3 ms·

In the US, it seems like insurance companies teach doctors how to think. How many times have we all heard from a doctor "we don't like to do so many tests each

by ugh123 3y ago

In the US, it seems like insurance companies teach doctors how to think. How many times have we all heard from a doctor "we don't like to do so many tests each year because of costs"

tombert 3y ago
Really? I feel like whenever a doctor sees that I have really good insurance they feel the need to use every single machine they have as a diagnostic. I generally don't care because my copay is generally the same regardless and I figure it is good to be thorough, but I do realize that is probably driving up the costs for everyone in the long run.
- notnaut 3y ago
  “really good insurance” I’d guess a massive % of the us population is having a different experience than you.
  - tombert 3y ago
    Sure, my wife and I had to deal with that not too long ago when I was unemployed and had to use the subsidized MetroPlus stuff in NYC. It wasn’t as bad as I thought it would be but it was definitely not as good as my fancy PPO I get from sexy desk jobs. I guess what I am getting at is that insurance sort of makes things worse for everyone here. When a person comes in with good insurance the doctor has incentive to abuse it, artificially driving up costs, making it harder for people with crappy/no insurance to get the treatments they need because insurance won’t cover it. It’s a messy system. A large part of me would prefer that we abolish private insurance entirely, but I fear that’s not likely in the states.
  - dandy23 3y ago
    I think OP is quite right that insurance drives tests and costs up because contrary to what we think it is good for the insurance companies if the doctor bill is high because then people buy more expensive insurances and thus higher revenue for the insurance company. If the cost would be low there would be no need for an insurance.
rscho 3y ago
I wouldn't say "teach". But you're right that docs are forced to obey insurance companies. Not only in the US, but everywhere insurance companies are a thing. Yet, docs are almost always the main target for complaints, while insurance companies act in a very capitalistic way by optimizing for C-suite bonuses.
- Aerbil313 3y ago
  > Not only in the US, but everywhere insurance companies are a thing. No, not at all. Insurance exists in plenty of places, without significantly influencing doctors' treatment.
  - rscho 3y ago
    I'd be interested in an example.
    - jboogie77 3y ago
      same
  - singleshot_ 3y ago
    The secondary purpose of insurance is for the best-positioned allocator of risk to explore new means of reducing risk by leveraging lower premiums against adoption of risk reduction methodologies. In other words, an insurance market that does not influence doctors’ behavior seems to be a pretty inefficient insurance market.
cameldrv 3y ago
Yeah like almost everything wrong in the economy, the question is where is the stabilizing feedback loop? Where can patients choose something better, and how do they get the information to choose the best option?
Calavar 3y ago
On the contrary, US doctors are significantly more aggressive with testing and treatment than doctors in most other countries. There's multiple reasons for that, but I think the main one is trying to CYA in the event of a malpractice lawsuit.
- ugh123 3y ago
  Source? And does more (or "significantly more") even mean it's making a difference? It's well known that younger and younger people are being diagnosed with cancer, yet only a few major tests have been recommended to be done sooner (colon, prostate, breast) and by just a few years.
  - n8henrie 3y ago
    Unfortunately I will probably not take the time to help you find a source, but FWIW this was taught to me several times in medical school and is generally believed to be true by myself and many colleagues. It is one huge reason I work as a federal employee -- FTCA helps me feel free to do what I think is right for my patient without worrying nearly as much about getting sued. In my line of work, a tremendous amount of absurd testing is done because there could be a 0.01% chance of missing something serious, and if you see 1,000 pts per year and plan to have a multi-decade career, it's easy to justify almost certainly unnecessary testing.

by ugh123 3y ago

In the US, it seems like insurance companies teach doctors how to think. How many times have we all heard from a doctor "we don't like to do so many tests each year because of costs"

tombert 3y ago

Really? I feel like whenever a doctor sees that I have really good insurance they feel the need to use every single machine they have as a diagnostic. I generally don't care because my copay is generally the same regardless and I figure it is good to be thorough, but I do realize that is probably driving up the costs for everyone in the long run.

notnaut 3y ago
“really good insurance” I’d guess a massive % of the us population is having a different experience than you.
- tombert 3y ago
  Sure, my wife and I had to deal with that not too long ago when I was unemployed and had to use the subsidized MetroPlus stuff in NYC. It wasn’t as bad as I thought it would be but it was definitely not as good as my fancy PPO I get from sexy desk jobs. I guess what I am getting at is that insurance sort of makes things worse for everyone here. When a person comes in with good insurance the doctor has incentive to abuse it, artificially driving up costs, making it harder for people with crappy/no insurance to get the treatments they need because insurance won’t cover it. It’s a messy system. A large part of me would prefer that we abolish private insurance entirely, but I fear that’s not likely in the states.
- dandy23 3y ago
  I think OP is quite right that insurance drives tests and costs up because contrary to what we think it is good for the insurance companies if the doctor bill is high because then people buy more expensive insurances and thus higher revenue for the insurance company. If the cost would be low there would be no need for an insurance.

rscho 3y ago

I wouldn't say "teach". But you're right that docs are forced to obey insurance companies. Not only in the US, but everywhere insurance companies are a thing. Yet, docs are almost always the main target for complaints, while insurance companies act in a very capitalistic way by optimizing for C-suite bonuses.

Aerbil313 3y ago
> Not only in the US, but everywhere insurance companies are a thing. No, not at all. Insurance exists in plenty of places, without significantly influencing doctors' treatment.
- rscho 3y ago
  I'd be interested in an example.
  - jboogie77 3y ago
    same
- singleshot_ 3y ago
  The secondary purpose of insurance is for the best-positioned allocator of risk to explore new means of reducing risk by leveraging lower premiums against adoption of risk reduction methodologies. In other words, an insurance market that does not influence doctors’ behavior seems to be a pretty inefficient insurance market.

cameldrv 3y ago

Yeah like almost everything wrong in the economy, the question is where is the stabilizing feedback loop? Where can patients choose something better, and how do they get the information to choose the best option?

Calavar 3y ago

On the contrary, US doctors are significantly more aggressive with testing and treatment than doctors in most other countries. There's multiple reasons for that, but I think the main one is trying to CYA in the event of a malpractice lawsuit.

ugh123 3y ago
Source? And does more (or "significantly more") even mean it's making a difference? It's well known that younger and younger people are being diagnosed with cancer, yet only a few major tests have been recommended to be done sooner (colon, prostate, breast) and by just a few years.
- n8henrie 3y ago
  Unfortunately I will probably not take the time to help you find a source, but FWIW this was taught to me several times in medical school and is generally believed to be true by myself and many colleagues. It is one huge reason I work as a federal employee -- FTCA helps me feel free to do what I think is right for my patient without worrying nearly as much about getting sued. In my line of work, a tremendous amount of absurd testing is done because there could be a 0.01% chance of missing something serious, and if you see 1,000 pts per year and plan to have a multi-decade career, it's easy to justify almost certainly unnecessary testing.