2 ms·

It is a well-known fact that the entire industry under-invests in tech infrastructure. Congress literally paid them to do it using "meaningful use" incentives a

It is a well-known fact that the entire industry under-invests in tech infrastructure. Congress literally paid them to do it using "meaningful use" incentives as part of the ACA, and still can't get them to invest more. Ask yourself who has better front-office CRM: your local car dealership or your doctor? Do you think the audo dealership does it because they like spending money? No, it's because they compete and are paid based on quality of customer service, and believe (rightly) that keeping good customer records is an important part of that. No such incentives exist in the medical industry. Everything is just "how many procedures can you do per hour". Since the industry doesn't encourage good record-keeping, it's seen as a "chore" doctors don't like doing and hence hate doing it, and try to do it as quickly as possible, before they can get back to "making money" doing hip and knee surgery, seeing more patients, etc. The solution is really pretty simple: there needs to be meaningful competition on the (patient-perceived) quality of care. Our current insurance-driven system doesn't promote that at all. Handing customers cash, whether from employers, the government, whoever, and letting them spend it, gets the incentives a lot closer to right.

aeternus 8y ago
Patient-perceived quality of care isn't the right measure. Patients don't like being told that they need to exercise, lose weight, drink less alcohol, rest. A large part of a patient-perceived score is whether they get what they want. This often isn't in the best interest of the patient. With patient-score focused medicine, you get over-prescription of pain-meds, adderall, antibiotics. You also incentivize doctors not to challenge patients with dangerous views like anti-vax.
- eldavido 8y ago
  That's perhaps true in some cases. But I think patients need to have a little more skin in the game. Take knee surgery. My surgeon friend does 7 of these each day at $30K/surgery (he "only" gets about 10% of the charged amount). If there was even a 10% copay on this, possibly means-tested if you want to make it fair for poor people (meaning it goes up the more income/wealth you have), you'd better believe more people would choose dietetics (my mom's profession, group classes cost like $10 each) over $30K knee replacements. You're talking about a procedure that costs roughly the yearly pretax median income of a US adult. Some people have multiple of these per life. We can play the "who pays" game all day, pushing the cost of care around on the plate, as it were, but until we stop prescribing high-cost surgeries and expensive solutions to chronic conditions, the needle isn't going to move on how much we spend on health. 20% of GDP and growing, to be exact. I just don't think there's a way around this without forcing patients to feel a bit more pain.
candiodari 8y ago
> The solution is really pretty simple: there needs to be meaningful competition on the (patient-perceived) quality of care. Competition would require at least a slight oversupply of doctors. Right now there's a shortage: we're training about 80% of the doctors we need for the current levels of procedures. Meanwhile the population is getting older and that means more procedures. This will get worse before it gets better. So this can only happen if we increase funding quite a bit for medical training programs, essentially country-wide. 25%, absolute minimum.

aeternus 8y ago

Patient-perceived quality of care isn't the right measure. Patients don't like being told that they need to exercise, lose weight, drink less alcohol, rest. A large part of a patient-perceived score is whether they get what they want. This often isn't in the best interest of the patient. With patient-score focused medicine, you get over-prescription of pain-meds, adderall, antibiotics. You also incentivize doctors not to challenge patients with dangerous views like anti-vax.

eldavido 8y ago
That's perhaps true in some cases. But I think patients need to have a little more skin in the game. Take knee surgery. My surgeon friend does 7 of these each day at $30K/surgery (he "only" gets about 10% of the charged amount). If there was even a 10% copay on this, possibly means-tested if you want to make it fair for poor people (meaning it goes up the more income/wealth you have), you'd better believe more people would choose dietetics (my mom's profession, group classes cost like $10 each) over $30K knee replacements. You're talking about a procedure that costs roughly the yearly pretax median income of a US adult. Some people have multiple of these per life. We can play the "who pays" game all day, pushing the cost of care around on the plate, as it were, but until we stop prescribing high-cost surgeries and expensive solutions to chronic conditions, the needle isn't going to move on how much we spend on health. 20% of GDP and growing, to be exact. I just don't think there's a way around this without forcing patients to feel a bit more pain.

candiodari 8y ago

> The solution is really pretty simple: there needs to be meaningful competition on the (patient-perceived) quality of care. Competition would require at least a slight oversupply of doctors. Right now there's a shortage: we're training about 80% of the doctors we need for the current levels of procedures. Meanwhile the population is getting older and that means more procedures. This will get worse before it gets better. So this can only happen if we increase funding quite a bit for medical training programs, essentially country-wide. 25%, absolute minimum.