5 ms·

I am no doctor, but I guess when you run health care as a for profit adventure you will try to extract more money from your patient. Maybe not the direct way, b

by dejv 9y ago

I am no doctor, but I guess when you run health care as a for profit adventure you will try to extract more money from your patient. Maybe not the direct way, but you might buy a lot of very expensive equipment and send your patients there even when there is another way of diagnosis that is cheaper. Or you might be even doing a lot of additional screenings just to be sure (you really want to be covered in case of some lawsuit).

anothercomment 9y ago
This seems to be more of a problem with insurance - there often is little transparency and doctors simply charge all sorts of things to the insurer that the patient has no idea about. I think that is one of the main challenges of health insurance. In my country (Germany) I have actually shied away from switching to private insurance, because they pay doctors more, and doctors are known to do as many tests and procedures as possible (not always a good thing, but in the end it is a gamble - too many examinations/procedures or too few?). The "public" health insurance is quite regulated as to what gets paid and how much. The downside is that doctors have to waste a lot of time on bureaucracy (every examination has to be entered into the computer to determine the costs), and transparency is still missing (patients typically don't even know how much their treatments cost). And some committee decides what procedures get paid. I don't trust committees. I trust the market (I mean I trust "in" markets, not necessarily any given market as markets can be broken by regulations, lack of transparency, all sorts of things). I have also spent a lot of money on things that weren't covered by public insurance. One story I heard is that for example in the UK they won't pay for dialysis after a certain age. So public health insurance is not an automatic solution to every problem. I think it is actually unavoidable that insurance will have to make a cut at some point, because medical procedures can become arbitrarily expensive. Perhaps even now for the right money, people could be kept alive indefinitely. I would have no problem with a doctor trying to be profitable - just as with other businesses. I guess the classic assumption is that to be profitable, businesses have to provide good service.
- DanWaterworth 9y ago
  > One story I heard is that for example in the UK they won't pay for dialysis after a certain age. So public health insurance is not an automatic solution to every problem. A quick Google search reveals this claim is spurious, so maybe don't believe everything you hear.
  - anothercomment 9y ago
    Sorry about that - I heard it a long time ago. Nevertheless, health insurance will always be capped at some point, you can not guarantee arbitrarily high expenses for everybody.
    - DanWaterworth 9y ago
      What happens is: treatments are evaluated and declared either cost effective or not. They don't refuse people treatment because they've used more than their 'fair share' of some allowance.
- DanBC 9y ago
  > One story I heard is that for example in the UK they won't pay for dialysis after a certain age. This is not true. In fact, most people getting dialysis are over 65. https://www.renalreg.org/wp-content/uploads/2014/12/Incidence-and-prevalence-final.pdf https://www.renalreg.org/wp-content/uploads/2014/12/Incidenc... > Kidney disease is more common as we get older, and although people of all ages can need to start dialysis, it most commonly affects people aged between 65 and 84 years. Figure 2 shows the number of people starting dialysis or going straight to transplantation in each age group and it can be seen that the age group with the most people was 65–74 for both haemodialysis and peritoneal dialysis. In 2013, the average age of people starting treatment was 65 years and this has changed little over the last six years. The average age at start was 67 years for people starting on haemodialysis, 60 for people starting on peritoneal dialysis and 50 for those having a transplant before they start dialysis. In 2013, more men started treatment than women (63% male versus 37% female). Diabetes was the single most common cause of kidney failure (25%). Here's a document talking about cost of dialysis for older people: https://academic.oup.com/ndt/article/18/10/2122/1807737/Costs-of-dialysis-for-elderly-people-in-the-UK https://academic.oup.com/ndt/article/18/10/2122/1807737/Cost... The NHS Constitution for England forbids discrimination based on age, as does the Equality Act 2010. https://www.gov.uk/government/publications/the-nhs-constitution-for-england https://www.gov.uk/government/publications/the-nhs-constitut... > The NHS provides a comprehensive service, available to all > It is available to all irrespective of gender, race, disability, age, sexual orientation, religion, belief, gender reassignment, pregnancy and maternity or marital or civil partnership status. The service is designed to improve, prevent, diagnose and treat both physical and mental health problems with equal regard. It has a duty to each and every individual that it serves and must respect their human rights. At the same time, it has a wider social duty to promote equality through the services it provides and to pay particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population. http://www.legislation.gov.uk/ukpga/2010/15/section/5 http://www.legislation.gov.uk/ukpga/2010/15/section/5
patryn20 9y ago
I think many people also get unintentionally screwed by the insurance pricing model that demands to only pay at most 25% (an oversimplification) of the stated cost and doesn't allow discounts to insured individuals. For instance: a hospital charges patients $300 for an X-ray if they pay directly in cash. However, insurer "X" has a policy that they only pay 25% of standard rate for all procedures. So the hospital states their standard rate is $1200 for an X-ray. So now I (as an insurer "X" policyholder) get billed $1200, but my insurer decides it's a non-covered expense. Does the hospital adjust my bill down to their cash rate of $300? No. That would violate their agreement with the insurer and potentially mean that the insurer would only pay them $75 per x-ray moving forward on ALL of insurer "X"'s policyholders. So now I hypothetically am stuck with a bill four times as large as it would have been if I were entirely uninsured. This is a product of the impersonal transformation of medicine caused by corporate ownership (and accounting) of local care facilities combined with the legal/profit seeking power of large insurance firms.
- madengr 9y ago
  Yep, and the $900 difference is written off as a loss by the hospital. They must pay zero taxes.
- hackits 9y ago
  You can go to their accounting department and tell them you're unable to pay the full amount of the bill due to hard-ship. They will in turn probably reduce the bill down to $300 dollars. Either that or you walk out the front door and they get paid for nothing, and they have sell the outstanding amount for penny's to the dollar to a debt collector.

by dejv 9y ago

anothercomment 9y ago

This seems to be more of a problem with insurance - there often is little transparency and doctors simply charge all sorts of things to the insurer that the patient has no idea about. I think that is one of the main challenges of health insurance. In my country (Germany) I have actually shied away from switching to private insurance, because they pay doctors more, and doctors are known to do as many tests and procedures as possible (not always a good thing, but in the end it is a gamble - too many examinations/procedures or too few?). The "public" health insurance is quite regulated as to what gets paid and how much. The downside is that doctors have to waste a lot of time on bureaucracy (every examination has to be entered into the computer to determine the costs), and transparency is still missing (patients typically don't even know how much their treatments cost). And some committee decides what procedures get paid. I don't trust committees. I trust the market (I mean I trust "in" markets, not necessarily any given market as markets can be broken by regulations, lack of transparency, all sorts of things). I have also spent a lot of money on things that weren't covered by public insurance. One story I heard is that for example in the UK they won't pay for dialysis after a certain age. So public health insurance is not an automatic solution to every problem. I think it is actually unavoidable that insurance will have to make a cut at some point, because medical procedures can become arbitrarily expensive. Perhaps even now for the right money, people could be kept alive indefinitely. I would have no problem with a doctor trying to be profitable - just as with other businesses. I guess the classic assumption is that to be profitable, businesses have to provide good service.

DanWaterworth 9y ago
> One story I heard is that for example in the UK they won't pay for dialysis after a certain age. So public health insurance is not an automatic solution to every problem. A quick Google search reveals this claim is spurious, so maybe don't believe everything you hear.
- anothercomment 9y ago
  Sorry about that - I heard it a long time ago. Nevertheless, health insurance will always be capped at some point, you can not guarantee arbitrarily high expenses for everybody.
  - DanWaterworth 9y ago
    What happens is: treatments are evaluated and declared either cost effective or not. They don't refuse people treatment because they've used more than their 'fair share' of some allowance.
DanBC 9y ago
> One story I heard is that for example in the UK they won't pay for dialysis after a certain age. This is not true. In fact, most people getting dialysis are over 65. https://www.renalreg.org/wp-content/uploads/2014/12/Incidence-and-prevalence-final.pdf https://www.renalreg.org/wp-content/uploads/2014/12/Incidenc... > Kidney disease is more common as we get older, and although people of all ages can need to start dialysis, it most commonly affects people aged between 65 and 84 years. Figure 2 shows the number of people starting dialysis or going straight to transplantation in each age group and it can be seen that the age group with the most people was 65–74 for both haemodialysis and peritoneal dialysis. In 2013, the average age of people starting treatment was 65 years and this has changed little over the last six years. The average age at start was 67 years for people starting on haemodialysis, 60 for people starting on peritoneal dialysis and 50 for those having a transplant before they start dialysis. In 2013, more men started treatment than women (63% male versus 37% female). Diabetes was the single most common cause of kidney failure (25%). Here's a document talking about cost of dialysis for older people: https://academic.oup.com/ndt/article/18/10/2122/1807737/Costs-of-dialysis-for-elderly-people-in-the-UK https://academic.oup.com/ndt/article/18/10/2122/1807737/Cost... The NHS Constitution for England forbids discrimination based on age, as does the Equality Act 2010. https://www.gov.uk/government/publications/the-nhs-constitution-for-england https://www.gov.uk/government/publications/the-nhs-constitut... > The NHS provides a comprehensive service, available to all > It is available to all irrespective of gender, race, disability, age, sexual orientation, religion, belief, gender reassignment, pregnancy and maternity or marital or civil partnership status. The service is designed to improve, prevent, diagnose and treat both physical and mental health problems with equal regard. It has a duty to each and every individual that it serves and must respect their human rights. At the same time, it has a wider social duty to promote equality through the services it provides and to pay particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population. http://www.legislation.gov.uk/ukpga/2010/15/section/5 http://www.legislation.gov.uk/ukpga/2010/15/section/5

patryn20 9y ago

I think many people also get unintentionally screwed by the insurance pricing model that demands to only pay at most 25% (an oversimplification) of the stated cost and doesn't allow discounts to insured individuals. For instance: a hospital charges patients $300 for an X-ray if they pay directly in cash. However, insurer "X" has a policy that they only pay 25% of standard rate for all procedures. So the hospital states their standard rate is $1200 for an X-ray. So now I (as an insurer "X" policyholder) get billed $1200, but my insurer decides it's a non-covered expense. Does the hospital adjust my bill down to their cash rate of $300? No. That would violate their agreement with the insurer and potentially mean that the insurer would only pay them $75 per x-ray moving forward on ALL of insurer "X"'s policyholders. So now I hypothetically am stuck with a bill four times as large as it would have been if I were entirely uninsured. This is a product of the impersonal transformation of medicine caused by corporate ownership (and accounting) of local care facilities combined with the legal/profit seeking power of large insurance firms.

madengr 9y ago
Yep, and the $900 difference is written off as a loss by the hospital. They must pay zero taxes.
hackits 9y ago
You can go to their accounting department and tell them you're unable to pay the full amount of the bill due to hard-ship. They will in turn probably reduce the bill down to $300 dollars. Either that or you walk out the front door and they get paid for nothing, and they have sell the outstanding amount for penny's to the dollar to a debt collector.