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Are you familiar with the path that an American needs to take in order to become a cardiologist capable of financially supporting a family in a city where their
by Dowwie 9y ago
Are you familiar with the path that an American needs to take in order to become a cardiologist capable of financially supporting a family in a city where their children can realize their potential? The system that creates an American cardiologist is designed such that the cardiologist and it's respective delivery system will charge as much as economically possible for services. There aren't many cardiologists in the country and that is by design. A hospital can't even establish itself without the explicit consent of other hospitals already operating in a region -- healthcare entrepreneurs require a "certificate of need" issued before they are permitted to open a new hospital -- and dare not compete. The American Medical Association, medical schools, lenders, cardiologist fellowship programs, and others play a role in manufacturing a cardiologist. Everyone is participating in the system as a profit seeking, economic growth oriented player. Long ago, their objectives shifted to maximizing shareholder value and honoring fiduciary responsibilities.
No one has managed to control the cost of care in a system like this.
- fedups 9y agoI was hopeful to see something about the difference in how countries control the supply of doctors, but looks like we'll need to wait longer till someone thinks to look into it. These well-trodden 'insights' must be too tempting.
- maxerickson 9y agoCONs aren't required in all states (and none at the federal level since the 1980s). http://www.ncsl.org/research/health/con-certificate-of-need-state-laws.aspx http://www.ncsl.org/research/health/con-certificate-of-need-... States that don't have them don't have dramatically lower prices.
- Dowwie 9y agothis is good to know (OC)
- rgbrenner 9y agoEvery state except LA had a CON law.. You can't restrain supply for a couple of decades, then repeal the law, and immediately say: see, there's no difference. We're already seeing a difference in prices after a few years[0].. and it takes years and hundreds of millions of dollars (up to $1B+) for a hospital to go from a proposal to operating: CON laws raise overall healthcare spending by 3.1 percent—5.0 percent for physician care. As for type of provider, while CON has little effect on Medicaid spend- ing, it increases overall Medicare spending by 6.9 percent. States that repealed CON laws have seen overall healthcare spending reduced by 0.8 percent per year, leveling out to a 4 percent drop after year five. The greatest decline in spending is with physicians at 1.4 percent per year, compared to a drop of 0.3 percent per year in hospital expenditures. And by constraining supply of beds, hospitals redirected investment into equipment, increasing per-unit costs of providing care [1,2]. Arguably CON laws have contributed to unnecessary tests (since hospitals need to use the equipment they buy to pay for it), and use of more expensive equipment than necessary. Of course this isn't the sole problem with our health system... there are many that contribute to the problem. But CON laws are negative, and are one of the issues we need to deal with if we want to reduce health costs. 0. https://www.mercatus.org/publication/health-spending-reined-in-CON-laws https://www.mercatus.org/publication/health-spending-reined-... 1. https://jhu.pure.elsevier.com/en/publications/impact-of-state-certificate-of-need-laws-on-health-care-costs-and-4 https://jhu.pure.elsevier.com/en/publications/impact-of-stat... 2. https://www.mercatus.org/publication/do-certificate-need-laws-limit-spending https://www.mercatus.org/publication/do-certificate-need-law...