4 ms·

The last bit of your comment, regarding misdiagnosis, reminds me of a recent episode of Peter Attia’s podcast The Drive, wherein he interviews an experienced on

The last bit of your comment, regarding misdiagnosis, reminds me of a recent episode of Peter Attia’s podcast The Drive, wherein he interviews an experienced oncologist. Her opinion was strong in that we are overspending in treatment research and underspending in (early) diagnosis research. Her case, as described in the interview, made sense to me and gave me some hope that at least others could benefit in the future from such spending adjustments. But, I am sorry for what you’re going through, and that such a change has not yet taken place from which you/your partner would have benefitted.

sacred_numbers 6y ago
The incentive for all parties (except the patients) is to increase revenue, rather than decrease costs. Insurance companies may want to reduce costs on a case by case basis, but on a macro level they want to spend more, since they are required to spend 80% of premiums received on treatment. More treatment means higher premiums, which means the 20% not spent on treatment is higher. Hospitals have similar incentives, since a higher top line means a higher bottom line. We need some sort of patient focused agent that is incentivized to minimize long term costs and maximize patient outcomes. Single payer government healthcare systems seem to do a decent job in this role in many countries. If there's a better method I'm open to it, but nothing will change until the economic incentives change or patient bargaining power increases.
- ghufran_syed 6y ago
  It's worth noting that Kaiser is a nonprofit that is both "payer" (insurance company) and "provider" (hospitals and clinics) in the US - so I would argue that they have exactly the right incentives that you outline - maximize patient outcomes for minimal cost. So I don't think you necessarily need the government involved.
  - petra 6y ago
    This begs the question: Why are for-profits winning over Kaiser, Why isn't the Kaiser model everywhere ?
    - tstrimple 6y ago
      Because healthcare isn't an elastic good with markets that observes the overly simplistic supply and demand model. It's the entire reason why pro-market capitalists are really bad at trying to solve this problem.
    - twunde 6y ago
      This is actually two questions: Why do we have for-profit vs non-profit healthcare providers in the US and does that affect how they're run? The main difference is that non-profits tend to be more profitable since they don't pay taxes, but otherwise they're pretty much the same including the high bills. They are required provide some threshold of charity care, but the forms you need to fill out differ from provider to provider. The 2nd question is why aren't there more dual payer-provider systems? There are two big barriers, firstly you need a large amount of capital to start up either a provider or a payer system, to do both you need even more money. Secondly you need expertise in running both a provider and a payer. Over the past decade a number of providers tried adding insurance arms. Many failed. In NY, both Northwell Healthcare and Crystal Run's insurance arms were started and closed (and these are both well-run healthcare systems) [1]. What's been going on recently in healthcare is that insurance companies have been starting joint ventures with providers. Even Kaiser has struggled when expanding in new markets, especially on the east coast (they're mainly on the West Coast where they were started as a way to provide healthcare to workers at Kaiser enterprises) [1] https://www.recordonline.com/news/20190329/crystal-run-to-pull-plug-on-its-health-plans https://www.recordonline.com/news/20190329/crystal-run-to-pu...
      - ivalm 6y ago
        Note only the KP Foundation Health Plan and Hospitals are non profit. The med groups (which employ drs and a lot of other personnel) are for profit. I think both a strength and weakness of KP is that it is not really one organization, but more like 20+ related legal entities. Each region has their own med group/health plan with some regions having their own hospital foundation (some like Georgia do not own hospitals). This means that a lot of work/decision making is extremely siloed and KP National has limited ability to lay down the law. Different Regions and even just medgroup vs health plan within one region often don’t want to share data. Also, KP’s ehr is not cross-region compatible.
  - kiba 6y ago
    My experience with Kaiser is that they from time to time have a clusterfuck system for online payment, and they still charging me high fees for various tests that costs hundred of dollars.
- jimbokun 6y ago
  If they diagnose more illnesses, wouldn't that also lead to more spent on treatments and higher reimbursements? Or do you mean if it's "caught early" the treatments might be cheaper and so less overall reimbursements? For the latter case, moving to a capitation model can't come soon enough: https://en.wikipedia.org/wiki/Capitation_(healthcare) https://en.wikipedia.org/wiki/Capitation_(healthcare)
petra 6y ago
The misdiagnosis problem isn't just a problem in the US, here in Israel, there's also a problem with misdiagnosis. And our healthcare system is considered very good, and uses Single payer, etc.

sacred_numbers 6y ago

The incentive for all parties (except the patients) is to increase revenue, rather than decrease costs. Insurance companies may want to reduce costs on a case by case basis, but on a macro level they want to spend more, since they are required to spend 80% of premiums received on treatment. More treatment means higher premiums, which means the 20% not spent on treatment is higher. Hospitals have similar incentives, since a higher top line means a higher bottom line. We need some sort of patient focused agent that is incentivized to minimize long term costs and maximize patient outcomes. Single payer government healthcare systems seem to do a decent job in this role in many countries. If there's a better method I'm open to it, but nothing will change until the economic incentives change or patient bargaining power increases.

ghufran_syed 6y ago
It's worth noting that Kaiser is a nonprofit that is both "payer" (insurance company) and "provider" (hospitals and clinics) in the US - so I would argue that they have exactly the right incentives that you outline - maximize patient outcomes for minimal cost. So I don't think you necessarily need the government involved.
- petra 6y ago
  This begs the question: Why are for-profits winning over Kaiser, Why isn't the Kaiser model everywhere ?
  - tstrimple 6y ago
    Because healthcare isn't an elastic good with markets that observes the overly simplistic supply and demand model. It's the entire reason why pro-market capitalists are really bad at trying to solve this problem.
  - twunde 6y ago
    This is actually two questions: Why do we have for-profit vs non-profit healthcare providers in the US and does that affect how they're run? The main difference is that non-profits tend to be more profitable since they don't pay taxes, but otherwise they're pretty much the same including the high bills. They are required provide some threshold of charity care, but the forms you need to fill out differ from provider to provider. The 2nd question is why aren't there more dual payer-provider systems? There are two big barriers, firstly you need a large amount of capital to start up either a provider or a payer system, to do both you need even more money. Secondly you need expertise in running both a provider and a payer. Over the past decade a number of providers tried adding insurance arms. Many failed. In NY, both Northwell Healthcare and Crystal Run's insurance arms were started and closed (and these are both well-run healthcare systems) [1]. What's been going on recently in healthcare is that insurance companies have been starting joint ventures with providers. Even Kaiser has struggled when expanding in new markets, especially on the east coast (they're mainly on the West Coast where they were started as a way to provide healthcare to workers at Kaiser enterprises) [1] https://www.recordonline.com/news/20190329/crystal-run-to-pull-plug-on-its-health-plans https://www.recordonline.com/news/20190329/crystal-run-to-pu...
    - ivalm 6y ago
      Note only the KP Foundation Health Plan and Hospitals are non profit. The med groups (which employ drs and a lot of other personnel) are for profit. I think both a strength and weakness of KP is that it is not really one organization, but more like 20+ related legal entities. Each region has their own med group/health plan with some regions having their own hospital foundation (some like Georgia do not own hospitals). This means that a lot of work/decision making is extremely siloed and KP National has limited ability to lay down the law. Different Regions and even just medgroup vs health plan within one region often don’t want to share data. Also, KP’s ehr is not cross-region compatible.
- kiba 6y ago
  My experience with Kaiser is that they from time to time have a clusterfuck system for online payment, and they still charging me high fees for various tests that costs hundred of dollars.
jimbokun 6y ago
If they diagnose more illnesses, wouldn't that also lead to more spent on treatments and higher reimbursements? Or do you mean if it's "caught early" the treatments might be cheaper and so less overall reimbursements? For the latter case, moving to a capitation model can't come soon enough: https://en.wikipedia.org/wiki/Capitation_(healthcare) https://en.wikipedia.org/wiki/Capitation_(healthcare)

petra 6y ago

The misdiagnosis problem isn't just a problem in the US, here in Israel, there's also a problem with misdiagnosis. And our healthcare system is considered very good, and uses Single payer, etc.