6 ms·
Author of Hacking Health for O'Reilly, managed operating companies for hundreds of hospital facilities, etc... One widely under realized aspect to healthcare c
by duffpkg 4y ago
Author of Hacking Health for O'Reilly, managed operating companies for hundreds of hospital facilities, etc...
One widely under realized aspect to healthcare costs in the US (there are many) is the very high number of ICU beds per capita, ~35 per 100,000 people. While it gets a little complicated to compare apples to apples, a reasonable person could say we have 30% more than germany which is the only european contry that is close and double to triple most other nations we are typically compared against like the UK and Canada.
ICU beds are extremely expensive to both build and operate. Also for the lay person the term "bed" has a specific regulatory meaning and does not refer to just the physical existence of the room and bed but means that it is operational with highly regulated amounts of staffing, services and equipment. Each "bed" has costs in the millions to build and equip and operating costs are typically in the neighbood of $10k to $40k per "bed" per day, occupied or not, a large portion being labor.
- Blammar 4y agoCan you explain why one ICU room costs millions, and why they cost 10k a day even if no one is in them? Neither makes sense to me. I can imagine say 100k in monitoring equipment in a room. Maybe it's the hospital inflation applied to equipment?
- Dma54rhs 4y agoFor one American medical workers earn absolute insane wages compared to their European counterparts.
- db48x 4y agoMost of the cost is people. It’s not much use calling it an ICU room unless there are doctors and nurses and anesthesiologists and other specialists on call to actually care for people intensively. Plus a janitor or two.
- duffpkg 4y agoAn ICU unit isn't exactly a single room. There are different configurations but they typically involve some sort of centralized monitoring station and 5-20 ICU "beds". Total cost of that / number of beds. Everything in hospital construction is expensive, ICUs are at the extreme end of that. Huge power requirements, medical gas lines, fixturing and surfaces needs to be able to be disinfected, special air, special water, on and on. It has requirements very similar to an operating theatre. The reason they cost so much even if no one is in them is because of what a "bed" means. It isn't the literal bed, it is a unit a treatable/treating capacity. Requiements vary somewhat by jurisdiction but it's going to mean 24/7/365 nursing and attending doctor staff. You can't just call them in when a patient shows up, they need to be scheduled and available. Then ICUs will also need a large cadre of oncall specialists, neurologists, cardiac, laboratory testing staff, and on an on to cover a huge range of possible patient needs. Stocked blood units, stocked medicine units. All those things have costs whether a patient in in the bed or not. Hospitals to a large extent spend an incredible amount of money on capacity. No wants wants to end up in a hospital to have them say, "oops, we didn't expect your spleen to rupture today, Dr. Bob won't be in till next tuesday so you are out of luck, sorry"
- throwaway892238 4y agoSo, they're complicated, they're expensive, they're necessary... why don't we have the state pay for them? We spend 720 Billion dollars on the military. Would it be useful to send a couple of those billion to make ICUs less expensive?
- NegativeLatency 4y agoYes it would, but in the US we have a for profit medical system so this is a natural result of that.
- xyzzyz 4y agoWhere do you think state money comes from? Even if it’s the government that foots the bill for ICUs, in the end it will still be paid collectively by all of us regular people.
- ThePadawan 4y agoWell good thing regular people don't ever need to use ICUs.
- MichaelZuo 4y agoDid you reply to the wrong comment?
- ThePadawan 4y agoNo. In case it was unclear, I was being sarcastic in my reply and pointing out the hypocrisy of being offended that "regular people" would have to foot the bill for ICUs - as if they weren't the ones relying on their existence.
- xyzzyz 4y agoI am not offended that regular people would foot the bill for ICUs if state decides to pay for those. My point is that I do not see why it would be an improvement in any way over the status quo. It will not make them cheaper or more available, most likely quite the opposite.
- _uvv0 4y agoMy impression as a Canadian resident was the bar seemed a lot lower to get into the ICU in the US. Unless they needed a tube to secure an airway, pressors, or CRRT we managed COPD with BiPAP, pretty profound hyponatremia, cirrhosis with& bleeds, DKA/HHS on the ward pretty regularly just as examples of repatriated patients I remember. I always figured it was due to an overly litigious culture and a money maker for the hospital. To be clear I didn't practice in the US.
- haldujai 4y agoIt’s probably because we don’t have enough ICU (or step down beds) in Canadian hospitals than the fear of litigation in the US. Canada’s capacity is amongst the least in G20 nations. A lot of patients we manage on the ward or step downs (i.e. pressors on step down, I’m unaware of any ward that will let you run these, very few tolerate central lines) really should be in a full ICU, or at least a high level step down unit like D4ICU at KGH (rather than the hilariously awful AMA units at TOH).
- throwaway2037 4y agoI am going to repeat myself here. You wrote: <<Canada’s capacity is amongst the least in G20 nations.>> Not even close. Quick Google search for "icu beds per capita" finds: https://www.oecd.org/coronavirus/en/data-insights/intensive-care-beds-capacity https://www.oecd.org/coronavirus/en/data-insights/intensive-... Canada: 12.9 / 100K population (slightly higher than OECD average) For the record, it is usually better to quote "OECD" than "G20". G20 just means total GDP is large, but GDP per capita can be very low, like India, Indonesia, and China. OECD is always (democratic and) high-income -- high GDP per capita. For example: Nederlands, Norway, and Switzerland are all OECD, but none G20. All are very high income and high human development.
- haldujai 4y agoThis number includes level 2/step-down ICUs inclusive of regional/community hospital. This is not the bed count of units capable of having cardiac support or prolonged ventilation. I can’t readily find the OECD figure but if you look at ventilator capable beds in Canada the number drops to ~9.7, again inclusive of community/regional hospitals mostly staffed by non-ICU trained physicians which are only equipped for short term ventilation. Which center in Canada have you trained at where there isn’t constant pressure to offload ICU patients to the ward due to a lack of beds?
- conductr 4y agoThis is a practical reality of the "we keep old people alive too long" category.
- tomcam 4y agoI’m old and statements like this are… interesting
- conductr 4y agoWe all will be old one day, if lucky. My comment was not about you because you happen to be old right now. But are you unfamiliar with typical end of life care in the US? Where the last few years is a constant stream of hospitalizations, rehabilitation, etc with no quality of life and no tangible benefit but a very substantial cost? I find that concept… interesting… as in, I don’t like paying the cost and I don’t intend on participating in it when my time comes. I think this feeling is growing with younger generations because we’ve witnessed what older generations are subjecting themselves and their families to.
- tomcam 4y agoI’m familiar with all those issues and have been for years. Have taken both parents through agonizing deaths. Doesn’t make comments like yours less unsettling.
- throwaway2037 4y agoI am going to repeat myself here. Quick Google search for "icu beds per capita" finds: https://www.oecd.org/coronavirus/en/data-insights/intensive-care-beds-capacity https://www.oecd.org/coronavirus/en/data-insights/intensive-... US: 25.8 / 100K population Germany: 33.9 / 100K