4 ms·

I can't speak for Denmark, but I can speak for New Zealand, which has similar spend, and similar results (compared to the US). I wrote a thesis about healthcare

I can't speak for Denmark, but I can speak for New Zealand, which has similar spend, and similar results (compared to the US). I wrote a thesis about healthcare software in uni, but as part of that I interviewed a bunch of people across the NZ healthcare industry, and learnt a lot about it. A big efficency for NZ is 'pharmac', which is essentially a country-wide medicine subsidizer, and supplier. It's a government entity which figures out how much of a certain drug the entire country will need for say a month, then goes and buys it, in bulk on the international market. Making such a large purchase gives them really good bargining power, and they'll buy generic versions. Not all drugs are pharmac covered, but most are. It means there's not much profit margin for drug supply in the system. The system is setup into 'district health boards'. Their job is to manage the health of everyone in a geographic area, and this means both in hospitals, and in primary care (your local doctors office). Because of this, they see the cost of their entire system, and are incentivised to optimise the care overall, as opposed to say a private hospital, and a private doctors office optimising their individual businesses. One way this manifests, is putting a big focus on getting people to go to primary care, instead of hospitals. Hospitals are the most expensive thing in the system turns out, so they'd much perfer people get to a primary care doctor sooner, before something becomes an issue that requires hospitalization. So they're incentivised to keep doctors visits cheap, and accessible. This comes into play quite a lot with elderly care, they make up a huge amount of primary care visits - but if they don't become hospital visits, that's great. You mentioned drug use. That's an interesting one as that's a government-wide issue, not just a healthcare issue. It affects poverty, education, emergency housing, the economy as a whole. There's been a big focus on public education, and actually ad campaigns about tabacco and alcahol, trying to make them seem really un-cool. And it's sort of been working, smoking rates are down, I'm not sure about vaping rates though. Meth is a big issue in NZ, but opiate/painkiller abuse is uncommon (compared to the US). One general point though, is there's not much profit oppertunity for companies in the system. As the majority of money comes from the government, the funding is very standardized. Running a doctors clinic or say a pharmacy is just like running a small business, with the same oppertunities. There just isn't huge 'startup' oppertunities to find a killer product and turn a huge profit. Profit isn't taken at every point of the supply chain in care. NZ's system has flaws, but overall I'm really pleased with it, and glad that we have it.

giantg2 2y ago
Thanks for the detailed response! In the US, Medicare is doing negotiation for meds for those in the program. There is talk about expanding that bargaining. The ACA was trying to get people into primary care early. I'm not sure how big of an impact that made. At least in my experience, the primary care is hard to get on short notice in my area - takes 1-4 weeks depending on different things. One big seems to be that the offices Tru to increase throughput and keep their schedule booked solid to make money based on what the insurance will pay per visit (eg maximize visits). I wonder how NZ deals with the availability part if prices are set. I would think the incentive would be similar.
- JusticeJuice 2y ago
  The funding for primary care comes from a bunch of places in NZ, but most of it comes from the government. Most people in NZ don't have private healthcare insurance, it's just not needed. The way it works is patients 'enroll' with a doctors office, and then the clinic gets funding based on that patient population (how many patients, what sort of patients, etc). GPs still set their own fees ontop of that, but it's usually not much (like $20 USD), as they're competitive. There isn't really an incentive to maximize the number of visits, the goal is to maintain a good patient population, who's satisfied with your services. The average book size for an individual doctor is about 1000 people (might have gone up a bit by now). But I found that number quite interesting, as it lets you frame the job of a doctor quite differently - their job isn't just to take appointments as they come, their job is to keep about 1k people healthy. It lets you think about how else that problem could be solved.
  - giantg2 2y ago
    Seems like they have as many or more here in the states, at least where I am. I see some stats that it's about 20 patients a day. I almost always end up at urgent care because they don't have enough availability at the primary in my area. The urgent care isn't covered by my insurance because they say there's enough covered providers in the area already. When I have a fever of 103F for 5 days and think it's time to investigate antibiotics, I want an appointment within 24 hours, not 5 business days from now. It seems the insurance payout and keeping the schedule booked solid drive the (under)staffing in my areas. Although it hasn't been like this in other areas I've been in, but that's more than 10 years ago now.

giantg2 2y ago

Thanks for the detailed response! In the US, Medicare is doing negotiation for meds for those in the program. There is talk about expanding that bargaining. The ACA was trying to get people into primary care early. I'm not sure how big of an impact that made. At least in my experience, the primary care is hard to get on short notice in my area - takes 1-4 weeks depending on different things. One big seems to be that the offices Tru to increase throughput and keep their schedule booked solid to make money based on what the insurance will pay per visit (eg maximize visits). I wonder how NZ deals with the availability part if prices are set. I would think the incentive would be similar.

JusticeJuice 2y ago
The funding for primary care comes from a bunch of places in NZ, but most of it comes from the government. Most people in NZ don't have private healthcare insurance, it's just not needed. The way it works is patients 'enroll' with a doctors office, and then the clinic gets funding based on that patient population (how many patients, what sort of patients, etc). GPs still set their own fees ontop of that, but it's usually not much (like $20 USD), as they're competitive. There isn't really an incentive to maximize the number of visits, the goal is to maintain a good patient population, who's satisfied with your services. The average book size for an individual doctor is about 1000 people (might have gone up a bit by now). But I found that number quite interesting, as it lets you frame the job of a doctor quite differently - their job isn't just to take appointments as they come, their job is to keep about 1k people healthy. It lets you think about how else that problem could be solved.
- giantg2 2y ago
  Seems like they have as many or more here in the states, at least where I am. I see some stats that it's about 20 patients a day. I almost always end up at urgent care because they don't have enough availability at the primary in my area. The urgent care isn't covered by my insurance because they say there's enough covered providers in the area already. When I have a fever of 103F for 5 days and think it's time to investigate antibiotics, I want an appointment within 24 hours, not 5 business days from now. It seems the insurance payout and keeping the schedule booked solid drive the (under)staffing in my areas. Although it hasn't been like this in other areas I've been in, but that's more than 10 years ago now.