physical's might not be a net positive, but you don't want to deter people from going to the doctor when they think something could be wrong.
Mz 10y ago
I expect there's a reason many companies emphasize and encourage their employees take advantage of 100% free preventive care under their insurance plans. Yeah, it is called brainwashing. I worked in insurance and was all tickled to see them offering "wellness" benefits. I was all "Oh, yay, the world is turning into a better and more clued place!" Then I went to the meetings. These were purely a sales gimmick. That's it. You encourage people to go to their annual check up and they feel like you actually care. It breeds employee loyalty. It mostly does very little for actual health outcomes. If you actually want better health, you are better off promoting exercise, healthy eating, sanitation, etc. in place of preventive medical screenings.
- odbol_ 10y ago
  Theoretically, that's what your doctor is supposed to do at these "preventative checkups": convince you to exercise, diet, etc.
  - danielweber 10y ago
    Since we don't see any benefits from annual check-up, that either isn't happening or is ineffective.
mattlutze 10y ago
However, that small personal costs may very well help not fill up a queue to the doctor for mundane, trivial crap that would have gone away in a day or two. Care quality is improved when the doctors are less stressed and can spend more time with their patients. Free-as-in-beer health care ensure more people going to the doctor for more crap, reducing availability and quality for the average person.
frostymarvelous 10y ago
I'm going to say this because I'm in a similar situation now. For weeks, I've been having pains in my chest, back and sides. I know for sure something is wrong. And I fear I may be dying. But being unsure where my next meal will come from, I can't even visit a clinic to get a test done. I keep praying to get some money so I can go check myself before I leave my young family without a caregiver. So yes, whatever you guys argue here today. Make sure people like me in future can be cared for. And that they don't have to worry about food, shelter, Healthcare.
- andruby 10y ago
  Go visit a clinic. You obviously have the time to write this comment on HN on a computer, so you have the time to go to a clinic. Like you said, you absolutely don't want to leave your family without a caregiver.
  - frostymarvelous 10y ago
    I wrote it on my phone. And it's not about time. It's about being able to afford the care. When you live in Africa, you have different problems. Either way, I was buttressing this point > even a small personal cost can encourage people to ignore warning signs and not seek aid until the problem has become severe and expensive

aetherson 10y ago

Yeah, this is deeply off-topic, but my reading of the evidence is that preventative or diagnostic care is typically not cost-effective or even outcome-enhancing, with a few specific exceptions like vaccinations.

bryondowd 10y ago
Interesting. I'd love to see support for this view. Everything I've heard suggests the opposite. Especially if you consider worker productivity in addition to healthcare costs.
- aetherson 10y ago
  http://www.nejm.org/doi/full/10.1056/NEJMp0708558 http://www.nejm.org/doi/full/10.1056/NEJMp0708558 http://www.reuters.com/article/us-preventive-economics-idUSBRE90S05M20130129 http://www.reuters.com/article/us-preventive-economics-idUSB... http://www.statcan.gc.ca/pub/82-003-x/2015012/article/14295-eng.htm http://www.statcan.gc.ca/pub/82-003-x/2015012/article/14295-... http://www.thehoopsnews.com/effectiveness-of-mammograms-vastly-overestimated-study-6622 http://www.thehoopsnews.com/effectiveness-of-mammograms-vast... It's a complex subject, and a few articles aren't the final word one way or the other. My opinion is based on various things I've read over the past couple of decades (most of which I can't summon up right now) and conversations with various medical professionals in my family and social circle, and my overall worldview (as anyone's must be).
  - bryondowd 10y ago
    Ok, this is interesting. Some of this fits my intuitions, and some was a surprise to me, so yes, this does modify my view, but only slightly. It seems there are preventative measures that are cost effective, and there are others that are not. So really, this indicates a need to determine a threshold. Perhaps we determine that we can afford to pay up to $50,000 per QALY, and cover any care that falls within that limit. So, we'd have coverage based on its efficiency rather than whether it is considered preventative or treatment or maintenance. The idea being to get the maximum amount of healthy years of life out of whatever amount of money we as society are willing to put toward healthcare. This could also be extended to programs outside of direct care, like some of those articles suggest, which encourage and support healthy activity in a way that still falls within the $/QALY target. Of course, I expect it would be a bear to fairly study every possible treatment and program to determine its efficiency, especially factoring in a changing environment which is bound to change the efficiency of any given treatment from year to year. Still, at a minimum, we should be grabbing those low-hanging fruits, where we can gain healthy years for a very low cost.
- samscully 10y ago
  It does not exactly answer your question but this study [1] had some relevant results. [1] https://en.wikipedia.org/wiki/RAND_Health_Insurance_Experiment https://en.wikipedia.org/wiki/RAND_Health_Insurance_Experime...
schmozz 10y ago
I have heard this as well, but I think the point still stands. Things like annual physical's might not be a net positive, but you don't want to deter people from going to the doctor when they think something could be wrong.

Mz 10y ago

I expect there's a reason many companies emphasize and encourage their employees take advantage of 100% free preventive care under their insurance plans. Yeah, it is called brainwashing. I worked in insurance and was all tickled to see them offering "wellness" benefits. I was all "Oh, yay, the world is turning into a better and more clued place!" Then I went to the meetings. These were purely a sales gimmick. That's it. You encourage people to go to their annual check up and they feel like you actually care. It breeds employee loyalty. It mostly does very little for actual health outcomes. If you actually want better health, you are better off promoting exercise, healthy eating, sanitation, etc. in place of preventive medical screenings.

odbol_ 10y ago
Theoretically, that's what your doctor is supposed to do at these "preventative checkups": convince you to exercise, diet, etc.
- danielweber 10y ago
  Since we don't see any benefits from annual check-up, that either isn't happening or is ineffective.

mattlutze 10y ago

However, that small personal costs may very well help not fill up a queue to the doctor for mundane, trivial crap that would have gone away in a day or two. Care quality is improved when the doctors are less stressed and can spend more time with their patients. Free-as-in-beer health care ensure more people going to the doctor for more crap, reducing availability and quality for the average person.

frostymarvelous 10y ago

I'm going to say this because I'm in a similar situation now. For weeks, I've been having pains in my chest, back and sides. I know for sure something is wrong. And I fear I may be dying. But being unsure where my next meal will come from, I can't even visit a clinic to get a test done. I keep praying to get some money so I can go check myself before I leave my young family without a caregiver. So yes, whatever you guys argue here today. Make sure people like me in future can be cared for. And that they don't have to worry about food, shelter, Healthcare.

andruby 10y ago
Go visit a clinic. You obviously have the time to write this comment on HN on a computer, so you have the time to go to a clinic. Like you said, you absolutely don't want to leave your family without a caregiver.
- frostymarvelous 10y ago
  I wrote it on my phone. And it's not about time. It's about being able to afford the care. When you live in Africa, you have different problems. Either way, I was buttressing this point > even a small personal cost can encourage people to ignore warning signs and not seek aid until the problem has become severe and expensive