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When private practices merge with hospital systems, costs go up
- megaloblasto 1y agoIt takes the great minds at yale to figure these things out
- ryoshu 1y agoData vs. feels
- lomase 1y agoNobody has ever said private is less wastefull than public?
- nzeid 1y agoMoot. When private equity and conglomerates get involved, operational concerns like waste and quality of service no longer matter. The only thing that matters is making money.
- nzeid 1y agoIt's also worth pointing out precisely who owns these hospital systems.
- cowsandmilk 1y agoMost hospitals in the US are nonprofits
- vjvjvjvjghv 1y ago"Nonprofit" is extremely misleading. Most nonprofit hospitals are as greedy as for profit hospitals. The money just doesn't go to shareholders but to executives and their friends who have businesses the hospital hires.
- ceejayoz 1y agoAh, but deaths… Go up too. https://hms.harvard.edu/news/deaths-rose-emergency-rooms-after-hospitals-were-acquired-private-equity-firms https://hms.harvard.edu/news/deaths-rose-emergency-rooms-aft... Part of the problem of modern society is that statistical murder of thousands is treated as less of a crime than a normal murder of one person.
- cyanydeez 1y agoI think you mean murder via diffusion of responsibility is good for business. Its like the trolley problem, but instead of one lever thete a chain of them and at least one of them is the final one, any number of them are like tumblers in a lock.
- johndhi 1y agoI hate the US healthcare system but I don't support using the word murder in this context. Murder is very very different from trying to help a person but being greedy while doing it.
- ceejayoz 1y agoBut it’s not “a person”. It’s millions of them.
- johndhi 1y agoI agree it's really sad and fucked up. But the way we deal with murder is long prison sentences and the death penalty. If we introduce horrible incentives for investing in medicine, we won't get compassionate care, we will just eliminate investment in healthcare. We need really thoughtful incentives and simple policies that let doctors run hospitals. Idk it's hard - I was going to say we should reward them for providing better care but I know the pay for performance system in place also hasn't worked that well.
- conductr 1y agoSingle payor system would solve a lot of problems as insurance companies and the economic system/incentives they’ve created in healthcare is the root cause of a lot of the issues. Also, it’s such a large and relatively unnecessary value extraction layer (middleman) that we’d immediately have many more dollars going towards providing care than to running of insurance companies and their owners. Even the hospitals and other providers have to employ armies of people just to understand how to bill things properly in this unnecessarily complex ecosystem. It’s a massive waste of resources in the name of capitalism that does nothing to improve the care provided. It’s even worse when considering these companies profit more by denying care altogether.
- zdw 1y agoThe primary reason that this happens is that medical billing and patient management systems are so complicated that it's cheaper for private practices to outsource this to a hospital that already has a contract with Epic or similar extractive vendors. If the US had a simpler billing/insurance system (or these extractive middlemen were removed entirely), this wouldn't be happening to the same extent.
- grafmax 1y agoEverybody needs healthcare. It’s a clear win for society if private actors can’t make it more inefficient by parasitizing a profit. The answer is single payer on the dime of the rentier capitalists. That’s how you reinvest in your society, not crypto and secret police.
- nradov 1y agoEverybody also needs food. Should the government also pay for everyone's food?
- cwillu 1y agoWhy not? Flour and rice and potatoes are cheap, why shouldn't a basic level of nutrition be available?
- braingravy 1y agoIn the richest country that has ever existed? The one that sends 1/3 of food into the dump? (https://refed.org/downloads/refed-2025-us-food-waste-report.pdf https://refed.org/downloads/refed-2025-us-food-waste-report....) Yes, obviously yes. If someone can’t pay for food, we clearly have enough to go around.
- nradov 1y agoWell now you're shifting the goal posts. There's an enormous difference between having the government buy food for a few poor people (which I support) versus being the single payer for food for everyone.
- trollbridge 1y agoLess competition usually means higher prices and inferior service. Imagine if every restaurant went to being owned by McDonald’s, and the reason we’re told for it is “credit card payment systems are so complicated!”
- knowitnone3 1y agoCosts go up on paper because now they need to charge people more while pretending they are starving. Costs in all other industries go down with mergers.
- cowsandmilk 1y ago> doctors are rather good at providing care across corporate boundaries I’ve found that to not be universally true. I say that as someone with eight different health systems in MyChart and who has been treated by two additional hospitals who don’t use MyChart in the past year. Some systems are very competent about sharing across borders and good at it. I’m lucky my primary hospital is one of those. Others are god awful at it and take multiple calls to get them to even fax records.
- kQq9oHeAz6wLLS 1y agoIronically, there are two nationwide networks for sharing patient data - CareEverywhere and Carequality. They even have a bridge between the two, so in effect it's one large network. But that's all predicated on the provider's EHR being able to talk to it, or at least talk to an interface engine that can be configured to talk to it. And money. It costs money.
- nradov 1y agoEvery modern EHR supports those nationwide networks. Many provider organizations have been too lazy to set it up or train their users.
- FireBeyond 1y agoOh, you say that, but... "Standards are anything but". I used to work for a company that wrote healthcare software, from EHRs to claims benefit management. And our software was riddled with little transformers, because vendor A's implementation of HL7 behaved differently to vendor B's, and C's.
- nradov 1y agoThat's a different problem. The national networks have standardized APIs. Obviously the content returned will have some variations depending on the original source.
- burnt-resistor 1y agoLocal regional hospitals and air ambulance companies are being bought up by private equity. And, surprise surprise, privately-owned regional hospitals are cutting critical care specialty services and so air ambulance life flights have increased 900%. I expect mortality has increased too logically because of delays in care. The Air-Ambulance Vultures (2022) https://archive.ph/2TYGj https://archive.ph/2TYGj Air ambulances, backed by private equity firms, leave patients with $45,000 bills (2018) https://www.latimes.com/business/la-fi-air-ambulance-cost-20180611-story.html https://www.latimes.com/business/la-fi-air-ambulance-cost-20...
- FireBeyond 1y agoNot for nothing though, and not defending PE... or insurers (UHC denying air ambulance for serious MVA trauma due to "lack of pre-auth")... but most air ambulance companies have fairly cheap "membership": Airlift NW has a $60/year membership for families that will bill your insurance, and consider what they get from insurance as payment-in-full (https://www.uwmedicine.org/airliftnw/membership https://www.uwmedicine.org/airliftnw/membership). Many also have reciprocal programs in other areas.
- wisty 1y agoAustralian here. It's always astounding that no-one in the US mentions the elephant pooping in the living room - that the US spends more tax dollars than Australia and IIRC the UK, and Canada. Per capita, or as a % of anything reasonable. The US is such bad value that Medicare and Medicaidel, VA, as well as othe government programs cost IIRC more than Canada's system. And Canada has a huge area with poor economies of scale. Republicans don't want to admit that they're taxing as hard as the French (for healthcare), Democrats don't want to lose the gold plated Medicare system that old people vote for, and literally everyone from nurses to band aid makers to doctors to healthcare CEOs makes more than in other countries. Maybe I have missed something, but universal single payer healthcare (especially with a hybrid system like Ausralia) seems cheaper than what the US does.
- altairprime 1y agoThe confusion likely comes from assuming that the U.S. is targeting “cheaper cost of care” as a goal. The target here is “profit for business”. Usually that’s done by businesses withholding wage increases over decades, but occasionally some regulation is canceled or some private capture opportunity is found that jumps profits and prices rapidly. Australian healthcare generates a lower share of private business profit, both per AUD spent on healthcare and per total AUD spent, and so is seen as inferior to the U.S. model by our leaders. Seen in that light, the increased prices are a universal winner for us: profits go up -> inflation goes up -> GDP goes up. Wages do not go up, and so as a whole we’ve surpassed 25% of all households unable to afford a one-bedroom home. Economists are taught to only model inflation in terms of price level: inflation = profit increases + wage increases, with no way to model their separate impacts. So our policies are economically sound, as long as one disregards the growing poverty. Despair is, as Demotivators reminds us, highly profitable :-(™
- Herring 1y agoIt's basically about racism and control. One of the key reasons the US didn't get universal healthcare in the Social Security Act of 1935(!) was because FDR relied on Southern Democrats who thought it was a threat to segregation. That culture is still very much alive. Conservatives in the US see the world as a power hierarchy and their most important job is to uphold it, like they are princes next in line to be King. See how hard they fight China and cut social services to funnel money up to billionaires. They will literally die for it.
- uslic001 1y agoMost of the private practices in my town have been bought out by the local hospital system as the older partners are unable to find anyone to become junior partners as the overhead costs have doubled since Covid. The only way to meet overhead is to have the hospital buy the practice as they can charge 2x to 10x for the same visits. It is a backdoor way to socialized medicine.