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At what point do we acknowledge that there is a systemic market failure and start trying to explore interventions and alternative arrangements? Hospitals are a

At what point do we acknowledge that there is a systemic market failure and start trying to explore interventions and alternative arrangements? Hospitals are a public good, but hospital executives seem uninterested now in providing that good. So how do we fix that?

BobbyJo 4y ago
It is more likely a regulatory failure, I believe. The market will do what the market does, raise prices for nurses until there are more. If nurses are in high demand, yet wages aren't rising, then there is either collusion among the employers, or some regulatory disfunction (too much, too little, the wrong kind, etc.) preventing it.
- xboxnolifes 4y ago
  It can still be a market failure if it's taking advantage of nurse empathy for patients.
madamelic 4y ago
One thought is to have a hospital co-op. I am half joking and have no clue how viable it would be. The most expensive part would be getting equipment but I am sure you could bait away people with the promise of ethical & responsible healthcare while being paid a fair salary. Something between a local charity clinic and a highly trauma-rated hospital. For instance, I use a local walk-in clinic like a primary care doctor but they occasionally tell you to go to the hospital. You can basically fit in between a walk-in clinic and a trauma rated hospital.
gruez 4y ago
>Hospitals are a public good Hospitals are emphatically not a public good. From wikipedia >In economics, a public good (also referred to as a social good or collective good)[1] is a good that is both non-excludable and non-rivalrous. For such goods, users cannot be barred from accessing or using them for failing to pay for them. Also, use by one person neither prevents access of other people nor does it reduce availability to others.[1] Therefore, the good can be used simultaneously by more than one person.[2] Hospitals definitely turn away patients who can't pay (non-emergencies), and a patient occupying a hospital bed prevents others from using it.
- nerdponx 4y ago
  You're completely right, I misused the term and I should've known better. I don't know why you are being downvoted.
jmnicolas 4y ago
For what it's worth we have the same problem in France where everything is managed by the government. I don't have an answer but in your case I'm not sure more government is the right thing to do.
- LorenPechtel 4y ago
  What's needed is the government to mandate what is required. Make it more expensive (via fines or the like) to understaff than it would cost to hire the staff. And I'd like to see all liability for tiredness-caused mistakes to flow upstream to the first person who had the authority and ability to improve the situation and didn't do so. Understaffing is a form of medical malpractice in my book.
mindslight 4y ago
As soon as we can defeat the medical provider, drug, and "insurance" lobbies. Given that legislation in the US only gets passed when it empowers some lobby, good luck. The main source of our dysfunction is this "HMO" fallacy that a 10kft-view insurance company can somehow create the intelligence to administer effective care. Rather, what we've gotten is more opaqueness, more market inefficiency, onerous and arbitrary approval/denials for arbitrary procedures, and every incentive for doctors to kick the can down the road as each visit is a billable event. To me, the obvious market based solution is based around making medical providers provide straightforward prices or rate schedules, like every other industry, as a requirement of forming a binding contract to bill against. Regulate that prices are all the same no matter who is paying, and regulate that every medical insurance plan must pay any provider. The sheer majority of care happens very slowly - not the emergency "car crash" example some healthy person with little experience with the medical system will inevitably throw out as an argument. Regulate the insurance industry such that coverage must be purely in financial terms. If an insurance company wants to set some cutoff on what they think a given serrvice should cost, they can do so in a transparent manner that can be easily checked against all provider quotes. Otherwise the default dynamic is to reimburse some percentage of all expenses. Emergency service costs get limited statutorily, similar to how the state regulates towing rates (when the police call to get a car towed, etc). Due to lobbying, these costs generally end up higher the open market, so there is no problem with constraining the market. Public health insurance plans continue to exist in the new framework, for those of limited means and those without access to insurance. Ideally we work towards unbundling insurance from employment over time, but that's not a necessary component. Of course I realize this is all a pipe dream given the aforementioned lobbies, despite the little bit of recent noise towards price "transparency". I'm not opposed to single payer (basically using two of the lobbies to kill the third), but the rot in our system goes far beyond the mere billing nonsense that makes much of the news and I don't think single payer would be enough to reform the deeper problem of providing effective care.
- SQueeeeeL 4y ago
  I like how this comment acknowledges acute horrific care incidents that essentially makes market based solutions horribly preditatory, but continue describing it anyway as if it's an afterthought

BobbyJo 4y ago

It is more likely a regulatory failure, I believe. The market will do what the market does, raise prices for nurses until there are more. If nurses are in high demand, yet wages aren't rising, then there is either collusion among the employers, or some regulatory disfunction (too much, too little, the wrong kind, etc.) preventing it.

xboxnolifes 4y ago
It can still be a market failure if it's taking advantage of nurse empathy for patients.

madamelic 4y ago

One thought is to have a hospital co-op. I am half joking and have no clue how viable it would be. The most expensive part would be getting equipment but I am sure you could bait away people with the promise of ethical & responsible healthcare while being paid a fair salary. Something between a local charity clinic and a highly trauma-rated hospital. For instance, I use a local walk-in clinic like a primary care doctor but they occasionally tell you to go to the hospital. You can basically fit in between a walk-in clinic and a trauma rated hospital.

gruez 4y ago

>Hospitals are a public good Hospitals are emphatically not a public good. From wikipedia >In economics, a public good (also referred to as a social good or collective good)[1] is a good that is both non-excludable and non-rivalrous. For such goods, users cannot be barred from accessing or using them for failing to pay for them. Also, use by one person neither prevents access of other people nor does it reduce availability to others.[1] Therefore, the good can be used simultaneously by more than one person.[2] Hospitals definitely turn away patients who can't pay (non-emergencies), and a patient occupying a hospital bed prevents others from using it.

nerdponx 4y ago
You're completely right, I misused the term and I should've known better. I don't know why you are being downvoted.

jmnicolas 4y ago

For what it's worth we have the same problem in France where everything is managed by the government. I don't have an answer but in your case I'm not sure more government is the right thing to do.

LorenPechtel 4y ago
What's needed is the government to mandate what is required. Make it more expensive (via fines or the like) to understaff than it would cost to hire the staff. And I'd like to see all liability for tiredness-caused mistakes to flow upstream to the first person who had the authority and ability to improve the situation and didn't do so. Understaffing is a form of medical malpractice in my book.

mindslight 4y ago

As soon as we can defeat the medical provider, drug, and "insurance" lobbies. Given that legislation in the US only gets passed when it empowers some lobby, good luck. The main source of our dysfunction is this "HMO" fallacy that a 10kft-view insurance company can somehow create the intelligence to administer effective care. Rather, what we've gotten is more opaqueness, more market inefficiency, onerous and arbitrary approval/denials for arbitrary procedures, and every incentive for doctors to kick the can down the road as each visit is a billable event. To me, the obvious market based solution is based around making medical providers provide straightforward prices or rate schedules, like every other industry, as a requirement of forming a binding contract to bill against. Regulate that prices are all the same no matter who is paying, and regulate that every medical insurance plan must pay any provider. The sheer majority of care happens very slowly - not the emergency "car crash" example some healthy person with little experience with the medical system will inevitably throw out as an argument. Regulate the insurance industry such that coverage must be purely in financial terms. If an insurance company wants to set some cutoff on what they think a given serrvice should cost, they can do so in a transparent manner that can be easily checked against all provider quotes. Otherwise the default dynamic is to reimburse some percentage of all expenses. Emergency service costs get limited statutorily, similar to how the state regulates towing rates (when the police call to get a car towed, etc). Due to lobbying, these costs generally end up higher the open market, so there is no problem with constraining the market. Public health insurance plans continue to exist in the new framework, for those of limited means and those without access to insurance. Ideally we work towards unbundling insurance from employment over time, but that's not a necessary component. Of course I realize this is all a pipe dream given the aforementioned lobbies, despite the little bit of recent noise towards price "transparency". I'm not opposed to single payer (basically using two of the lobbies to kill the third), but the rot in our system goes far beyond the mere billing nonsense that makes much of the news and I don't think single payer would be enough to reform the deeper problem of providing effective care.

SQueeeeeL 4y ago
I like how this comment acknowledges acute horrific care incidents that essentially makes market based solutions horribly preditatory, but continue describing it anyway as if it's an afterthought