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I once worked at a US biotech startup getting paid by insurers where we would build ML models just to reverse-engineer the inconsistencies of CPT coding & claim
by mochomocha 7y ago
I once worked at a US biotech startup getting paid by insurers where we would build ML models just to reverse-engineer the inconsistencies of CPT coding & claim reimbursement by insurers & hospitals so we could get paid. Basically trying to automate "learn that Karen at insurer X processing claims wiht code Y from hospital Z usually decides to reimburse $XX". This whole idea of "free market is more efficient for healthcare" has to die. All the incentives are backwards. For example: insurers don't want efficient claim processing because that means less revenues for them.
- beat 7y agoYes! Perverse incentives are what is making it like this. And the incentives cross boundaries - relationships between providers, insurers, regulators, legislators, and consumers. There's no single guilty party that we can blame and fix. (Since insurance companies are such a target for blame, I've started to say blaming insurance is like yelling at the cashier.)
- BurningFrog 7y ago> * This whole idea of "free market is more efficient for healthcare" has to die* The current US healthcare system has very little to do with "free markets"!
- joe_the_user 7y ago"The current US healthcare system has very little to do with 'free markets'!" Sure, the US health care system is certainly not governed by wide open competition, transparent pricing or similar things. But it certainly has something to do with the "free markets". The system is basically "what you get when you realize you have to insure and regulate but you never, ever do it in a centralized rational way, 'cause that would be socialism - plus you never, ever separate an 'entrepreneur' from a real or potential stream profits". Which indeed, builds the worst of all possible systems, sending risks to the consumer and profits to the investor/rent-seekers. And from here, we could go forward to actual socialized, state-run medicine as functions adequately in most industrialized economies or back to a "wild west" system, where costs are lower, treatment is often OK and the heroin runs in large rivers as due the fatal scams(as was the US' 19th century health care reality).
- maxerickson 7y agoMedicine changed so much after ~1880 (or maybe ~1900) that there's little to learn from the prior era.
- chrisdhoover 7y agoYou realize the market is highly regulated and fully captured by the insurance companies? Not to mention the doctors guild that limits practitioners. The current system is not a free market. It is highly distorted and gamed.