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In order to open a new hospital in most jurisdictions, by law you need the permission of other local hospitals [0]. That's like being required to get the permis

In order to open a new hospital in most jurisdictions, by law you need the permission of other local hospitals [0]. That's like being required to get the permission from Google to start a new search engine. 0. https://en.wikipedia.org/wiki/Certificate_of_need https://en.wikipedia.org/wiki/Certificate_of_need

limeblack 9y ago
My father is an executive at a major hospital and this is only part of it. There is also issues of brands forming monopolies when appearing in communities. Mergers are also incredibly complex. Also lots (but not all hospitals) are nonprofits which complicates it further. ERs are required to treat patients if they come in which means some are making tons of money while some not at all. One person can significantly alter ERs profits[0]. [0] https://www.beckershospitalreview.com/finance/the-12m-patient-that-drove-insurance-rates-higher-in-iowa.html https://www.beckershospitalreview.com/finance/the-12m-patien...
- FireBeyond 9y ago
  Is very insightful to read those comments. So many people who, faced with socialized medicine, screamed "DEATH PANELS!"... See premiums rising and all of a sudden, "We need to consider letting this person die a noble death." It's like a paradigm shifting, without a clutch.
  - Shivetya 9y ago
    however this issue like the costs of health care are exaggerated by local and federal government rules. when you prevent competition, when you force coverage regardless of need, and you lock out more options, costs only go one direction. just like tax laws, medical laws and implementation are done to favor specific groups to the detriment of others unfortunately
    - raquo 9y ago
      > force coverage regardless of need This is like, the main way to make insurance affordable. https://www.investopedia.com/terms/a/adverseselection.asp https://www.investopedia.com/terms/a/adverseselection.asp
- bostonpete 9y ago
  The link you provided doesn't say anything about ERs, much less ER profits. I can't imagine this patient with the severe genetic disorder is getting much of his $1M/month health care treatment in the emergency room.
  - limeblack 9y ago
    A more common example are blood clot disorders. Literally a door or ball hitting a person can cause major life threatening issues and are incredibly expensive depending on the type of disorder. That is the most common situation at his healthcare system. Someone with a rare disorder has been been dubbed internally as the million dollar man because of this. In this case the man has been on and off insurance and has come to their healthcare system's ER multiple times. Edit: The media only publishes the most extreme examples so I wasn't left with many options.
pg_bot 9y ago
Yep, it is appalling that these laws are still on the books in so many states. For those who live in CON states you should expect your healthcare bills to be about 10% higher with no increase in quality of care due to monopoly pricing. The FTC goes into further detail here about the history and reasoning behind why the laws exist and why they should be repealed here[0] [0] https://www.ftc.gov/system/files/documents/public_statements/896453/1512fall15-ohlhausenc.pdf https://www.ftc.gov/system/files/documents/public_statements...
firstplacelast 9y ago
The medical industry has done a superb job of convincing everyone that “patients are their number one priority” when in reality they have all worked to have their own little monopolies. From physicians to pharma companies, everyone is focused on leverage and ensuring they control the supply in their vertical. Everyone pretends like the next round of drugs will make us so much healthier/live longer/etc. But we could have 0 innovation in medical/pharma technology in the next 20 years and if we instead focused on innovating in efficiency, expanding supply of docs and healthcare workers, and building a sustainable system, we would all be better off for it. The next new procedure or pharmaceutical can’t do jack shit when most people that need them can’t get them in a timely and affordable manner. Raise the bars for what you contribute to, folks!
chimeracoder 9y ago
> In order to open a new hospital in most jurisdictions, by law you need the permission of other local hospitals That doesn't really have much of an effect these days, though, because if anything, we already have an excess of hospitals in most areas where this would come into effect. That's why hospitals have been hemorrhaging money, and so many have either gone broke and closed up entirely or been consolidated into larger hospital systems. The independent hospital is a dying breed, and it's been dying for a very long time. In other words, there just simply isn't really any appreciable desire to open hospitals in those regions. The Certificate of Need isn't the limiting factor; their ability to break even on their operating expenses is.
- dbatten 9y ago
  Really? I can't speak for the country as a whole, but in my area (Raleigh/Durham, NC) the major healthcare providers have been battling each other for years over when, where, and what types of new hospitals they can open. These laws have been and continue to be central to the fight. Just a few days ago: http://www.newsobserver.com/news/business/article188329569.html http://www.newsobserver.com/news/business/article188329569.h...
- pg_bot 9y ago
  If you take the time to look at the research you will find that it does have an effect.[0] Here is the money quote from that article "More likely, CON has affected the intensity and speed with which hospitals pursue particular construction activities. For example, the absence of CON in Indianapolis is likely an important factor in its rapid build-up of new full-service hospitals and specialty facilities. In Seattle, where CON is present, multiple hospital organizations are seeking to build new facilities in population-growth areas, but they must await review and final approval. CON requirements in this community could explain why Seattle hospitals expressed greater interest in better management of their existing capacity in the face of growing demand, because they cannot move quickly to build more capacity." Anecdotally, there has been a 10 year long fight near where I live over opening a hospital with CON laws being at the center of state supreme court litigation[1] As someone who works in healthcare and understands the economics of the system your perception cannot be further from reality. [0]https://www.healthaffairs.org/doi/full/10.1377/hlthaff.25.3.783 https://www.healthaffairs.org/doi/full/10.1377/hlthaff.25.3.... [1] http://www.charlotteobserver.com/news/local/article126222794.html http://www.charlotteobserver.com/news/local/article126222794...
Shivetya 9y ago
Like turning away cancer patients? Sadly this happens too often http://www.cbs46.com/story/34481437/local-hospital-says-its-being-forced-to-turn-away-ga-cancer-patients http://www.cbs46.com/story/34481437/local-hospital-says-its-...

limeblack 9y ago

My father is an executive at a major hospital and this is only part of it. There is also issues of brands forming monopolies when appearing in communities. Mergers are also incredibly complex. Also lots (but not all hospitals) are nonprofits which complicates it further. ERs are required to treat patients if they come in which means some are making tons of money while some not at all. One person can significantly alter ERs profits[0]. [0] https://www.beckershospitalreview.com/finance/the-12m-patient-that-drove-insurance-rates-higher-in-iowa.html https://www.beckershospitalreview.com/finance/the-12m-patien...

FireBeyond 9y ago
Is very insightful to read those comments. So many people who, faced with socialized medicine, screamed "DEATH PANELS!"... See premiums rising and all of a sudden, "We need to consider letting this person die a noble death." It's like a paradigm shifting, without a clutch.
- Shivetya 9y ago
  however this issue like the costs of health care are exaggerated by local and federal government rules. when you prevent competition, when you force coverage regardless of need, and you lock out more options, costs only go one direction. just like tax laws, medical laws and implementation are done to favor specific groups to the detriment of others unfortunately
  - raquo 9y ago
    > force coverage regardless of need This is like, the main way to make insurance affordable. https://www.investopedia.com/terms/a/adverseselection.asp https://www.investopedia.com/terms/a/adverseselection.asp
bostonpete 9y ago
The link you provided doesn't say anything about ERs, much less ER profits. I can't imagine this patient with the severe genetic disorder is getting much of his $1M/month health care treatment in the emergency room.
- limeblack 9y ago
  A more common example are blood clot disorders. Literally a door or ball hitting a person can cause major life threatening issues and are incredibly expensive depending on the type of disorder. That is the most common situation at his healthcare system. Someone with a rare disorder has been been dubbed internally as the million dollar man because of this. In this case the man has been on and off insurance and has come to their healthcare system's ER multiple times. Edit: The media only publishes the most extreme examples so I wasn't left with many options.

pg_bot 9y ago

Yep, it is appalling that these laws are still on the books in so many states. For those who live in CON states you should expect your healthcare bills to be about 10% higher with no increase in quality of care due to monopoly pricing. The FTC goes into further detail here about the history and reasoning behind why the laws exist and why they should be repealed here[0] [0] https://www.ftc.gov/system/files/documents/public_statements/896453/1512fall15-ohlhausenc.pdf https://www.ftc.gov/system/files/documents/public_statements...

firstplacelast 9y ago

The medical industry has done a superb job of convincing everyone that “patients are their number one priority” when in reality they have all worked to have their own little monopolies. From physicians to pharma companies, everyone is focused on leverage and ensuring they control the supply in their vertical. Everyone pretends like the next round of drugs will make us so much healthier/live longer/etc. But we could have 0 innovation in medical/pharma technology in the next 20 years and if we instead focused on innovating in efficiency, expanding supply of docs and healthcare workers, and building a sustainable system, we would all be better off for it. The next new procedure or pharmaceutical can’t do jack shit when most people that need them can’t get them in a timely and affordable manner. Raise the bars for what you contribute to, folks!

chimeracoder 9y ago

> In order to open a new hospital in most jurisdictions, by law you need the permission of other local hospitals That doesn't really have much of an effect these days, though, because if anything, we already have an excess of hospitals in most areas where this would come into effect. That's why hospitals have been hemorrhaging money, and so many have either gone broke and closed up entirely or been consolidated into larger hospital systems. The independent hospital is a dying breed, and it's been dying for a very long time. In other words, there just simply isn't really any appreciable desire to open hospitals in those regions. The Certificate of Need isn't the limiting factor; their ability to break even on their operating expenses is.

dbatten 9y ago
Really? I can't speak for the country as a whole, but in my area (Raleigh/Durham, NC) the major healthcare providers have been battling each other for years over when, where, and what types of new hospitals they can open. These laws have been and continue to be central to the fight. Just a few days ago: http://www.newsobserver.com/news/business/article188329569.html http://www.newsobserver.com/news/business/article188329569.h...
pg_bot 9y ago
If you take the time to look at the research you will find that it does have an effect.[0] Here is the money quote from that article "More likely, CON has affected the intensity and speed with which hospitals pursue particular construction activities. For example, the absence of CON in Indianapolis is likely an important factor in its rapid build-up of new full-service hospitals and specialty facilities. In Seattle, where CON is present, multiple hospital organizations are seeking to build new facilities in population-growth areas, but they must await review and final approval. CON requirements in this community could explain why Seattle hospitals expressed greater interest in better management of their existing capacity in the face of growing demand, because they cannot move quickly to build more capacity." Anecdotally, there has been a 10 year long fight near where I live over opening a hospital with CON laws being at the center of state supreme court litigation[1] As someone who works in healthcare and understands the economics of the system your perception cannot be further from reality. [0]https://www.healthaffairs.org/doi/full/10.1377/hlthaff.25.3.783 https://www.healthaffairs.org/doi/full/10.1377/hlthaff.25.3.... [1] http://www.charlotteobserver.com/news/local/article126222794.html http://www.charlotteobserver.com/news/local/article126222794...

Shivetya 9y ago

Like turning away cancer patients? Sadly this happens too often http://www.cbs46.com/story/34481437/local-hospital-says-its-being-forced-to-turn-away-ga-cancer-patients http://www.cbs46.com/story/34481437/local-hospital-says-its-...