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Anecdotally anyone can talk to a few doctors and find out just how much time they spend on updating charts/documenting information that's not directly relevant

Anecdotally anyone can talk to a few doctors and find out just how much time they spend on updating charts/documenting information that's not directly relevant to the care, its just to protect against liability or work with insurance. Or how many hours they spend on phone calls fighting with insurance companies. The people who actually understand medicine wasting hours with some clueless rep with 0 understanding and a flowchart who's only job is to deny claims. Dr. Glaucomflecken on youtube has many videos about that too. So on the ground level, it's already clear some of our highest paid most valuable people spend 20-30% of their time on a flavor of administrative junk which isn't necessary in a single-payer system. I'm skeptical of claims that this waste doesn't translate into the higher level metrics.

xapata 2y ago
It'd still occur in a single-payer system. The problem is fees for services instead of fees for results.
- looping__lui 2y ago
  So the wealthy can finally cheat death efficiently once and for all ;-) On a more serious note: that might be hard in medicine per se to pay for “results”. And I found some of the insights from “Outlive” quite interesting: how we focus in cure but not prevention; and how in the bigger scheme of things Antibiotics was almost the only “real big invention” in western medicine for a very long time (e.g., in terms of actual medical impact)
- contrast 2y ago
  Any evidence for that claim? The issue is not whether there is administrative overhead, but the amount of it. It’s not obvious to me that completely different funding models would incur the exact same amount of overhead on the practitioners.
  - cmrdporcupine 2y ago
    It does happen in a fashion in the Canadian system where family doctors at least operate as private businesses that bill the gov't, and because of that have to spend quite a bit of time on paperwork which then requires a whole edifice which there has been a lot of complaint about recently. A search will find you plenty of articles about this. That and the nature of the relationship introduces conflict. Plus the bulk of provincial governments administrating the thing are ideologically biased against it because they are conservative or neo-liberal in bent, and have been chronically underfunding it for years....
  - xapata 2y ago
    If I only earn when I treat, then I have an incentive to over-diagnose. Insurance thus forces me to document my diagnoses, and I spend much of my time on documentation and appealing denials.
- btilly 2y ago
  How would you measure results? Go to a doctor, get a prognosis, get a treatment then a new prognosis? The incentive to inflate results is obvious. How else would you measure it? Survival rates? Doctors now have a strong incentive to avoid taking on sick patients.
miki123211 2y ago
> So on the ground level, it's already clear some of our highest paid most valuable people spend 20-30% of their time on a flavor of administrative junk This is most definitely not just a US problem. I work adjacent to this industry in Poland, where we basically have a single-payer system[1], and I'd say 20-30% is definitely in the ballpark. Especially in larger institutions (think hospital, not a single doctor's office), records must be kept and handovers between different doctors must occur. This means that you have to do all this work anyway, regardless of how much of it is actually transmitted to the insurance provider, and in our case, it's definitely far, far too little. [1] we do have private healthcare, but that's typically small / less-complicated procedures and usually covered out-of-pocket by those who can afford it, so there are no insurance considerations there.
- inglor_cz 2y ago
  "This is most definitely not just a US problem. I work adjacent to this industry in Poland, where we basically have a single-payer system[1], and I'd say 20-30% is definitely in the ballpark." I wonder if this could be the killer app for AI. Teach it how to do this sort of bureaucracy instead of humans, and let doctors treat actual people instead.
btilly 2y ago
I'm skeptical of claims that this waste doesn't translate into the higher level metrics. The claim is that the size of the pot of money to be split is determined by the willingness of consumers to pay. Which is determined by their wealth. Therefore the inclusion of a lot of administration changes the split of where that money goes. More administration = less money for nurses and doctors. Less administration = more money for nurses and doctors. This fits observed behavior in other places. Your potential client has a problem and a potential budget for the solution. Clients are remarkably indifferent to how that budget is split up, as long as a solution to the problem is worth spending the budget. Here is the example that originally brought this point home to me. When Oracle moved from Solaris to Linux around the year 2000, it was able to charge more money for the database. Why? Because companies were willing to spend money on Oracle that previously went to the hardware and operating system. This incentive to open source the complement of whatever product you're providing is one of the reasons why so much money has been invested into creating open source.
- seadan83 2y ago
  Interesting point, though would you agree that an individuals budget for healthcare is unique? The budget for healthy vs not, tends to be 'all of it.' Hence, excessive healthcare costs.
  - btilly 2y ago
    Exactly. And the relationship seems to be that if your income goes up 1%, your available wealth at a point in crisis goes up 2.8%. However your willingness to spend at the moment of crisis is dictated by your problem and available wealth. And now how that money is going to be split among different parties.
rsynnott 2y ago
> Anecdotally anyone can talk to a few doctors and find out just how much time they spend on updating charts/documenting information that's not directly relevant to the care, its just to protect against liability or work with insurance. It’s not just for that. Documentation and checklists exist in public health systems, too, and IIRC there’s some fairly hard evidence that they do reduce errors. Doctors hate them, tho. I was in hospital a few years back for a fairly inoffensive surgical procedure (public hospital, though in Ireland’s rather weird hybrid system, because I had private insurance my insurance was paying), and I’d say I was asked at least ten times if I was allergic to anything, and had the barcode on my wristband read more times than I can count. This was extremely irritating… but apparently it does _work_; some patients don’t always give the same answer to that question every time.
ForOldHack 2y ago
"our highest paid most valuable people spend 20-30% of their time on a flavor of administrative junk..." By choice. Medical coders are a dime a dozen. Front office/back office/in office. You hire and train other people or you whine and complain, and be unproductive. Hopefully you will get one of the smart ones who understand this.

xapata 2y ago

It'd still occur in a single-payer system. The problem is fees for services instead of fees for results.

looping__lui 2y ago
So the wealthy can finally cheat death efficiently once and for all ;-) On a more serious note: that might be hard in medicine per se to pay for “results”. And I found some of the insights from “Outlive” quite interesting: how we focus in cure but not prevention; and how in the bigger scheme of things Antibiotics was almost the only “real big invention” in western medicine for a very long time (e.g., in terms of actual medical impact)
contrast 2y ago
Any evidence for that claim? The issue is not whether there is administrative overhead, but the amount of it. It’s not obvious to me that completely different funding models would incur the exact same amount of overhead on the practitioners.
- cmrdporcupine 2y ago
  It does happen in a fashion in the Canadian system where family doctors at least operate as private businesses that bill the gov't, and because of that have to spend quite a bit of time on paperwork which then requires a whole edifice which there has been a lot of complaint about recently. A search will find you plenty of articles about this. That and the nature of the relationship introduces conflict. Plus the bulk of provincial governments administrating the thing are ideologically biased against it because they are conservative or neo-liberal in bent, and have been chronically underfunding it for years....
- xapata 2y ago
  If I only earn when I treat, then I have an incentive to over-diagnose. Insurance thus forces me to document my diagnoses, and I spend much of my time on documentation and appealing denials.
btilly 2y ago
How would you measure results? Go to a doctor, get a prognosis, get a treatment then a new prognosis? The incentive to inflate results is obvious. How else would you measure it? Survival rates? Doctors now have a strong incentive to avoid taking on sick patients.

miki123211 2y ago

> So on the ground level, it's already clear some of our highest paid most valuable people spend 20-30% of their time on a flavor of administrative junk This is most definitely not just a US problem. I work adjacent to this industry in Poland, where we basically have a single-payer system[1], and I'd say 20-30% is definitely in the ballpark. Especially in larger institutions (think hospital, not a single doctor's office), records must be kept and handovers between different doctors must occur. This means that you have to do all this work anyway, regardless of how much of it is actually transmitted to the insurance provider, and in our case, it's definitely far, far too little. [1] we do have private healthcare, but that's typically small / less-complicated procedures and usually covered out-of-pocket by those who can afford it, so there are no insurance considerations there.

inglor_cz 2y ago
"This is most definitely not just a US problem. I work adjacent to this industry in Poland, where we basically have a single-payer system[1], and I'd say 20-30% is definitely in the ballpark." I wonder if this could be the killer app for AI. Teach it how to do this sort of bureaucracy instead of humans, and let doctors treat actual people instead.

btilly 2y ago

I'm skeptical of claims that this waste doesn't translate into the higher level metrics. The claim is that the size of the pot of money to be split is determined by the willingness of consumers to pay. Which is determined by their wealth. Therefore the inclusion of a lot of administration changes the split of where that money goes. More administration = less money for nurses and doctors. Less administration = more money for nurses and doctors. This fits observed behavior in other places. Your potential client has a problem and a potential budget for the solution. Clients are remarkably indifferent to how that budget is split up, as long as a solution to the problem is worth spending the budget. Here is the example that originally brought this point home to me. When Oracle moved from Solaris to Linux around the year 2000, it was able to charge more money for the database. Why? Because companies were willing to spend money on Oracle that previously went to the hardware and operating system. This incentive to open source the complement of whatever product you're providing is one of the reasons why so much money has been invested into creating open source.

seadan83 2y ago
Interesting point, though would you agree that an individuals budget for healthcare is unique? The budget for healthy vs not, tends to be 'all of it.' Hence, excessive healthcare costs.
- btilly 2y ago
  Exactly. And the relationship seems to be that if your income goes up 1%, your available wealth at a point in crisis goes up 2.8%. However your willingness to spend at the moment of crisis is dictated by your problem and available wealth. And now how that money is going to be split among different parties.

rsynnott 2y ago

> Anecdotally anyone can talk to a few doctors and find out just how much time they spend on updating charts/documenting information that's not directly relevant to the care, its just to protect against liability or work with insurance. It’s not just for that. Documentation and checklists exist in public health systems, too, and IIRC there’s some fairly hard evidence that they do reduce errors. Doctors hate them, tho. I was in hospital a few years back for a fairly inoffensive surgical procedure (public hospital, though in Ireland’s rather weird hybrid system, because I had private insurance my insurance was paying), and I’d say I was asked at least ten times if I was allergic to anything, and had the barcode on my wristband read more times than I can count. This was extremely irritating… but apparently it does _work_; some patients don’t always give the same answer to that question every time.

ForOldHack 2y ago

"our highest paid most valuable people spend 20-30% of their time on a flavor of administrative junk..." By choice. Medical coders are a dime a dozen. Front office/back office/in office. You hire and train other people or you whine and complain, and be unproductive. Hopefully you will get one of the smart ones who understand this.