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> Generating revenue is in direct conflict with providing patient care Without revenue, there's no money to use to actually provide care. > It's a uniquely Am

> Generating revenue is in direct conflict with providing patient care Without revenue, there's no money to use to actually provide care. > It's a uniquely American problem. It's not at all. Aside from the fact that most of the world uses at least some degree of privatization in providing or paying for healthcare, even the few that don't do so at the metaphorical "last mile" (such as England) still suffer from the unavoidable problem that money isn't infinite, and sometimes decisions have to be made to deny people care that otherwise still would have a material benefit to the patient.

bdamm 9y ago
In most developed nations outside America, a doctor's opinion carries more administrative weight. There may be an administrator, but if a doctor says a procedure is to be done, the payment can generally follow. A doctor is like an officer in that regard. In America, the insurance company and their payment policies carry more weight than the doctor's decisions. This matters a great deal if you have a traumatic accident and require many surgeries, as happened to a friend of mine. In America, if you have a trauma, you are recommended to get a lawyer immediately to help your medical expenses be handled properly. Think about that... in America, if you get hurt, you need a lawyer almost a badly as you need a doctor. Not because you need to sue the cause, but because you need to encourage the insurance company. There's something fundamentally miserable about that.
- chimeracoder 9y ago
  > In most developed nations outside America, a doctor's opinion carries more administrative weight. In America, the insurance company and their payment policies carry more weight than the doctor's decisions. No, in most developed nations other than the US, the doctor has approximately the same power that they do in the US. The difference is that, under capitated systems or systems like the NHS (which is not actually capitated yet, but functions more or less like it is), the doctor factors the cost into their decision-making process. That might sound like a good thing for patients, but it's generally not - it means they have an incentive to avoid unnecessary care, but they also have a very direct incentive to bias on the side of avoiding necessary care as well, to avoid eating into their budget. This is absolutely a problem with the NHS, although Hacker News readers tend not to be the demographics that suffer from it the most, so you don't hear about it as much here. > in America, if you get hurt, you need a lawyer almost a badly as you need a doctor I get that this is intended to be hyperbole, but even on that scale, it's absurd.
  - bdamm 9y ago
    It is not at all hyperbole. Companies that sell rescue insurance include lawyers fees in their benefits package.
vidarh 9y ago
The difference is that those systems goes to great lengths to ensure that the decision is done based on clinical needs and objective measures of what achieves the most patient benefit for the available money. As a result it is very transparent what is sacrificed - e.g. you can find NICE [1] documentation on evaluations of individual drugs and treatments and their benefits, and documentation of the decision making processes of the NHS trusts, so they can be debated and used as a basis for deciding funding, or you're free to sign on to additional private cover if the exemptions worry you. What we don't get is debates like this where people need to exchange information about whether or not an insurer is likely to try do be excessively strict in denying claims etc., because those kinds of things are extremely marginal here, not something most people ever need to deal with. [1] https://www.nice.org.uk/ https://www.nice.org.uk/
- chimeracoder 9y ago
  > As a result it is very transparent what is sacrificed - e.g. you can find NICE [1] documentation on evaluations of individual drugs and treatments and their benefits, and documentation of the decision making processes of the NHS trusts, so they can be debated and used as a basis for deciding funding, or you're free to sign on to additional private cover if the exemptions worry you. The decisions that NICE makes are not fundamentally different from the decisions that insurers make when deciding which medications and treatments are covered for various conditions, and in fact, you can find analogous documentation of these decisions from every major insurer. > The difference is that those systems goes to great lengths to ensure that the decision is done based on clinical needs and objective measures of what achieves the most patient benefit for the available money. Emphasis mine. NICE is not operating in some magical world where "revenue" and "costs" are somehow not intrinsically linked with clinical decisions. They're doing the same thing that insurers do - make decisions about treatments based on objective measures of clinical outcomes, subject to a finite budget. Ironically, this entire thread is about HIV, and HIV treatment and prevention are one area in which the NHS falls drastically short of what's available in the US both to people on private insurance and to people without insurance coverage whatsoever.
  - vidarh 9y ago

bdamm 9y ago

In most developed nations outside America, a doctor's opinion carries more administrative weight. There may be an administrator, but if a doctor says a procedure is to be done, the payment can generally follow. A doctor is like an officer in that regard. In America, the insurance company and their payment policies carry more weight than the doctor's decisions. This matters a great deal if you have a traumatic accident and require many surgeries, as happened to a friend of mine. In America, if you have a trauma, you are recommended to get a lawyer immediately to help your medical expenses be handled properly. Think about that... in America, if you get hurt, you need a lawyer almost a badly as you need a doctor. Not because you need to sue the cause, but because you need to encourage the insurance company. There's something fundamentally miserable about that.

chimeracoder 9y ago
> In most developed nations outside America, a doctor's opinion carries more administrative weight. In America, the insurance company and their payment policies carry more weight than the doctor's decisions. No, in most developed nations other than the US, the doctor has approximately the same power that they do in the US. The difference is that, under capitated systems or systems like the NHS (which is not actually capitated yet, but functions more or less like it is), the doctor factors the cost into their decision-making process. That might sound like a good thing for patients, but it's generally not - it means they have an incentive to avoid unnecessary care, but they also have a very direct incentive to bias on the side of avoiding necessary care as well, to avoid eating into their budget. This is absolutely a problem with the NHS, although Hacker News readers tend not to be the demographics that suffer from it the most, so you don't hear about it as much here. > in America, if you get hurt, you need a lawyer almost a badly as you need a doctor I get that this is intended to be hyperbole, but even on that scale, it's absurd.
- bdamm 9y ago
  It is not at all hyperbole. Companies that sell rescue insurance include lawyers fees in their benefits package.

vidarh 9y ago

The difference is that those systems goes to great lengths to ensure that the decision is done based on clinical needs and objective measures of what achieves the most patient benefit for the available money. As a result it is very transparent what is sacrificed - e.g. you can find NICE [1] documentation on evaluations of individual drugs and treatments and their benefits, and documentation of the decision making processes of the NHS trusts, so they can be debated and used as a basis for deciding funding, or you're free to sign on to additional private cover if the exemptions worry you. What we don't get is debates like this where people need to exchange information about whether or not an insurer is likely to try do be excessively strict in denying claims etc., because those kinds of things are extremely marginal here, not something most people ever need to deal with. [1] https://www.nice.org.uk/ https://www.nice.org.uk/

chimeracoder 9y ago
> As a result it is very transparent what is sacrificed - e.g. you can find NICE [1] documentation on evaluations of individual drugs and treatments and their benefits, and documentation of the decision making processes of the NHS trusts, so they can be debated and used as a basis for deciding funding, or you're free to sign on to additional private cover if the exemptions worry you. The decisions that NICE makes are not fundamentally different from the decisions that insurers make when deciding which medications and treatments are covered for various conditions, and in fact, you can find analogous documentation of these decisions from every major insurer. > The difference is that those systems goes to great lengths to ensure that the decision is done based on clinical needs and objective measures of what achieves the most patient benefit for the available money. Emphasis mine. NICE is not operating in some magical world where "revenue" and "costs" are somehow not intrinsically linked with clinical decisions. They're doing the same thing that insurers do - make decisions about treatments based on objective measures of clinical outcomes, subject to a finite budget. Ironically, this entire thread is about HIV, and HIV treatment and prevention are one area in which the NHS falls drastically short of what's available in the US both to people on private insurance and to people without insurance coverage whatsoever.
- vidarh 9y ago