4 ms·

You list two things that are fundamentally incompatible: > I think there's space for Amazon's uncaring, industrial approach to do good for people and improve q

You list two things that are fundamentally incompatible: > I think there's space for Amazon's uncaring, industrial approach to do good for people and improve quality of life. > [I want a] minimum standard of service. Doctors who won't immediately rush you out the door without solving the root cause, who won't prescribe you medication that they were sold over lunch, who'll listen to your symptoms, and because the outcome is measured by Amazon's uncaring data collection machinery, they're incentivized to actually solve the issue. Anyone who has actual clinical experience will tell you that an "uncaring data collection machinery" does not incentivize anyone to "actually solve the issue". Quite the opposite: the reason that the patient experience has gotten worse over the last few decades is because the industry has already been moving towards an "uncaring data collection machinery", while simultaneously squeezing providers and narrowing their already-small margins[0] and as it turns out, uncaring data collection machineries don't care about patients. Amazon's entire modus operandi fits very well with the absolute worst[1] forces that already exist within the healthcare industry, so it's quite hard to imagine a world in which this actually works out to patients' benefit in the long run. They might sprinkle a few shiny bells and whistles on top to placate people's fear, but actual care delivery is going to suffer in pretty much every way that you list aspirationally. [0] People sometimes treat this as a victory because they think that it'll lead to lower healthcare costs, but providers' pay actually makes up a very small fraction of healthcare spending in the US. Even if you could eliminate those costs entirely without impacting clinical care delivery or patients in any way (which is impossible), it would still translate to a 15% reduction (which wouldn't even be passed on to patients anyway, because the system incentivizes insurers to increase costs on the claims side to increase their own earnings) [1] worst for everyone involved except shareholders

ctvo 4y ago
> as it turns out, uncaring data collection machineries don't care about patients. I'm not sure this is true. The current implementation -- maybe. But the incentives, from an outsider's perspective, seem to align? 1. Healthy patients cost less in the long term. Solving for long term issues (type 2 diabetes!) vs. the immediate issue and getting someone out the door is profit seeking. 2. Patients being alive continue to pay service fees is profit seeking. Why would Amazon not aggressively track outcomes, measure every dimension of provider care, and ruthlessly fire / downgrade low performers to maintain the above goals?
- chimeracoder 4y ago
  > 1. Healthy patients cost less in the long term. Solving for long term issues (type 2 diabetes!) vs. the immediate issue and getting someone out the door is profit seeking. This is an extremely common misconception. Luckily, you've picked a really easy example to illustrate. "Solving" type 2 diabetes is an incredibly tricky problem. It's not something that can even be measured in the short-term, let alone solved. It's also quite individualized, more so than probably any other common diagnosis except cancer. There's no magic bullet intervention, and it takes a lot of active work to build the provider-patient relationship to a point where it can identify the appropriate interventions for that patient, identify problems with those interventions, and help the patient execute on them successfully. Because it's so individualized, and because it's so long-term, any system designed to "streamline" that is ultimately going to fail, because the curse of dimensionality will inevitably collapse away the requisite information, and the pursuit of short-term profit will inevitably cause the system to prioritize short-term interventions over long-term ones which will actually address the issue. "Healthy patients cost less in the long term" is technically true, but there's no way of turning unhealthy patients into healthy ones that doesn't, in aggregate, cost more than the theoretical savings. > Why would Amazon not aggressively track outcomes, measure every dimension of provider care, and ruthlessly fire / downgrade low performers to maintain the above goals? Again, this is an incredibly technocratic approach to a field (care delivery) that requires a different approach. It works if you assume that negative outcomes are the fault of individual providers ("low performers") and that individual providers have both the agency and resources to solve arbitrary cases. In practice, that's almost never the case: there are way too many confounding factors that impact clinical outcomes, and providers are quite limited in their power compared to other players: the insurance companies, the administration of the system they work within, and most importantly, the patients themselves. Honestly, the only way you could meaningfully "fire low performers" is to identify patients who aren't performing well and then drop them. Which is, in a way, what the health insurance system does... but we tend to consider that an antipattern.
- rscho 4y ago
  In the long term, healthy patients cost less, yes. And bring more in by staying alive, yes. But you know what's even better? A more or less healthy patient on which you can perform lots of procedures that make money. So I (as an MD myself) very much doubt that the incentives will benefit patients, here. People always forget that the main goal of private providers is making money, not keeping people healthy...

ctvo 4y ago

> as it turns out, uncaring data collection machineries don't care about patients. I'm not sure this is true. The current implementation -- maybe. But the incentives, from an outsider's perspective, seem to align? 1. Healthy patients cost less in the long term. Solving for long term issues (type 2 diabetes!) vs. the immediate issue and getting someone out the door is profit seeking. 2. Patients being alive continue to pay service fees is profit seeking. Why would Amazon not aggressively track outcomes, measure every dimension of provider care, and ruthlessly fire / downgrade low performers to maintain the above goals?

chimeracoder 4y ago
> 1. Healthy patients cost less in the long term. Solving for long term issues (type 2 diabetes!) vs. the immediate issue and getting someone out the door is profit seeking. This is an extremely common misconception. Luckily, you've picked a really easy example to illustrate. "Solving" type 2 diabetes is an incredibly tricky problem. It's not something that can even be measured in the short-term, let alone solved. It's also quite individualized, more so than probably any other common diagnosis except cancer. There's no magic bullet intervention, and it takes a lot of active work to build the provider-patient relationship to a point where it can identify the appropriate interventions for that patient, identify problems with those interventions, and help the patient execute on them successfully. Because it's so individualized, and because it's so long-term, any system designed to "streamline" that is ultimately going to fail, because the curse of dimensionality will inevitably collapse away the requisite information, and the pursuit of short-term profit will inevitably cause the system to prioritize short-term interventions over long-term ones which will actually address the issue. "Healthy patients cost less in the long term" is technically true, but there's no way of turning unhealthy patients into healthy ones that doesn't, in aggregate, cost more than the theoretical savings. > Why would Amazon not aggressively track outcomes, measure every dimension of provider care, and ruthlessly fire / downgrade low performers to maintain the above goals? Again, this is an incredibly technocratic approach to a field (care delivery) that requires a different approach. It works if you assume that negative outcomes are the fault of individual providers ("low performers") and that individual providers have both the agency and resources to solve arbitrary cases. In practice, that's almost never the case: there are way too many confounding factors that impact clinical outcomes, and providers are quite limited in their power compared to other players: the insurance companies, the administration of the system they work within, and most importantly, the patients themselves. Honestly, the only way you could meaningfully "fire low performers" is to identify patients who aren't performing well and then drop them. Which is, in a way, what the health insurance system does... but we tend to consider that an antipattern.
rscho 4y ago
In the long term, healthy patients cost less, yes. And bring more in by staying alive, yes. But you know what's even better? A more or less healthy patient on which you can perform lots of procedures that make money. So I (as an MD myself) very much doubt that the incentives will benefit patients, here. People always forget that the main goal of private providers is making money, not keeping people healthy...