3 ms·

Counter argument: Medical personel is hard to find and expensive, as is IC infrastructure. Why would we've needed to keep spare IC capacity for decades only to

by wjnc 5y ago

Counter argument: Medical personel is hard to find and expensive, as is IC infrastructure. Why would we've needed to keep spare IC capacity for decades only to find out we need it in case of a pandemic? The German argument could be re-constructed into an argument that any country will run into IC shortages regardless of the level of IC availability. In an exponential curve it's only three or four cycles (8-12 days?) away, regardless of capacity. Hence, keep your IC capacity at regular efficient rates and use vaccination to get out of the hot seat. IC's save some but lose many. Vaccinations save many. I can't say that I like the Dutch approach to covid in general, but in my first job I was deep into governement budgetting of hospitals (just before the introduction of the current Dutch reimbursement system) and it was a whole lot about 'keeping beds' and keeping patients in them to fulfill the budget. That was not what I'd call a generally efficient system. Even the health outcomes were worse since outpatient treatments usually have fewer side effects. What I've learned in that job is that doctors are like people. They respond to incentives. If that incentive is to have beds filled with people, you get just that. Beds with people.

Auracle 5y ago
You can’t throw a stone without hitting a nurse in the US, but I’m guessing they’re paid far better here as well just as doctors are. I know Germany has a mixed system but it seems to me that socialized medicine keeping costs down slowly erodes care. The increase in costs in the US is also unsustainable. There might be a happy medium in there but it might be too early to tell.
- scohesc 5y ago
  > I know Germany has a mixed system but it seems to me that socialized medicine keeping costs down slowly erodes care. You can see this happening in Canada too. We have a hybrid system in healthcare where the majority of critical care is paid for via taxes/government subsidies however secondary/tertiary stuff is either out of pocket or through insurance agencies (prescriptions, out-patient care like physiotherapy, etc). Over the past 20-30 years, our system has seen the typical government thought process of throwing more money at problems but not actually having someone be accountable for the actions of the government over decades. You end up with a bunch of overpaid, under-worked management at the top while the actual front-line workers suffer with low staffing, not enough beds, budget cuts for the front line but raises for management etc. etc. Not to mention the number of students coming here for health education (doctor, nurse, specialist) - then immediately saying sayonara for another country like the US or in the case of foreign students, their home country. I don't understand why we keep cutting healthcare budgets - one possible reason could be because corporations have slowly been taking over every aspect of society as they move faster and make smarter decisions than government officials.
- marton78 5y ago
  This is accurate. The socialized health care system in Germany worked fine for multiple decades, until a few years ago our government decided to reimburse hospitals not based on days a patient spends there (which created perverse incentives, agreed) but rather based on diagnosis. So, a hospital earns X euros for every patient with condition X, creating other perverse incentives, and resulting in less money for the hospitals, which of course trickled down to nurses.
  - piva00 5y ago
    The same happens here in Sweden. Since the implementation of more neoliberalist policies on healthcare, allowing more private clinics and paying clinics based on diagnosis created a perverse incentive to overdiagnose patients. There was a case of a clinic that performed unnecessary surgeries and procedures just to rake in more tax money. The problem isn't socialised medicine per se, it's trying to mash a socialised medicine system with "market forces", it's the ideology of the Third Way [1] to appease to these neoliberalist policy desires that is crumbling the Swedish healthcare (and welfare) system for the past 2 decades. [1] https://en.wikipedia.org/wiki/Third_Way https://en.wikipedia.org/wiki/Third_Way
int_19h 5y ago
How expensive is it as a percentage of overall healhcare spending?
- wjnc 5y ago
  There is no easy answer to that question to my knowledge. All of what hospitals do is translated into the Dutch equivalent of diagnosis-related groups. Those DRGs are standardized across the hospitals doing procedures. Insurers bargain with hospitals (usually on a higher level) for price-setting. So while there are DRGs that probably have a large IC-component, most have only a little. So the costs of IC are reimbursed via all treatments that have an average IC-component. A hospital with a good cost based activity system could probably tell you more, although that would require a very high measure of control. Dutch press just reports the general direction of (internal) prices for IC-days (about € 3k / night). That really is nowhere close to the proper answer to the question "How much would expansion cost?" The sum based on that € 3k would be: €3k * 365 * 65% * 1200 = about € 850 million for the whole of IC-care. That is a low figure for the Netherlands (€ 25 billion total medical specialist care), so I expect a lot of the IC-costs are absorbed by other DRGs or the other way around: that price doesn't include all of the fixed costs and is a marginal price.

by wjnc 5y ago

Auracle 5y ago

You can’t throw a stone without hitting a nurse in the US, but I’m guessing they’re paid far better here as well just as doctors are. I know Germany has a mixed system but it seems to me that socialized medicine keeping costs down slowly erodes care. The increase in costs in the US is also unsustainable. There might be a happy medium in there but it might be too early to tell.

scohesc 5y ago
> I know Germany has a mixed system but it seems to me that socialized medicine keeping costs down slowly erodes care. You can see this happening in Canada too. We have a hybrid system in healthcare where the majority of critical care is paid for via taxes/government subsidies however secondary/tertiary stuff is either out of pocket or through insurance agencies (prescriptions, out-patient care like physiotherapy, etc). Over the past 20-30 years, our system has seen the typical government thought process of throwing more money at problems but not actually having someone be accountable for the actions of the government over decades. You end up with a bunch of overpaid, under-worked management at the top while the actual front-line workers suffer with low staffing, not enough beds, budget cuts for the front line but raises for management etc. etc. Not to mention the number of students coming here for health education (doctor, nurse, specialist) - then immediately saying sayonara for another country like the US or in the case of foreign students, their home country. I don't understand why we keep cutting healthcare budgets - one possible reason could be because corporations have slowly been taking over every aspect of society as they move faster and make smarter decisions than government officials.
marton78 5y ago
This is accurate. The socialized health care system in Germany worked fine for multiple decades, until a few years ago our government decided to reimburse hospitals not based on days a patient spends there (which created perverse incentives, agreed) but rather based on diagnosis. So, a hospital earns X euros for every patient with condition X, creating other perverse incentives, and resulting in less money for the hospitals, which of course trickled down to nurses.
- piva00 5y ago
  The same happens here in Sweden. Since the implementation of more neoliberalist policies on healthcare, allowing more private clinics and paying clinics based on diagnosis created a perverse incentive to overdiagnose patients. There was a case of a clinic that performed unnecessary surgeries and procedures just to rake in more tax money. The problem isn't socialised medicine per se, it's trying to mash a socialised medicine system with "market forces", it's the ideology of the Third Way [1] to appease to these neoliberalist policy desires that is crumbling the Swedish healthcare (and welfare) system for the past 2 decades. [1] https://en.wikipedia.org/wiki/Third_Way https://en.wikipedia.org/wiki/Third_Way

int_19h 5y ago

How expensive is it as a percentage of overall healhcare spending?

wjnc 5y ago
There is no easy answer to that question to my knowledge. All of what hospitals do is translated into the Dutch equivalent of diagnosis-related groups. Those DRGs are standardized across the hospitals doing procedures. Insurers bargain with hospitals (usually on a higher level) for price-setting. So while there are DRGs that probably have a large IC-component, most have only a little. So the costs of IC are reimbursed via all treatments that have an average IC-component. A hospital with a good cost based activity system could probably tell you more, although that would require a very high measure of control. Dutch press just reports the general direction of (internal) prices for IC-days (about € 3k / night). That really is nowhere close to the proper answer to the question "How much would expansion cost?" The sum based on that € 3k would be: €3k * 365 * 65% * 1200 = about € 850 million for the whole of IC-care. That is a low figure for the Netherlands (€ 25 billion total medical specialist care), so I expect a lot of the IC-costs are absorbed by other DRGs or the other way around: that price doesn't include all of the fixed costs and is a marginal price.