9 ms·

I'm the technical cofounder of a mid-sized healthcare startup, and when I start explaining hospital administration to people, I start with this - every person w

I'm the technical cofounder of a mid-sized healthcare startup, and when I start explaining hospital administration to people, I start with this - every person working in your hospital or clinic has no incentive whatsoever for you to emerge healthier. The only goal is to maximize the ratio between the amount your insurance is willing to pay, and the amount of care that is provided. In the case of joint replacement, each insurance provider has negotiated a fixed block payment for all costs related to the surgery. If the surgeon makes a mistake, or the patient doesn't follow along with physical therapy, or something goes wrong for whatever reason, the care provider is financially responsible for any corrective actions on the procedure. This means any complaint in a follow-up visit is usually met with some kind of platitude to make you go away, like "here is a prescription for some pain medication, let us know if the problem persists". There is no incentive to do any scans or tests, since this would eat into the profits that the hospital has made on this patient. For certain GI surgeries, patients are instructed not to eat solid food for a week or two after surgery. A certain percentage of people ignore these instructions and end up in the hospital ER requiring another surgery. In the last couple years, providers of these treatments have learned how to bring that percentage down by hammering post-op patients with daily email/SMS messages to ensure they are educated about their procedure. These systems were not put in place by someone at the hospital who wanted patients to be better informed, they were put in place because someone noticed that percentage and calculated how much money the hospital could be saving for each percentage point in reduced readmission. I have heard good arguments against Medicare-for-all, but I have never heard any logical argument to defend the status quo.

Spooky23 6y ago
In helping with a family member struggling with a very serious medical condition, the only incentive I’ve been work is the stick. The Medicare incentives to kick patients out of rehab is very effective, to the point that it’s a cruel game for families operating under the mistaken assumption that healing is a goal. In the hospital, the only urgency outside of acute/intensive care that I saw was when my family member was readmitted due to incompetence on the part of the hospital, and ended up costing them thousands of unremimbursed dollars.
RIDDLERTHIS 6y ago
I worked on the tech-side of healthcare informatics with researchers and healthcare economists. What you say is correct. The cost/benefit ratio of hospital admittance and hospital stays has been quantified to an alarming degree. Not that we shouldn't be looking at such costs, but I feel as though it should involve some level of humanity. The other, often overlooked angle of healthcare in the U.S. is the dynamic at play between for-profit and non-profit hospitals. Both of which require and actively seek profit of course. As others have stated - we need a complete overhaul of the healthcare system here. Something that would require a Teddy Roosevelt-esque stature of a man (or woman) to get started.
- bitdizzy 6y ago
  It won't be a great person who saves us.
  - Judgmentality 6y ago
    Can you elaborate?
    - jollofricepeas 6y ago
      Politicians are often not great especially Teddy Roosevelt - a war-mongering, braggard focused on making a name for the himself and furthering the ‘forward race’. Change if it comes at all will come by... 1. a populist demagogue with unchecked power 2. Or when the market wills it more than likely via technological disruption of some kind Things must get worse before they get better as with all major advancements in human history.
      - cercatrova 6y ago
        Looks like you're saying that they won't be good (a moral quality), not that they won't be great (a performance measurement); Alexander was Great, as well as the Great Khan Genghis, shaping the world as we know it, yet neither were good.
      - 6y ago
fineIllregister 6y ago
I'm not following your example. I don't want to end up in the ER requiring another surgery. If the provider can do something such that I can avoid that, I feel that's healthier. So the provider "hammers" me with reminders which makes that less likely to happen. Sure, they might not be doing it out of the kindness of their hearts (I've worked in a hospital and many people definitely do want patients to be healthier, but that's neither here nor there), but it seems like they're "incentiv[sized] for you to emerge healthier."
- ianai 6y ago
  It’s the counter example that makes the point. The only reason it seems a better outcome is coincidence.
- sircastor 6y ago
  I think the point being made is that a patient’s health is a adjacent to the effort the hospital administration is putting in. The incentive isn’t “keep the patient healthy”, it’s “keep the patient from costing us money”
gregsq 6y ago
My mother lives in country australia and had pancreatitis it seemed. Hospital, cat and mri’s, spent a week in hospital, sent home, returned after pain returned. More tests, it was decided she should be sent to a larger regional hospital for biopsy. Flew by Lear jet, drove by road home I guess about three hundred miles. Advise was a Whipple procedure. I wasn’t inclined to agree for reasons I won’t go into. I declined before second opinion from brisbane world class surgeon. He agreed. Flown commercial to brisbane. More mri’s and cat scans. Acinar cell carcinoma suspected. No need for full duodenectomy. Hospital stay and operation. After care and so on. Total cost zero. I live in the US. Healthcare here is a grift. The wife did medical billing, mostly reconciling and working all the codes. It’s a complete mess
- aantix 6y ago
  “Total cost zero”. The cost is never zero. Doctors, nurses, don’t work for free. Infrastructure isn’t maintained without money. It comes from somewhere.
  - toomuchtodo 6y ago
    “Total out of pocket cost zero, with taxes funding a functioning care driven universal healthcare system.” We’re not arguing that funding is required, simply how it flows and to whom. Disclosure: I too have first hand experience with Australia’s healthcare system. It’s very good.
  - xtian 6y ago
    What is the cost of an unhealthy population that defers or forgoes medical treatment? Where is that price exacted? In a 2019 Gallup poll, 25% of US adults said they or a family member had delayed treatment for a serious medical condition that year for financial reasons.
    - chadcmulligan 6y ago
      Australian here - was listening to a local doctor who has a radio program. He travelled to the US for something and remarked on the number of people he saw squinting - apparently this is treated here by the appropriate glasses when young (for free) but not so over there.
Fomite 6y ago
The infection control people do, because those won't be reimbursed.
disabled 6y ago
> I start with this - every person working in your hospital or clinic has no incentive whatsoever for you to emerge healthier. The only goal is to maximize the ratio between the amount your insurance is willing to pay, and the amount of care that is provided. This is the gist of American healthcare. A good read from someone who had a medical crisis, from a series of medical errors, is "Our Malady" by Timothy Snyder. He took great notes in his personal diary when the whole ordeal occurred and was able to trace back the errors, unlike most people. He also nearly died. He is a renowned American historian who is a scholar of European history, and particularly of eastern European history. Anyways, the third leading cause of death in the US is believed to be preventable medical errors (you can also google "3rd leading cause of death preventable medical errors" and find other sources which corroborate the findings of this peer-reviewed journal article): https://www.bmj.com/content/353/bmj.i2139 https://www.bmj.com/content/353/bmj.i2139 When it comes to longevity of the human lifespan, as in life expectancy, by country, the US is about to soon mirror Croatia (I am a dual US|EU [Croatian] citizen). You know, that war-torn eastern European country that went through a nasty war in the 90s. Anyways, I am proud of my country, I mean Croatia. But, as Americans, we should be ashamed. U.S. life expectancy will soon be on par with Mexico’s and the Czech Republic’s: https://www.washingtonpost.com/news/to-your-health/wp/2017/02/21/us-life-expectancy-will-soon-be-on-par-with-mexicos-and-croatias/ https://www.washingtonpost.com/news/to-your-health/wp/2017/0... (non-paywalled version: https://archive.md/3EpBi https://archive.md/3EpBi) Anyways, there are countries with national health insurance ("socialized medicine") and there are also countries that have universal health insurance coverage (guaranteed issue health insurance, which you are required to have under law). From an access perspective Germany is very similar to the US, and has universal health insurance coverage. Switzerland has a system closer to what we have in the US, with respect to both access and privitization, and they do not seem to be having the problems that we have in the American healthcare system. Just some food for thought...
LocalH 6y ago
It's almost like certain things should be exempt from the "profit first" mentality that is pervasive in capitalism.

Spooky23 6y ago

In helping with a family member struggling with a very serious medical condition, the only incentive I’ve been work is the stick. The Medicare incentives to kick patients out of rehab is very effective, to the point that it’s a cruel game for families operating under the mistaken assumption that healing is a goal. In the hospital, the only urgency outside of acute/intensive care that I saw was when my family member was readmitted due to incompetence on the part of the hospital, and ended up costing them thousands of unremimbursed dollars.

RIDDLERTHIS 6y ago

I worked on the tech-side of healthcare informatics with researchers and healthcare economists. What you say is correct. The cost/benefit ratio of hospital admittance and hospital stays has been quantified to an alarming degree. Not that we shouldn't be looking at such costs, but I feel as though it should involve some level of humanity. The other, often overlooked angle of healthcare in the U.S. is the dynamic at play between for-profit and non-profit hospitals. Both of which require and actively seek profit of course. As others have stated - we need a complete overhaul of the healthcare system here. Something that would require a Teddy Roosevelt-esque stature of a man (or woman) to get started.

bitdizzy 6y ago
It won't be a great person who saves us.
- Judgmentality 6y ago
  Can you elaborate?
  - jollofricepeas 6y ago
    Politicians are often not great especially Teddy Roosevelt - a war-mongering, braggard focused on making a name for the himself and furthering the ‘forward race’. Change if it comes at all will come by... 1. a populist demagogue with unchecked power 2. Or when the market wills it more than likely via technological disruption of some kind Things must get worse before they get better as with all major advancements in human history.
    - cercatrova 6y ago
      Looks like you're saying that they won't be good (a moral quality), not that they won't be great (a performance measurement); Alexander was Great, as well as the Great Khan Genghis, shaping the world as we know it, yet neither were good.
    - 6y ago

fineIllregister 6y ago

I'm not following your example. I don't want to end up in the ER requiring another surgery. If the provider can do something such that I can avoid that, I feel that's healthier. So the provider "hammers" me with reminders which makes that less likely to happen. Sure, they might not be doing it out of the kindness of their hearts (I've worked in a hospital and many people definitely do want patients to be healthier, but that's neither here nor there), but it seems like they're "incentiv[sized] for you to emerge healthier."

ianai 6y ago
It’s the counter example that makes the point. The only reason it seems a better outcome is coincidence.
sircastor 6y ago
I think the point being made is that a patient’s health is a adjacent to the effort the hospital administration is putting in. The incentive isn’t “keep the patient healthy”, it’s “keep the patient from costing us money”

gregsq 6y ago

My mother lives in country australia and had pancreatitis it seemed. Hospital, cat and mri’s, spent a week in hospital, sent home, returned after pain returned. More tests, it was decided she should be sent to a larger regional hospital for biopsy. Flew by Lear jet, drove by road home I guess about three hundred miles. Advise was a Whipple procedure. I wasn’t inclined to agree for reasons I won’t go into. I declined before second opinion from brisbane world class surgeon. He agreed. Flown commercial to brisbane. More mri’s and cat scans. Acinar cell carcinoma suspected. No need for full duodenectomy. Hospital stay and operation. After care and so on. Total cost zero. I live in the US. Healthcare here is a grift. The wife did medical billing, mostly reconciling and working all the codes. It’s a complete mess

aantix 6y ago
“Total cost zero”. The cost is never zero. Doctors, nurses, don’t work for free. Infrastructure isn’t maintained without money. It comes from somewhere.
- toomuchtodo 6y ago
  “Total out of pocket cost zero, with taxes funding a functioning care driven universal healthcare system.” We’re not arguing that funding is required, simply how it flows and to whom. Disclosure: I too have first hand experience with Australia’s healthcare system. It’s very good.
- xtian 6y ago
  What is the cost of an unhealthy population that defers or forgoes medical treatment? Where is that price exacted? In a 2019 Gallup poll, 25% of US adults said they or a family member had delayed treatment for a serious medical condition that year for financial reasons.
  - chadcmulligan 6y ago
    Australian here - was listening to a local doctor who has a radio program. He travelled to the US for something and remarked on the number of people he saw squinting - apparently this is treated here by the appropriate glasses when young (for free) but not so over there.

Fomite 6y ago

The infection control people do, because those won't be reimbursed.

disabled 6y ago

> I start with this - every person working in your hospital or clinic has no incentive whatsoever for you to emerge healthier. The only goal is to maximize the ratio between the amount your insurance is willing to pay, and the amount of care that is provided. This is the gist of American healthcare. A good read from someone who had a medical crisis, from a series of medical errors, is "Our Malady" by Timothy Snyder. He took great notes in his personal diary when the whole ordeal occurred and was able to trace back the errors, unlike most people. He also nearly died. He is a renowned American historian who is a scholar of European history, and particularly of eastern European history. Anyways, the third leading cause of death in the US is believed to be preventable medical errors (you can also google "3rd leading cause of death preventable medical errors" and find other sources which corroborate the findings of this peer-reviewed journal article): https://www.bmj.com/content/353/bmj.i2139 https://www.bmj.com/content/353/bmj.i2139 When it comes to longevity of the human lifespan, as in life expectancy, by country, the US is about to soon mirror Croatia (I am a dual US|EU [Croatian] citizen). You know, that war-torn eastern European country that went through a nasty war in the 90s. Anyways, I am proud of my country, I mean Croatia. But, as Americans, we should be ashamed. U.S. life expectancy will soon be on par with Mexico’s and the Czech Republic’s: https://www.washingtonpost.com/news/to-your-health/wp/2017/02/21/us-life-expectancy-will-soon-be-on-par-with-mexicos-and-croatias/ https://www.washingtonpost.com/news/to-your-health/wp/2017/0... (non-paywalled version: https://archive.md/3EpBi https://archive.md/3EpBi) Anyways, there are countries with national health insurance ("socialized medicine") and there are also countries that have universal health insurance coverage (guaranteed issue health insurance, which you are required to have under law). From an access perspective Germany is very similar to the US, and has universal health insurance coverage. Switzerland has a system closer to what we have in the US, with respect to both access and privitization, and they do not seem to be having the problems that we have in the American healthcare system. Just some food for thought...

LocalH 6y ago

It's almost like certain things should be exempt from the "profit first" mentality that is pervasive in capitalism.