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That sounds like a good plan if you have good insurance, but it doesn't sound like a sustainable way to improve health care service to a wider population. Doct

That sounds like a good plan if you have good insurance, but it doesn't sound like a sustainable way to improve health care service to a wider population. Doctors are a scarce resource, and having the doctor drive around to each patient's house is not a very good use of their time. At my Doctor's office, the doctors are scheduled for 15 minute appointments. at an optimistic assumption of 15 minutes travel time to and from each appointment, a model where the doctor visits each patient requires 3x as many doctors for the same level of care.

kfriede 9y ago
Cost could be minimized if the particular doctor does not have to pay for a facility. I can't even begin to imagine what the cost per sq/ft of a generic doctor's office is, given all the regulation and equipment requirements. Having them mobile may remove a significant cost (though probably won't come close to the added opportunity-cost you mentioned).
- SiempreViernes 9y ago
  I can’t see how there would be any cost savings except if you dump equipment that would otherwise be available; making the entire contents of a clinic mobile is surely more costly and complicated than paying rent.
  - bobthepanda 9y ago
    Test kits are mobile, vaccines and bloodwork are mobile, basic diagnostic equipment is mobile. Most people do not need the vast majority of things a clinic contains; nothing you couldn't solve with a small refrigerable unit in a vehicle. That being said, the downsides of travel time are so negative it's hard to see how they could be overcome.
  - dragonwriter 9y ago
    > I can’t see how there would be any cost savings except if you dump equipment that would otherwise be available Compared to an urgent care facility, they pretty clearly have to be doing that.
- notatoad 9y ago
  My point wasn't just about cost, but rather care. People need doctors, and "there isn't enough doctors" seems to be a common problem in health care. The cost could also be mitigated by simply charging more, but having doctors spend their time driving instead of treating patients means that the number of doctors needed for the same quality of care goes way up, and in many cases doctors are not a resource that you can simply get more of because you need more. For every doctor's appointment serviced by Heal, ~3 appointments are taken away from a community clinic somewhere.
  - trevyn 9y ago
    >For every doctor's appointment serviced by Heal, ~3 appointments are taken away from a community clinic somewhere. It sounds to me like you may be making unjustified assumptions to get to that conclusion. Citation?
    - notatoad 9y ago
      I outlined my reasoning in my post above, unless heal is creating new doctors they are hiring away doctors from more efficient types of care.
      - trevyn 9y ago
        Your reasoning is based on assumptions that there is no evidence for. Not all doctors are employed in providing care, you don’t know what Heal doctors are doing between seeing patients, you don’t know how Heal sources or compensates doctors, medical efficiency is not measured in patient-minutes, you don’t know how many patients a Heal doctor sees vs a clinic doctor, you don’t know the bottlenecks of community clinics, etc. etc.
        alsetmusic 9y ago
        > Your reasoning is based on assumptions that there is no evidence for. I have no horse in this race, but I found it interesting that the above was followed by four “you don’t know…” statements. You’re making assumptions as well. The person to whom you are responding may know a great deal more than they have revealed.
- mbesto 9y ago
  > doctor does not have to pay for a facility > given all the regulation and equipment requirements. Um, so how does not having a facility, which is probably required to give care, all of the sudden eliminate all of the equipment and regulatory requirements? I mean, don't you think the equipment and the regulation is probably there for a reason..?
  - newfoundglory 9y ago
    Well, if you build a clinic it needs to be wheelchair accessible, and have access to parking for all the patients that might be present at one time, for example. If you visit patients then they either live somewhere accessible or not and you just need to get one car to their place.
  - dragonwriter 9y ago
    > Um, so how does not having a facility, which is probably required to give care It's required for certain levels of care, but not every encounter requires those.
  - koolba 9y ago
    Same way a taco truck is cheaper to operate than a sit down restaurant. You still have to follow the local health codes but your fixed costs would be less.
hndamien 9y ago
Doing this with Facetime and some other tools (telehealth) might be the best of both worlds.
- teniutza 9y ago
  How would "open your mouth and say aaaahhh" work over Facetime? Some things need a hands-on approach.
  - hndamien 9y ago
    Yes, but only some things. My brother and best man are doctors, and we have a home doctor service and a GP. The first two provide ample support for most instances.
vadimberman 9y ago
> That sounds like a good plan if you have good insurance, but it doesn't sound like a sustainable way to improve health care service to a wider population A home visit of a physician is hardly a new concept. If I'm not mistaken, it's a norm in France, and I know that it functioned that way in the USSR (not sure about the modern Russia). The doctors were indeed complaining about the number of visits but somehow it functioned: while booking a specialist or finding quality equipment was an issue, there was rarely an issue to book a visit of a family doctor within a couple of days' notice, at least in a big city.
- csydas 9y ago
  > (not sure about the modern Russia) Highly dependent on the hospital and provider you have. Modern Russian does have a general government health care for most things, but you can also get private insurance. For the general care, you usually end up going to a local community clinic. For paid insurance, typically you can get a home visit within a few hours from a doctor who does the basics and writes you a doctors note for sick leave. (My experience has been that the sick leave is pretty generous; last time I had the flu I was given a week's rest, then for my follow up the doctor told me to take another 3 days) It's not perfect for other things, but compared to the health care situation I had when still living in the US, this facet is far better. (at my last job in the US, both Insurance and my Work Place refused to approve sick leave for a summary from my in-network GP that suggested that a treatment required several days of recovery after some radiation therapy. They said I'd have to go to another clinic to have the situation reviewed; the second clinic decided I was fit to work so my choices were either burn vacation days or sign a form to accept time off without pay during recovery.)
- Buetol 9y ago
  As a French, I can tell you we go to the doctor office / hospital 99% of the time, it’s very rare for the doctor to come to you, except for nurses.
  - vadimberman 9y ago
    (Filthy thoughts aside) Why the differentiation? What's the purpose of the nurses visiting?
ekianjo 9y ago
> At my Doctor's office, the doctors are scheduled for 15 minute appointments. at an optimistic assumption of 15 minutes travel time to and from each appointment, a model where the doctor visits each patient requires 3x as many doctors for the same level of care. It's not "either/or", there is no reason not to have both systems running in parallel. I would have no issue paying a doctor more for him to come visit us at home, to ensure it makes it as profitable for them to do that.
hrktb 9y ago
We have this large scale in France, as “sos medecin”. The key points are the “I need help” focus right in the name, and a triage process done by phone. They’ll deal with sny unforseen event that needs medical attention. It can be a severe pain in the back in the middle of the night or high fever for a kid, anything that is not a regular check-up or renewing a prescription. Then there’s pre-filtering of the calls to decide if it’s worth it to send someone, or if the patient better come to the office, or straight up call official emergency services. Price is higher than an usual consultation but not that much, and interestingly it’s also higher than ER in a public hospital, so you have incentives to choose the right service for you. We end up using it a lot because usually we detect our kid is sick after picking up from school or during week-ends, when normal offices are already closed and there’s no hope to get an appointment.
WalterSear 9y ago
Or, maybe we shouldn't just roll over and accept artificial scarcities driven by archaic, guild-like gatekeeping and capitalism. https://www.motherjones.com/kevin-drum/2013/11/its-doctors-who-control-number-doctors-america-not-government/ https://www.motherjones.com/kevin-drum/2013/11/its-doctors-w... > So the number and composition of residencies is controlled by doctors, even as they’re subsidized by $13 billion in taxpayer money every year. And doctor pay, which almost everywhere is based on Medicare rates, is controlled by doctors. It’s doctors who are directly responsible for both their own high pay and their own low numbers. https://washingtonmonthly.com/magazine/julyaugust-2013/first-teach-no-harm/#13850498142331&action=collapse_widget&id=8589671 https://washingtonmonthly.com/magazine/julyaugust-2013/first... > The U.S. spends $13 billion a year subsidizing graduate medical education. Yet almost all of this money winds up producing the wrong kinds of doctors in the wrong places, with America’s most elite teaching hospitals being the worst offenders.
- nine_k 9y ago
  I only don't see how it's a shortcoming of capitalism. I'd say it's the lack of capitalism, with its free market competition. Artificially limited supply is usually a result some state-enforced regulation.

kfriede 9y ago

Cost could be minimized if the particular doctor does not have to pay for a facility. I can't even begin to imagine what the cost per sq/ft of a generic doctor's office is, given all the regulation and equipment requirements. Having them mobile may remove a significant cost (though probably won't come close to the added opportunity-cost you mentioned).

SiempreViernes 9y ago
I can’t see how there would be any cost savings except if you dump equipment that would otherwise be available; making the entire contents of a clinic mobile is surely more costly and complicated than paying rent.
- bobthepanda 9y ago
  Test kits are mobile, vaccines and bloodwork are mobile, basic diagnostic equipment is mobile. Most people do not need the vast majority of things a clinic contains; nothing you couldn't solve with a small refrigerable unit in a vehicle. That being said, the downsides of travel time are so negative it's hard to see how they could be overcome.
- dragonwriter 9y ago
  > I can’t see how there would be any cost savings except if you dump equipment that would otherwise be available Compared to an urgent care facility, they pretty clearly have to be doing that.
notatoad 9y ago
My point wasn't just about cost, but rather care. People need doctors, and "there isn't enough doctors" seems to be a common problem in health care. The cost could also be mitigated by simply charging more, but having doctors spend their time driving instead of treating patients means that the number of doctors needed for the same quality of care goes way up, and in many cases doctors are not a resource that you can simply get more of because you need more. For every doctor's appointment serviced by Heal, ~3 appointments are taken away from a community clinic somewhere.
- trevyn 9y ago
  >For every doctor's appointment serviced by Heal, ~3 appointments are taken away from a community clinic somewhere. It sounds to me like you may be making unjustified assumptions to get to that conclusion. Citation?
  - notatoad 9y ago
    I outlined my reasoning in my post above, unless heal is creating new doctors they are hiring away doctors from more efficient types of care.
    - trevyn 9y ago
      Your reasoning is based on assumptions that there is no evidence for. Not all doctors are employed in providing care, you don’t know what Heal doctors are doing between seeing patients, you don’t know how Heal sources or compensates doctors, medical efficiency is not measured in patient-minutes, you don’t know how many patients a Heal doctor sees vs a clinic doctor, you don’t know the bottlenecks of community clinics, etc. etc.
      - alsetmusic 9y ago
        > Your reasoning is based on assumptions that there is no evidence for. I have no horse in this race, but I found it interesting that the above was followed by four “you don’t know…” statements. You’re making assumptions as well. The person to whom you are responding may know a great deal more than they have revealed.
mbesto 9y ago
> doctor does not have to pay for a facility > given all the regulation and equipment requirements. Um, so how does not having a facility, which is probably required to give care, all of the sudden eliminate all of the equipment and regulatory requirements? I mean, don't you think the equipment and the regulation is probably there for a reason..?
- newfoundglory 9y ago
  Well, if you build a clinic it needs to be wheelchair accessible, and have access to parking for all the patients that might be present at one time, for example. If you visit patients then they either live somewhere accessible or not and you just need to get one car to their place.
- dragonwriter 9y ago
  > Um, so how does not having a facility, which is probably required to give care It's required for certain levels of care, but not every encounter requires those.
- koolba 9y ago
  Same way a taco truck is cheaper to operate than a sit down restaurant. You still have to follow the local health codes but your fixed costs would be less.

hndamien 9y ago

Doing this with Facetime and some other tools (telehealth) might be the best of both worlds.

teniutza 9y ago
How would "open your mouth and say aaaahhh" work over Facetime? Some things need a hands-on approach.
- hndamien 9y ago
  Yes, but only some things. My brother and best man are doctors, and we have a home doctor service and a GP. The first two provide ample support for most instances.

vadimberman 9y ago

> That sounds like a good plan if you have good insurance, but it doesn't sound like a sustainable way to improve health care service to a wider population A home visit of a physician is hardly a new concept. If I'm not mistaken, it's a norm in France, and I know that it functioned that way in the USSR (not sure about the modern Russia). The doctors were indeed complaining about the number of visits but somehow it functioned: while booking a specialist or finding quality equipment was an issue, there was rarely an issue to book a visit of a family doctor within a couple of days' notice, at least in a big city.

csydas 9y ago
> (not sure about the modern Russia) Highly dependent on the hospital and provider you have. Modern Russian does have a general government health care for most things, but you can also get private insurance. For the general care, you usually end up going to a local community clinic. For paid insurance, typically you can get a home visit within a few hours from a doctor who does the basics and writes you a doctors note for sick leave. (My experience has been that the sick leave is pretty generous; last time I had the flu I was given a week's rest, then for my follow up the doctor told me to take another 3 days) It's not perfect for other things, but compared to the health care situation I had when still living in the US, this facet is far better. (at my last job in the US, both Insurance and my Work Place refused to approve sick leave for a summary from my in-network GP that suggested that a treatment required several days of recovery after some radiation therapy. They said I'd have to go to another clinic to have the situation reviewed; the second clinic decided I was fit to work so my choices were either burn vacation days or sign a form to accept time off without pay during recovery.)
Buetol 9y ago
As a French, I can tell you we go to the doctor office / hospital 99% of the time, it’s very rare for the doctor to come to you, except for nurses.
- vadimberman 9y ago
  (Filthy thoughts aside) Why the differentiation? What's the purpose of the nurses visiting?

ekianjo 9y ago

> At my Doctor's office, the doctors are scheduled for 15 minute appointments. at an optimistic assumption of 15 minutes travel time to and from each appointment, a model where the doctor visits each patient requires 3x as many doctors for the same level of care. It's not "either/or", there is no reason not to have both systems running in parallel. I would have no issue paying a doctor more for him to come visit us at home, to ensure it makes it as profitable for them to do that.

hrktb 9y ago

We have this large scale in France, as “sos medecin”. The key points are the “I need help” focus right in the name, and a triage process done by phone. They’ll deal with sny unforseen event that needs medical attention. It can be a severe pain in the back in the middle of the night or high fever for a kid, anything that is not a regular check-up or renewing a prescription. Then there’s pre-filtering of the calls to decide if it’s worth it to send someone, or if the patient better come to the office, or straight up call official emergency services. Price is higher than an usual consultation but not that much, and interestingly it’s also higher than ER in a public hospital, so you have incentives to choose the right service for you. We end up using it a lot because usually we detect our kid is sick after picking up from school or during week-ends, when normal offices are already closed and there’s no hope to get an appointment.

WalterSear 9y ago

Or, maybe we shouldn't just roll over and accept artificial scarcities driven by archaic, guild-like gatekeeping and capitalism. https://www.motherjones.com/kevin-drum/2013/11/its-doctors-who-control-number-doctors-america-not-government/ https://www.motherjones.com/kevin-drum/2013/11/its-doctors-w... > So the number and composition of residencies is controlled by doctors, even as they’re subsidized by $13 billion in taxpayer money every year. And doctor pay, which almost everywhere is based on Medicare rates, is controlled by doctors. It’s doctors who are directly responsible for both their own high pay and their own low numbers. https://washingtonmonthly.com/magazine/julyaugust-2013/first-teach-no-harm/#13850498142331&action=collapse_widget&id=8589671 https://washingtonmonthly.com/magazine/julyaugust-2013/first... > The U.S. spends $13 billion a year subsidizing graduate medical education. Yet almost all of this money winds up producing the wrong kinds of doctors in the wrong places, with America’s most elite teaching hospitals being the worst offenders.

nine_k 9y ago
I only don't see how it's a shortcoming of capitalism. I'd say it's the lack of capitalism, with its free market competition. Artificially limited supply is usually a result some state-enforced regulation.