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> The medical industry has the biggest conflict of interest I have seen in any industry. It's actually bad for doctors if preventive healthcare takes off the wa

by xiaq 7y ago

> The medical industry has the biggest conflict of interest I have seen in any industry. It's actually bad for doctors if preventive healthcare takes off the way it should, we all eat healthy, balanced diets and exercise to take care of our bodies and mind. Not in countries with a national health system, where the government is incentivized to keep people healthy in order to reduce cost.

r_singh 7y ago
Haven't experienced this so don't know as much, but yes, does make sense (in theory, at least).
catalogia 7y ago
The government may have that incentive, but what about the individual doctors who are actually examining patients and diagnosing people? Do these employees truly share their employer's desire to cut costs? I don't really believe that doctors are keeping people sick on purpose to keep demand for their profession high, but if that were going on, I don't think socialized healthcare would necessarily erase that incentive. There are plenty of government and private sector workers who try to preserve their own jobs to the detriment of the whole.
- pimmen 7y ago
  Universal healthcare doesn’t erase that incentive, nothing does. You need a vigilant medical board that penalizes bad doctors to deal with that, fortunately something like that can be reconciled with the system we have in the Nordics. Of course, it’s far from perfect just like any regulatory agency ever.
Consultant32452 7y ago
What is unique about healthcare that the government would feel incentivized to reduce costs? How is it different from roads, schools, military, etc?
- virgilp 7y ago
  Government is in theory incentivized to reduce costs because it has limited funds. The thing with healthcare is that the purchaser, if private, pays whatever (s)he can afford (how much is your health worth it to you?). Whereas if the state is the purchaser, it is (a) A monopsony, having substantial power over healthcare providers; and (b) Doesn't care as much about any individual patient, thus being able to make decisions that are rational on the aggregate level On short: much better to be a healthcare provider in US; much better to be a patient in EU.
  - Consultant32452 7y ago
    Do you think the same downward pressure on costs applies to schools? What about fighter jets?
- deleted 7y ago
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- deleted 7y ago
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- refurb 7y ago
  The demand for healthcare is infinite. Even when there are marginal improvements in treatment, patients and physicians want the best. The ability of national health systems to say “no” is one of the big levers to controlling cost, in the US, that control is quite fragmented.
gvjddbnvdrbv 7y ago
In general you are correct but sadly there are perverse incentives even in a system like the NHS. There are two problems. (1) treatments are approved only if they make financial sense for the country and (2) sometimes those calculations go wrong. At one point people were being allowed to go blind based on a cost calculation. Even though letting people go blind was more expensive overall to the country. The cost of treatment to the NHS budget was greater than non-treatment but the social care costs came from another budget.
- eterm 7y ago
  Source? Because the NHS doesn't optimise for cost, it optimises for cost per QALY (quality adjusted life years). Given the high impact to quality of life for blindness your claim is dubious. NICE make the decisions over cost effectiveness of treatments, and publish their findings. If you can tell me the name of the drug we can find the actual report.
  - gvjddbnvdrbv 7y ago
    I heard this on a BBC radio 4 radio program related to disability issues aired on either a Tuesday or Thursday around 9pm in around 2014/2015.
    - DanBC 7y ago
      2011? https://www.bbc.co.uk/programmes/b016817t https://www.bbc.co.uk/programmes/b016817t Avastin / Lucentis does not support the point being made. Lucentis, a very expensive medication, was both licenced for AMD and was approved by NICE for that use. Avastin is identical, but was not licenced for AMD and so NICE was not able to recommend its use for AMD. Doctors were using Avastin off label, and they wanted the government to force Avastin to be licenced for AMD which would have allowed it to be recommended by NICE. The makers of Avastin and Lucentis fought this in the courts for years, and took action against NHS Trusts using Avastin off-label. The NHS won that legal case. https://www.bbc.co.uk/news/health-30138097 https://www.bbc.co.uk/news/health-30138097 https://www.hsj.co.uk/finance-and-efficiency/breaking-nhs-wins-landmark-legal-battle-against-drug-companies/7023422.article https://www.hsj.co.uk/finance-and-efficiency/breaking-nhs-wi... There is a problem of people going blind while waiting for treatment, but this is related to cataracts and glaucoma, not AMD, and it has nothing to do with NICE (who are the organisation that decides about cost effectiveness) and everything to do with a government that has chosen to de-fund the NHS.
WalterBright 7y ago
> Not in countries with a national health system, where the government is incentivized to keep people healthy in order to reduce cost. It's hard to see how this can be true, since government operations are infamous for excessive cost.
- speedgoose 7y ago
  Look at the health-care situation in Europe.
  - throw47899544 7y ago
    In France if, for an average employee, you add the employer and employee contribution to social security, for 40 years, you find that it pays two large houses. At the same time most average employees will struggle to buy a house. And the social security will reimburse well only medical costs (visit to family doctors or medical acts done in hospitals). For other costs, hospital care, glasses, dental or hearing costs, it reimburses very little. So for me France's SS is actually a kind of mandatory way to channel money towards doctors.
    - pbhjpbhj 7y ago
      I thought France has a rental culture, no? I'd rather be alive and renting than dead with an estate that has ownership of a building.
    - kokx 7y ago
      Lets assume that instead that money would go to the employee and not to social security. And we will assume that a large house would cost about 500k EUR. Thus, in 40 years, you would have collected a million euros more. That is about 25k EUR extra per year. That seems to be about the amount of income tax a French citizen would pay every year. Thus, that money doesn't just go to health care. It also goes to other social security programs and government projects.
- tonyedgecombe 7y ago
  We have a pretty lean system in the UK, possibly too lean. The private system in the US however seems a poster child for excessive cost.
ekianjo 7y ago
> Not in countries with a national health system, where the government is incentivized to keep people healthy in order to reduce cost. Except that in such countries healthcare costs completely explode over time as well.
- donkeyd 7y ago
  Can you please provide some form of a source for your statement? I read this a lot, but I can't find any factual basis for the statement. The US is known for having the highest cost of health care per capita, more than twice that of France and the UK, two countries commonly named for having socialized health care [0]. 0: https://www.businessinsider.com/cost-of-healthcare-countries-ranked-2019-3 https://www.businessinsider.com/cost-of-healthcare-countries...
  - ekianjo 7y ago
    Please find me another country that creates as many new drugs as the US and that has a national health care system. If you dont have such an example it cannot be a fair comparison. the world is not summed up by a single variable.
    - majewsky 7y ago
      Why are you moving the goalposts by now requiring the country in question to "create as many new drugs as the US"? I don't see how that relates to this discussion at all.
    - kiney 7y ago
      switzerland has way more new drug patents (per capita) and universal healthcare
      - cyphar 7y ago
        Switzerland (unfortunately) doesn't have what I (as an Australian) would recognise as universal healthcare. It's very similar to the "public option" to use the US terminology. It is still closer to modern healthcare than the US, but it's not the same thing (and suffers from problems that other more progressive healthcare systems do not suffer from).
cosmodisk 7y ago
In countries with national health system, doctors have the opposite target to not referr people further for expensive procedures. A good example was in London,where a hospital was paying to GP practices so they won't refer people for certain treatment ( because of the workload the hospital had). You need to go to your GP at least 3 times before they even start listening what's going on or prescribe more than just paracetamol.
refurb 7y ago
It really comes down to how doctors are compensated. I know Canada used to be fee-for-service. The more the doctor does, the more they get paid. They certainly had an incentive to “do more”.

by xiaq 7y ago

r_singh 7y ago

Haven't experienced this so don't know as much, but yes, does make sense (in theory, at least).

catalogia 7y ago

The government may have that incentive, but what about the individual doctors who are actually examining patients and diagnosing people? Do these employees truly share their employer's desire to cut costs? I don't really believe that doctors are keeping people sick on purpose to keep demand for their profession high, but if that were going on, I don't think socialized healthcare would necessarily erase that incentive. There are plenty of government and private sector workers who try to preserve their own jobs to the detriment of the whole.

pimmen 7y ago
Universal healthcare doesn’t erase that incentive, nothing does. You need a vigilant medical board that penalizes bad doctors to deal with that, fortunately something like that can be reconciled with the system we have in the Nordics. Of course, it’s far from perfect just like any regulatory agency ever.

Consultant32452 7y ago

What is unique about healthcare that the government would feel incentivized to reduce costs? How is it different from roads, schools, military, etc?

virgilp 7y ago
Government is in theory incentivized to reduce costs because it has limited funds. The thing with healthcare is that the purchaser, if private, pays whatever (s)he can afford (how much is your health worth it to you?). Whereas if the state is the purchaser, it is (a) A monopsony, having substantial power over healthcare providers; and (b) Doesn't care as much about any individual patient, thus being able to make decisions that are rational on the aggregate level On short: much better to be a healthcare provider in US; much better to be a patient in EU.
- Consultant32452 7y ago
  Do you think the same downward pressure on costs applies to schools? What about fighter jets?
deleted 7y ago
[deleted]
deleted 7y ago
[deleted]
refurb 7y ago
The demand for healthcare is infinite. Even when there are marginal improvements in treatment, patients and physicians want the best. The ability of national health systems to say “no” is one of the big levers to controlling cost, in the US, that control is quite fragmented.

gvjddbnvdrbv 7y ago

In general you are correct but sadly there are perverse incentives even in a system like the NHS. There are two problems. (1) treatments are approved only if they make financial sense for the country and (2) sometimes those calculations go wrong. At one point people were being allowed to go blind based on a cost calculation. Even though letting people go blind was more expensive overall to the country. The cost of treatment to the NHS budget was greater than non-treatment but the social care costs came from another budget.

eterm 7y ago
Source? Because the NHS doesn't optimise for cost, it optimises for cost per QALY (quality adjusted life years). Given the high impact to quality of life for blindness your claim is dubious. NICE make the decisions over cost effectiveness of treatments, and publish their findings. If you can tell me the name of the drug we can find the actual report.
- gvjddbnvdrbv 7y ago
  I heard this on a BBC radio 4 radio program related to disability issues aired on either a Tuesday or Thursday around 9pm in around 2014/2015.
  - DanBC 7y ago
    2011? https://www.bbc.co.uk/programmes/b016817t https://www.bbc.co.uk/programmes/b016817t Avastin / Lucentis does not support the point being made. Lucentis, a very expensive medication, was both licenced for AMD and was approved by NICE for that use. Avastin is identical, but was not licenced for AMD and so NICE was not able to recommend its use for AMD. Doctors were using Avastin off label, and they wanted the government to force Avastin to be licenced for AMD which would have allowed it to be recommended by NICE. The makers of Avastin and Lucentis fought this in the courts for years, and took action against NHS Trusts using Avastin off-label. The NHS won that legal case. https://www.bbc.co.uk/news/health-30138097 https://www.bbc.co.uk/news/health-30138097 https://www.hsj.co.uk/finance-and-efficiency/breaking-nhs-wins-landmark-legal-battle-against-drug-companies/7023422.article https://www.hsj.co.uk/finance-and-efficiency/breaking-nhs-wi... There is a problem of people going blind while waiting for treatment, but this is related to cataracts and glaucoma, not AMD, and it has nothing to do with NICE (who are the organisation that decides about cost effectiveness) and everything to do with a government that has chosen to de-fund the NHS.

WalterBright 7y ago

> Not in countries with a national health system, where the government is incentivized to keep people healthy in order to reduce cost. It's hard to see how this can be true, since government operations are infamous for excessive cost.

speedgoose 7y ago
Look at the health-care situation in Europe.
- throw47899544 7y ago
  In France if, for an average employee, you add the employer and employee contribution to social security, for 40 years, you find that it pays two large houses. At the same time most average employees will struggle to buy a house. And the social security will reimburse well only medical costs (visit to family doctors or medical acts done in hospitals). For other costs, hospital care, glasses, dental or hearing costs, it reimburses very little. So for me France's SS is actually a kind of mandatory way to channel money towards doctors.
  - pbhjpbhj 7y ago
    I thought France has a rental culture, no? I'd rather be alive and renting than dead with an estate that has ownership of a building.
  - kokx 7y ago
    Lets assume that instead that money would go to the employee and not to social security. And we will assume that a large house would cost about 500k EUR. Thus, in 40 years, you would have collected a million euros more. That is about 25k EUR extra per year. That seems to be about the amount of income tax a French citizen would pay every year. Thus, that money doesn't just go to health care. It also goes to other social security programs and government projects.
tonyedgecombe 7y ago
We have a pretty lean system in the UK, possibly too lean. The private system in the US however seems a poster child for excessive cost.

ekianjo 7y ago

> Not in countries with a national health system, where the government is incentivized to keep people healthy in order to reduce cost. Except that in such countries healthcare costs completely explode over time as well.

donkeyd 7y ago
Can you please provide some form of a source for your statement? I read this a lot, but I can't find any factual basis for the statement. The US is known for having the highest cost of health care per capita, more than twice that of France and the UK, two countries commonly named for having socialized health care [0]. 0: https://www.businessinsider.com/cost-of-healthcare-countries-ranked-2019-3 https://www.businessinsider.com/cost-of-healthcare-countries...
- ekianjo 7y ago
  Please find me another country that creates as many new drugs as the US and that has a national health care system. If you dont have such an example it cannot be a fair comparison. the world is not summed up by a single variable.
  - majewsky 7y ago
    Why are you moving the goalposts by now requiring the country in question to "create as many new drugs as the US"? I don't see how that relates to this discussion at all.
  - kiney 7y ago
    switzerland has way more new drug patents (per capita) and universal healthcare
    - cyphar 7y ago
      Switzerland (unfortunately) doesn't have what I (as an Australian) would recognise as universal healthcare. It's very similar to the "public option" to use the US terminology. It is still closer to modern healthcare than the US, but it's not the same thing (and suffers from problems that other more progressive healthcare systems do not suffer from).

cosmodisk 7y ago

In countries with national health system, doctors have the opposite target to not referr people further for expensive procedures. A good example was in London,where a hospital was paying to GP practices so they won't refer people for certain treatment ( because of the workload the hospital had). You need to go to your GP at least 3 times before they even start listening what's going on or prescribe more than just paracetamol.

refurb 7y ago

It really comes down to how doctors are compensated. I know Canada used to be fee-for-service. The more the doctor does, the more they get paid. They certainly had an incentive to “do more”.