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A commercialized health care system also has absolutely no incentive to keep excess capacity for emergencies. It seems to be very good at finding the optimal ef

by lutorm 7y ago

A commercialized health care system also has absolutely no incentive to keep excess capacity for emergencies. It seems to be very good at finding the optimal efficiency point, which essentially is very close to "no unused resources in the nimal situation". But societal resiliency requires that health care, utilities, food supply, etc, has some excess capacity just because at some point something will happen. A public system can at least be responsive to the value society puts on resiliency.

malandrew 7y ago
How does that square with a system that has the most critical care beds per capita: https://sccm.org/Blog/March-2020/United-States-Resource-Availability-for-COVID-19 https://sccm.org/Blog/March-2020/United-States-Resource-Avai...
- rblatz 7y ago
  Interesting, the last number I saw was 10x less. That is comforting
- chmod775 7y ago
  Second most at best. Turkey has 46 / 100k. https://en.wikipedia.org/wiki/List_of_countries_by_hospital_beds#Numbers https://en.wikipedia.org/wiki/List_of_countries_by_hospital_...
- bildung 7y ago
  As user lima-lima pointed out above, this most probably is an artifact resulting from different definitions of what constitutes an ICU bed - for example pediatric and neoanatal beds are included for the US, but excluded in the European numbers. It also fails the sniff test: The US has less total hospital beds than almost every other industrial nation, but at the same time the most ICU beds?
  - malandrew 7y ago
    It only has less total beds if you exclude outpatient facility beds.
    - bildung 7y ago
      Are these included in the count of the other countries? This is exactly what I mean: Without the same definitions for all countries, the numbers per se are not really comparable.
dingaling 7y ago
> A commercialized health care system also has absolutely no incentive to keep excess capacity for emergencies. I disagree, I'd say it's the opposite. A commercial system can value surge capacity for peaks just like an online retailer does; the capacity to handle extra load means extra profit. Whereas in a public health systems like the UK NHS everything is geared towards routine operational targets such as A&E waiting times. There is no budgetary or promotional reward for having reserve capacity. Incidentally the NHS has just identified an unintended reserve: a pool of nurses who have been sitting in nadministrative middle-management roles for years. They are being retrained and redeployed now, but it illustrates the lack of efficiency in the system. A private provider would not have 'wasted' nursing staff in those positions.
- 8note 7y ago
  this assumes that health care scales in the same way that an online retailer does, no? the retraining nurses is somewhat of a point in the opposite direction -- the NHS has an easy pool to pull in because of the inefficiency. if all of the nurses were being used efficiently to begin with, there would not be an easy group to bring in. scaling the number of doctors and nurses available takes a bit more time than hiring a bunch of people to put items in boxes
- Red_Leaves_Flyy 7y ago
  Private providers are not immune to oversights and waste.
  - tryptophan 7y ago
    Atleast they get punished for it, unlike public systems which might get punished once every 20 election cycles.
- hellomyguys 7y ago
  >A commercial system can value surge capacity for peaks just like an online retailer does; the capacity to handle extra load means extra profit. Sure it can, but that's obviously not the reality and spinning up extra servers is not the same as adding extra physical rooms and beds. This analogy doesn't make any sense. >ncidentally the NHS has just identified an unintended reserve: a pool of nurses who have been sitting in nadministrative middle-management roles for years. They are being retrained and redeployed now, but it illustrates the lack of efficiency in the system. A private provider would not have 'wasted' nursing staff in those positions. You're right. A private company would just fire the nurses instead.
maxerickson 7y ago
Medicare and state licensing agencies more or less control the hospital bed capacity in the US, not commercial incentives. Want to build a hospital in many states? Better be able to convince the licensing agency there is need for the beds. Want to build a hospital and accept Medicare? Better meet all the structural requirements they put in place. Open the March update pdf here and look at the "excess" column on page 4: https://www2.illinois.gov/sites/hfsrb/InventoriesData/MonthlyHCFInventory/Pages/default.aspx https://www2.illinois.gov/sites/hfsrb/InventoriesData/Monthl... The state has big impact on the capacity of the medical system.

by lutorm 7y ago

malandrew 7y ago

How does that square with a system that has the most critical care beds per capita: https://sccm.org/Blog/March-2020/United-States-Resource-Availability-for-COVID-19 https://sccm.org/Blog/March-2020/United-States-Resource-Avai...

rblatz 7y ago
Interesting, the last number I saw was 10x less. That is comforting
chmod775 7y ago
Second most at best. Turkey has 46 / 100k. https://en.wikipedia.org/wiki/List_of_countries_by_hospital_beds#Numbers https://en.wikipedia.org/wiki/List_of_countries_by_hospital_...
bildung 7y ago
As user lima-lima pointed out above, this most probably is an artifact resulting from different definitions of what constitutes an ICU bed - for example pediatric and neoanatal beds are included for the US, but excluded in the European numbers. It also fails the sniff test: The US has less total hospital beds than almost every other industrial nation, but at the same time the most ICU beds?
- malandrew 7y ago
  It only has less total beds if you exclude outpatient facility beds.
  - bildung 7y ago
    Are these included in the count of the other countries? This is exactly what I mean: Without the same definitions for all countries, the numbers per se are not really comparable.

dingaling 7y ago

> A commercialized health care system also has absolutely no incentive to keep excess capacity for emergencies. I disagree, I'd say it's the opposite. A commercial system can value surge capacity for peaks just like an online retailer does; the capacity to handle extra load means extra profit. Whereas in a public health systems like the UK NHS everything is geared towards routine operational targets such as A&E waiting times. There is no budgetary or promotional reward for having reserve capacity. Incidentally the NHS has just identified an unintended reserve: a pool of nurses who have been sitting in nadministrative middle-management roles for years. They are being retrained and redeployed now, but it illustrates the lack of efficiency in the system. A private provider would not have 'wasted' nursing staff in those positions.

8note 7y ago
this assumes that health care scales in the same way that an online retailer does, no? the retraining nurses is somewhat of a point in the opposite direction -- the NHS has an easy pool to pull in because of the inefficiency. if all of the nurses were being used efficiently to begin with, there would not be an easy group to bring in. scaling the number of doctors and nurses available takes a bit more time than hiring a bunch of people to put items in boxes
Red_Leaves_Flyy 7y ago
Private providers are not immune to oversights and waste.
- tryptophan 7y ago
  Atleast they get punished for it, unlike public systems which might get punished once every 20 election cycles.
hellomyguys 7y ago
>A commercial system can value surge capacity for peaks just like an online retailer does; the capacity to handle extra load means extra profit. Sure it can, but that's obviously not the reality and spinning up extra servers is not the same as adding extra physical rooms and beds. This analogy doesn't make any sense. >ncidentally the NHS has just identified an unintended reserve: a pool of nurses who have been sitting in nadministrative middle-management roles for years. They are being retrained and redeployed now, but it illustrates the lack of efficiency in the system. A private provider would not have 'wasted' nursing staff in those positions. You're right. A private company would just fire the nurses instead.

maxerickson 7y ago

Medicare and state licensing agencies more or less control the hospital bed capacity in the US, not commercial incentives. Want to build a hospital in many states? Better be able to convince the licensing agency there is need for the beds. Want to build a hospital and accept Medicare? Better meet all the structural requirements they put in place. Open the March update pdf here and look at the "excess" column on page 4: https://www2.illinois.gov/sites/hfsrb/InventoriesData/MonthlyHCFInventory/Pages/default.aspx https://www2.illinois.gov/sites/hfsrb/InventoriesData/Monthl... The state has big impact on the capacity of the medical system.