6 ms·

You do realize that the US has this problem alone. It doesn't require innovation or technology. Just proper policy on pricing, like every other western nation

by ralfn 9y ago

You do realize that the US has this problem alone. It doesn't require innovation or technology. Just proper policy on pricing, like every other western nation has. The market will fix the efficiency, but not as long as the medical field itself can set the prices, since life and death choices are the ultimate i-will-rob-a-bank-for-this price elasticity.

dazc 9y ago
'Nobody else is this incompetent.' Here in the UK we have 'free' healthcare and the system is equally incompetent.
- ralfn 9y ago
  You aren't spending nearly as much as Americans and for that money you treat everyone. Are large organisation inefficient? Yes. Is it frustration when you look at it? Yes. Does this mean the US situation where they are spending 3 to 5 times as much to provide the same level of care to only a part of the population, is objectively worse than the UK situation? Yes. (I removed the quoted line, because the tone of voice is suboptimal - but it doesn't change the argument)
  - dazc 9y ago
    I agree the sum total cost may be significantly different but I was simply acknowledging that inefficient health care administration wasn't purely an American phenomenon.
    - ralfn 9y ago
      It is not unique to healthcare either. It is simple a common aspect of large organisations that have too many stake holders that need to coordinate to get things done. It is an interesting organisational problem. But inefficient does not mean expensive. Generally you see a lot of inefficiency, much like with code, when it is not the hot path. If you would fix all the obvious inefficiencies it will not drastically reduce cost (actually: it would mean the hospitals have more money, so anybody selling anything to them would up their prices) Inefficiency only makes a difference when the price is based on cost not on negotiation position (i.e. value based). So in a red ocean as they say, there is a strong economic incentive to fix all in efficiencies and squeeze the last dollar out of it. This is referred to a race to the bottom. But health care is the opposite of a red ocean. And no price is too high if it means survival, so the consumer (i.e. the patient) needs a much better negotiation position. For example: having all patients collectively negotiating the price. If only over time the invisible hand of the market would have created structures for this purpose again and again everywhere in the world. Oh wait! It did. It's called government.
- DanBC 9y ago
  The "UK" NHS is failing because government has made the choice to defund it and to privatise it. It's a purely political choice from a health minister who believes in homeopathy and who has previously written about the need to sell off the NHS.
  - dazc 9y ago
    The NHS has been failing for at least the last 25 years. We've had labour, lib-dem/con and conservative Governments and countless health ministers in all this time. I fail to see the political connection?
    - pjc50 9y ago
      That's an awfully long time to be in a state of "failing"? Can we quantify what we mean by "failing" here?
      - dazc 9y ago
        'Can we quantify what we mean by "failing" here?' 'In decline' maybe? The NHS has been in some crisis or another for all of these years.
        DanBC 9y ago
        No, it hasn't. Standards have got considerably worse in many measures recently. When people talk about the winter crisis it's differently to previous winter crises -- A&Es turning away ambos because the corridors are full isn't something that used to happen. In the past Ambos have been turned away, but that's because the beds were full. Those A&Es still had emergency capacity (in the corridors).
        dazc 9y ago
        'A&Es turning away ambos because the corridors are full isn't something that used to happen.' 'In the past Ambos have been turned away, but that's because the beds were full...' And before this, what? Ambos queuing up, patients treated in ambos, patients waiting a long time for ambos, etc, etc. You have to go a long way back to find a time when everything was working as it should be.
- lambdadmitry 9y ago
  As far as I know it's not. Here are two pieces of anecdotal evidence: - cycle responders in London [1]. I can't see how private companies can get enough "client density" to afford the fleet in a congested city centre to reduce response time. Moreover, centralized dispatch is inherently more efficient. - centralized and somewhat open control of life-saving procedures' efficiency [2][3]. In this particular case it's children heart surgery. NHS not only applied country-wide risk-adjusted statistical model, they also did a project to communicate it to patients. I'm not sure if it's possible in the US healthcare system. From the POV of a recent immigrant it looks like most dissatisfaction with NHS stems from their approach to mundane and/or chronic problems, that's where you see GP resistance and long waiting times. They seem very good at not letting people die. Arguably it's a reasonable tradeoff given their constrained resources. [1]: http://www.londonambulance.nhs.uk/calling_999/who_will_treat_you/single_responder/cycle_responder.aspxhttp://www.londonambulance.nhs.uk/calling_999/who_will_treat_you/single_responder/cycle_responder.aspx http://www.londonambulance.nhs.uk/calling_999/who_will_treat... [2]: https://www.youtube.com/watch?v=-NebRpbMTK8 https://www.youtube.com/watch?v=-NebRpbMTK8 [3]: http://childrensheartsurgery.info/ http://childrensheartsurgery.info/
gepi79 9y ago
IMO technology can improve much. But the decision to use the technology or not is a political one.

by ralfn 9y ago

dazc 9y ago

'Nobody else is this incompetent.' Here in the UK we have 'free' healthcare and the system is equally incompetent.

ralfn 9y ago
You aren't spending nearly as much as Americans and for that money you treat everyone. Are large organisation inefficient? Yes. Is it frustration when you look at it? Yes. Does this mean the US situation where they are spending 3 to 5 times as much to provide the same level of care to only a part of the population, is objectively worse than the UK situation? Yes. (I removed the quoted line, because the tone of voice is suboptimal - but it doesn't change the argument)
- dazc 9y ago
  I agree the sum total cost may be significantly different but I was simply acknowledging that inefficient health care administration wasn't purely an American phenomenon.
  - ralfn 9y ago
    It is not unique to healthcare either. It is simple a common aspect of large organisations that have too many stake holders that need to coordinate to get things done. It is an interesting organisational problem. But inefficient does not mean expensive. Generally you see a lot of inefficiency, much like with code, when it is not the hot path. If you would fix all the obvious inefficiencies it will not drastically reduce cost (actually: it would mean the hospitals have more money, so anybody selling anything to them would up their prices) Inefficiency only makes a difference when the price is based on cost not on negotiation position (i.e. value based). So in a red ocean as they say, there is a strong economic incentive to fix all in efficiencies and squeeze the last dollar out of it. This is referred to a race to the bottom. But health care is the opposite of a red ocean. And no price is too high if it means survival, so the consumer (i.e. the patient) needs a much better negotiation position. For example: having all patients collectively negotiating the price. If only over time the invisible hand of the market would have created structures for this purpose again and again everywhere in the world. Oh wait! It did. It's called government.
DanBC 9y ago
The "UK" NHS is failing because government has made the choice to defund it and to privatise it. It's a purely political choice from a health minister who believes in homeopathy and who has previously written about the need to sell off the NHS.
- dazc 9y ago
  The NHS has been failing for at least the last 25 years. We've had labour, lib-dem/con and conservative Governments and countless health ministers in all this time. I fail to see the political connection?
  - pjc50 9y ago
    That's an awfully long time to be in a state of "failing"? Can we quantify what we mean by "failing" here?
    - dazc 9y ago
      'Can we quantify what we mean by "failing" here?' 'In decline' maybe? The NHS has been in some crisis or another for all of these years.
      - DanBC 9y ago
        No, it hasn't. Standards have got considerably worse in many measures recently. When people talk about the winter crisis it's differently to previous winter crises -- A&Es turning away ambos because the corridors are full isn't something that used to happen. In the past Ambos have been turned away, but that's because the beds were full. Those A&Es still had emergency capacity (in the corridors).
        dazc 9y ago
        'A&Es turning away ambos because the corridors are full isn't something that used to happen.' 'In the past Ambos have been turned away, but that's because the beds were full...' And before this, what? Ambos queuing up, patients treated in ambos, patients waiting a long time for ambos, etc, etc. You have to go a long way back to find a time when everything was working as it should be.
lambdadmitry 9y ago
As far as I know it's not. Here are two pieces of anecdotal evidence: - cycle responders in London [1]. I can't see how private companies can get enough "client density" to afford the fleet in a congested city centre to reduce response time. Moreover, centralized dispatch is inherently more efficient. - centralized and somewhat open control of life-saving procedures' efficiency [2][3]. In this particular case it's children heart surgery. NHS not only applied country-wide risk-adjusted statistical model, they also did a project to communicate it to patients. I'm not sure if it's possible in the US healthcare system. From the POV of a recent immigrant it looks like most dissatisfaction with NHS stems from their approach to mundane and/or chronic problems, that's where you see GP resistance and long waiting times. They seem very good at not letting people die. Arguably it's a reasonable tradeoff given their constrained resources. [1]: http://www.londonambulance.nhs.uk/calling_999/who_will_treat_you/single_responder/cycle_responder.aspxhttp://www.londonambulance.nhs.uk/calling_999/who_will_treat_you/single_responder/cycle_responder.aspx http://www.londonambulance.nhs.uk/calling_999/who_will_treat... [2]: https://www.youtube.com/watch?v=-NebRpbMTK8 https://www.youtube.com/watch?v=-NebRpbMTK8 [3]: http://childrensheartsurgery.info/ http://childrensheartsurgery.info/

gepi79 9y ago

IMO technology can improve much. But the decision to use the technology or not is a political one.