6 ms·

I imagine it's on account of all the administration and intermediaries.

marcinzm 6y ago
Probably some of it but I suspect the lack of limitations on services rendered plays into it as well. If someone in the US wants to see specialists 50 times in a month due to munchausens then they'll just be charged their co-pay each time (in most insurance plans). In Germany I suspect they'd not be allowed to book appointments anymore or would require a gatekeeping referral. Same with expensive drugs that don't help outcomes but are advertised to patients and doctors.
- moooo99 6y ago
  Thats not right. You can easily get an appointment in Germany, even multiple times. If you have a referral, you usually get an appointment earlier than people who directly went to the specialist. However, if you have acute pain you will quickly get an appointment on the same or the next day. Source: Me. just made the second appointment with a specialist within a week thanks to pain, appointment is tomorrow
  - marcinzm 6y ago
    In the US on self-referral plans (60% of health plans) you can get an appointment without any acute symptoms and with no delay versus a referral. I'd say that's a fairly large difference in ease of access without probably any impact on patient outcomes.
- jgeada 6y ago
  > In Germany I suspect they'd not be allowed to book appointments anymore or would require a gatekeeping referral. This is the kind of comment that immediately classifies the commenter as never having lived outside the US and/or not reading anything but US news sources. And with the wilful blindness to how exactly those gatekeeping referrals are present in most every single healthcare plan in the US.
  - marcinzm 6y ago
    >And with the wilful blindness to how exactly those gatekeeping referrals are present in most every single healthcare plan in the US. This is only required by HMO plans which cover around 40% of the US population. PPO plans don't have such a requirement. So please don't call other people willfully blind when you yourself make broad factually incorrect statements. Pot please meet kettle. edit: Also my statements about Germany are based on comments Germans have made on hacker news regarding their own health plans. So you should really go yell at those Germans for not knowing how their own health system works.
bhupy 6y ago
It's not. There's a good breakdown that compares what drives healthcare spending between the US vs Germany (and others). https://www.healthsystemtracker.org/brief/what-drives-health-spending-in-the-u-s-compared-to-other-countries/ https://www.healthsystemtracker.org/brief/what-drives-health... The vast majority of the difference comes from just the raw cost of inpatient and outpatient care. Even if you were to completely zero out the administrative costs per capita, you'd hardly make a dent in bridging the gap.
- aaronblohowiak 6y ago
  >raw cost of inpatient and outpatient care I am interested to understand what makes the "raw" costs so wildly different. When my son had an infection in germany, we went to the equivalent of pediatric urgent care and after seeing the nurse, having bloodwork done and a few different 15 minute sessions with the physician we came to the end of the visit with the doctor, they apologized that we had to be charged the full uninsured rate and that a bill would be given to us later that we could use to have our insurance (they could not bill our insurance internationally.) We paid the 50 euros and asked what the total amount would be, assuming that was the co-pay. There was a lot of confusion because the 50 euro wasn't the copay -- it was the full-freight amount. Getting a single 15 minutes with a doctor, let alone the prep with the nurses and bloodwork being rushed would be far more than that in USA.
  - mschuster91 6y ago
    > I am interested to understand what makes the "raw" costs so wildly different. In the US, hospitals lose a lot of money on patients who don't pay at all or pay pennies, and in order to not make a loss at the end of the year they charge those who can pay more money. Also, insurances have an incentive in having hospitals set high "sticker prices" because then they can claim "higher savings" for their members. Contrast to that, in Germany as long as a patient has any insurance (and 99.9999% of Germans do) the hospitals and doctors will get their services paid (so no need to overcharge for financial reasons), and both the mandatory insurance scheme and the private insurance companies pay fixed, government-regulated fees (https://de.wikipedia.org/wiki/Einheitlicher_Bewertungsma%C3%9Fstab https://de.wikipedia.org/wiki/Einheitlicher_Bewertungsma%C3%... for the government insurance, https://de.wikipedia.org/wiki/Geb%C3%BChrenordnung_f%C3%BCr_%C3%84rzte https://de.wikipedia.org/wiki/Geb%C3%BChrenordnung_f%C3%BCr_... for the private insurance system).
dboreham 6y ago
Also lack of shame and, greed.
bazooka_penguin 6y ago
Physicians and hospitals have 2 of the most powerful lobbies in the US and have previously gatekept the doctor profession.
- 1024core 6y ago
  AMA (American Medical Association) is known to play games to limit the supply of doctors, so they can keep salaries high. http://www.econ.yale.edu/seminars/strategy/st03/nicholson-031002.pdf http://www.econ.yale.edu/seminars/strategy/st03/nicholson-03...
  - bazooka_penguin 6y ago
    Do you have a different link? The file is missing

Probably some of it but I suspect the lack of limitations on services rendered plays into it as well. If someone in the US wants to see specialists 50 times in a month due to munchausens then they'll just be charged their co-pay each time (in most insurance plans). In Germany I suspect they'd not be allowed to book appointments anymore or would require a gatekeeping referral. Same with expensive drugs that don't help outcomes but are advertised to patients and doctors.

moooo99 6y ago
Thats not right. You can easily get an appointment in Germany, even multiple times. If you have a referral, you usually get an appointment earlier than people who directly went to the specialist. However, if you have acute pain you will quickly get an appointment on the same or the next day. Source: Me. just made the second appointment with a specialist within a week thanks to pain, appointment is tomorrow
- marcinzm 6y ago
  In the US on self-referral plans (60% of health plans) you can get an appointment without any acute symptoms and with no delay versus a referral. I'd say that's a fairly large difference in ease of access without probably any impact on patient outcomes.
jgeada 6y ago
> In Germany I suspect they'd not be allowed to book appointments anymore or would require a gatekeeping referral. This is the kind of comment that immediately classifies the commenter as never having lived outside the US and/or not reading anything but US news sources. And with the wilful blindness to how exactly those gatekeeping referrals are present in most every single healthcare plan in the US.
- marcinzm 6y ago
  >And with the wilful blindness to how exactly those gatekeeping referrals are present in most every single healthcare plan in the US. This is only required by HMO plans which cover around 40% of the US population. PPO plans don't have such a requirement. So please don't call other people willfully blind when you yourself make broad factually incorrect statements. Pot please meet kettle. edit: Also my statements about Germany are based on comments Germans have made on hacker news regarding their own health plans. So you should really go yell at those Germans for not knowing how their own health system works.

bhupy 6y ago

It's not. There's a good breakdown that compares what drives healthcare spending between the US vs Germany (and others). https://www.healthsystemtracker.org/brief/what-drives-health-spending-in-the-u-s-compared-to-other-countries/ https://www.healthsystemtracker.org/brief/what-drives-health... The vast majority of the difference comes from just the raw cost of inpatient and outpatient care. Even if you were to completely zero out the administrative costs per capita, you'd hardly make a dent in bridging the gap.

aaronblohowiak 6y ago
>raw cost of inpatient and outpatient care I am interested to understand what makes the "raw" costs so wildly different. When my son had an infection in germany, we went to the equivalent of pediatric urgent care and after seeing the nurse, having bloodwork done and a few different 15 minute sessions with the physician we came to the end of the visit with the doctor, they apologized that we had to be charged the full uninsured rate and that a bill would be given to us later that we could use to have our insurance (they could not bill our insurance internationally.) We paid the 50 euros and asked what the total amount would be, assuming that was the co-pay. There was a lot of confusion because the 50 euro wasn't the copay -- it was the full-freight amount. Getting a single 15 minutes with a doctor, let alone the prep with the nurses and bloodwork being rushed would be far more than that in USA.
- mschuster91 6y ago
  > I am interested to understand what makes the "raw" costs so wildly different. In the US, hospitals lose a lot of money on patients who don't pay at all or pay pennies, and in order to not make a loss at the end of the year they charge those who can pay more money. Also, insurances have an incentive in having hospitals set high "sticker prices" because then they can claim "higher savings" for their members. Contrast to that, in Germany as long as a patient has any insurance (and 99.9999% of Germans do) the hospitals and doctors will get their services paid (so no need to overcharge for financial reasons), and both the mandatory insurance scheme and the private insurance companies pay fixed, government-regulated fees (https://de.wikipedia.org/wiki/Einheitlicher_Bewertungsma%C3%9Fstab https://de.wikipedia.org/wiki/Einheitlicher_Bewertungsma%C3%... for the government insurance, https://de.wikipedia.org/wiki/Geb%C3%BChrenordnung_f%C3%BCr_%C3%84rzte https://de.wikipedia.org/wiki/Geb%C3%BChrenordnung_f%C3%BCr_... for the private insurance system).

dboreham 6y ago

Also lack of shame and, greed.

bazooka_penguin 6y ago

Physicians and hospitals have 2 of the most powerful lobbies in the US and have previously gatekept the doctor profession.

1024core 6y ago
AMA (American Medical Association) is known to play games to limit the supply of doctors, so they can keep salaries high. http://www.econ.yale.edu/seminars/strategy/st03/nicholson-031002.pdf http://www.econ.yale.edu/seminars/strategy/st03/nicholson-03...
- bazooka_penguin 6y ago
  Do you have a different link? The file is missing