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Because patients ARE the customer. Drug companies constantly work to make drugs easier to take (long acting forms, or even once a month injections) and have few

Because patients ARE the customer. Drug companies constantly work to make drugs easier to take (long acting forms, or even once a month injections) and have fewer side effects. ADHD meds are a great example. In America long lasting ADHD meds with fewer side effects were available for literal decades before they were available in certain EU countries. Modern drug delivery systems that can slowly dose a medicine over 12 hours (!!!) are the direct result of pharmaceutical companies working to improve QoL for the patient. The doctor, and especially the healthcare system, don't consider the patient's UX to be of that much importance. This is analogous to having the CTO make a software purchase VS giving user's input. Should the IT directors and CTO have a majority of the say? Of course. But the end users must be considered or you end up with painful to use software.

arcticbull 6y ago
> Because patients ARE the customer. Drug companies constantly work to make drugs easier to take (long acting forms, or even once a month injections) and have fewer side effects. Patients aren't the customer in Europe because they're not buying the drugs. They're consumers, end-users even, but they're not buying them so they're not the customers. Frankly the same is true at any US HMO. The reduction in side-effects is considered by the health system when making purchasing decisions (as side-effects cost the health system money and reduce its ability to provide care on a fixed budget). And yeah, at a company, the CIO is the decision maker, and the company is the customer. The employees are the end-users. That's why at a big company, employees may not always get to use the tools they want; they're not customers, and they're not making the purchasing decisions. In both cases, the end-users and their needs are considered, but ultimately, it's not their names on the invoice and they're not the customers.
- com2kid 6y ago
  > In both cases, the end-users and their needs are considered, but ultimately, it's not their names on the invoice and they're not the customers. And sub-optimal results thus occur. What happens with crappy drugs that technically work is that patient adherence is bad and the government + doctors say "well those poor people with mental disorders are just incapable of following the rigorous treatment protocol that we know works." (and you literally end up with people dying on the street) Maybe now and then some innovation happens to try and improve adherence, but progress is slow. You can see this in the glacial pace that drugs in certain areas of the the mental health space have progressed. For mental health disorders where the patient is making a decision on the drug, each decade sees tons of innovation. Meanwhile for drugs that are "assigned" to a patient, progress is much slower and an untold number of people have suffered as a result. I'm not saying free market healthcare is a panacea or that people should be able to pick any drug they want, but medicine should be designed to make people's lives easier. And letting drug companies advertise "this drug is like the current drug you are taking but has 1/2 the side effects and won't cause your hair to fall out so ask your doctor today!" isn't the worst thing in the world. It means patients will demand their health insurance covers the drug, and it means patients will force their doctor to read up on the drug. Without the patient being a forcing function there is literally zero motive (beyond altruism) for those two things to happen.
  - czzr 6y ago
    Patient compliance is considered by the bodies that assess the value of medication.
  - arcticbull 6y ago
    Patients do not demand insurers cover anything, they plead, usually in futility. Insurers in the US are goaled on how little care they can provide for the premiums paid, not how much.
    - com2kid 6y ago
      > Patients do not demand insurers cover anything, they plead, usually in futility. Insurers in the US are goaled on how little care they can provide for the premiums paid, not how much. Depends, employees at higher end employers have more say. Since health benefits are "feature" employers have motivation to make their benefits package better to attract employees. Heck one of Microsoft's defining features as a company used to be their health insurance package. Everything imaginable was covered 100%, no out of pocket costs ever. I'm still completely confused as to how acupuncture is covered by so many insurers though...
      - arcticbull 6y ago
        I've not found a single piece of evidence that lobbying by consumers has led to insurers covering a previously excluded treatment. Happy to be proven wrong. I would suggest also that since we're talking about the system in aggregate, the 1% of tech workers probably aren't a representative sample. Not least because they're not the ones negotiating an all-inclusive package. That's the employer.
        com2kid 6y ago
        I'm reasonably sure that Asperger's treatment was added to a few tech company health insurance plans by popular demand. Fertility treatments would likely be another "by popular demand" addition.

arcticbull 6y ago

> Because patients ARE the customer. Drug companies constantly work to make drugs easier to take (long acting forms, or even once a month injections) and have fewer side effects. Patients aren't the customer in Europe because they're not buying the drugs. They're consumers, end-users even, but they're not buying them so they're not the customers. Frankly the same is true at any US HMO. The reduction in side-effects is considered by the health system when making purchasing decisions (as side-effects cost the health system money and reduce its ability to provide care on a fixed budget). And yeah, at a company, the CIO is the decision maker, and the company is the customer. The employees are the end-users. That's why at a big company, employees may not always get to use the tools they want; they're not customers, and they're not making the purchasing decisions. In both cases, the end-users and their needs are considered, but ultimately, it's not their names on the invoice and they're not the customers.

com2kid 6y ago
> In both cases, the end-users and their needs are considered, but ultimately, it's not their names on the invoice and they're not the customers. And sub-optimal results thus occur. What happens with crappy drugs that technically work is that patient adherence is bad and the government + doctors say "well those poor people with mental disorders are just incapable of following the rigorous treatment protocol that we know works." (and you literally end up with people dying on the street) Maybe now and then some innovation happens to try and improve adherence, but progress is slow. You can see this in the glacial pace that drugs in certain areas of the the mental health space have progressed. For mental health disorders where the patient is making a decision on the drug, each decade sees tons of innovation. Meanwhile for drugs that are "assigned" to a patient, progress is much slower and an untold number of people have suffered as a result. I'm not saying free market healthcare is a panacea or that people should be able to pick any drug they want, but medicine should be designed to make people's lives easier. And letting drug companies advertise "this drug is like the current drug you are taking but has 1/2 the side effects and won't cause your hair to fall out so ask your doctor today!" isn't the worst thing in the world. It means patients will demand their health insurance covers the drug, and it means patients will force their doctor to read up on the drug. Without the patient being a forcing function there is literally zero motive (beyond altruism) for those two things to happen.
- czzr 6y ago
  Patient compliance is considered by the bodies that assess the value of medication.
- arcticbull 6y ago
  Patients do not demand insurers cover anything, they plead, usually in futility. Insurers in the US are goaled on how little care they can provide for the premiums paid, not how much.
  - com2kid 6y ago
    > Patients do not demand insurers cover anything, they plead, usually in futility. Insurers in the US are goaled on how little care they can provide for the premiums paid, not how much. Depends, employees at higher end employers have more say. Since health benefits are "feature" employers have motivation to make their benefits package better to attract employees. Heck one of Microsoft's defining features as a company used to be their health insurance package. Everything imaginable was covered 100%, no out of pocket costs ever. I'm still completely confused as to how acupuncture is covered by so many insurers though...
    - arcticbull 6y ago
      I've not found a single piece of evidence that lobbying by consumers has led to insurers covering a previously excluded treatment. Happy to be proven wrong. I would suggest also that since we're talking about the system in aggregate, the 1% of tech workers probably aren't a representative sample. Not least because they're not the ones negotiating an all-inclusive package. That's the employer.
      - com2kid 6y ago
        I'm reasonably sure that Asperger's treatment was added to a few tech company health insurance plans by popular demand. Fertility treatments would likely be another "by popular demand" addition.