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In contrast, Austria and Germany apparently pay for any nonsense a doctor recommends. The money they save on paperwork is spent sending people to the spa. Not

by paulgb 17y ago

In contrast, Austria and Germany apparently pay for any nonsense a doctor recommends. The money they save on paperwork is spent sending people to the spa. Not all of it, it seems. Germany spends 10.7% of the GDP on health care vs. 16% in the USA. http://en.wikipedia.org/wiki/Universal_health_care#Germany http://en.wikipedia.org/wiki/Universal_health_care#Germany

yummyfajitas 17y ago
You are asking the wrong question. The question is not, "how much does Germany spend compared to the US?" The relevant question is, "how much could Germany save if they put a greater effort into weeding out waste and fraud?" My point is that you simple can't look at administrative costs alone, since there is an important tradeoff between admin costs and waste/fraud costs. To determine who is closer to the optimum, we need data on (admin+waste+fraud), not simply admin. Similarly, you can't say "GM spends 1% of costs on programmers, while 37signals spends 95% on programmers, therefore GM is more efficient." You have to know what those programmers produce.
- Retric 17y ago
  No, it's "how much would Germany spend weeding out waste and fraud compared to how much it would save?" The most effective system for detecting fraud is to investigate a low but random number of cases in depth, and build an algorithm find the most likely cases of waste and fraud and then weed them out. Look at how the IRS operates for a good example of this. PS: If anything the best number to look for would be the quality of care vs cost. The fastest way to save money on US heath care would be to ban or more tightly regulate medical advertising in the US. In one day you could save 8+ billion a year in direct costs and far more than that in indirect costs. (If a drug company is spending a 100 million on advertising they think it's driving more than 100 million in extra sales + 20% over head from insurance companies etc.)
  - yummyfajitas 17y ago
    Your question is the correct one. That's actually what I was thinking, if not what I said. :) Concerning quality of care vs cost, that's also irrelevant. I don't want health care, I want health. Health outcomes vs cost are the relevant quantity, but it has not actually been shown that quality of care significantly affects health outcomes. I submitted an article on this topic previously: http://news.ycombinator.com/item?id=775284 http://news.ycombinator.com/item?id=775284
- m0th87 17y ago
  * As of 2000 (the latest report with country ranking) the WHO rates America #37 in overall effectiveness in healthcare, whereas Germany is #25 (#1 is France, which also has universal coverage): http://www.who.int/whr/2000/en/ http://www.who.int/whr/2000/en/ * According to the CIA world factbook, we're ranked #35 in life expectancy, Germany #23: http://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy http://en.wikipedia.org/wiki/List_of_countries_by_life_expec... * Again according to the CIA world factbook, the US is ranked #46 in lowest infant mortality rate, Germany #15: http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate http://en.wikipedia.org/wiki/List_of_countries_by_infant_mor... In terms of production, as well as in spending, Germany kicks our butt (as does the UK, France, etc.) If we can reduce costs and at the same time get free spa visits, I'm all for it!
  - yummyfajitas 17y ago
    The WHO rankings do not measure effectiveness in health care. They measure a weighted average of many factors, most of which are unrelated to health care effectiveness: 25% health 25% health equality 12.5% responsiveness 12.5% responsiveness equality 25% financial equality Near as I can tell, only 12.5% of the score (responsiveness) is directly related to health care effectiveness. Remarkable fact: an improvement in health care can actually lower a score if it is unequally distributed (e.g., half the country gets better health care at higher cost, half the country stays the same).
    - m0th87 17y ago
      Outlining the factors without showing how they are measured is misleading. According to the WHO, the HSP (health system performance) is measured via: * measuring the health system's contribution to socially desirable goals; * measuring the health system and non-health system resources used to achieve these outcomes; * estimating the efficiency with which the resources are used to attain these outcomes; * evaluating the way the functions of the system influence observed levels of attainment and efficiency; * designing and implementing policies to improve attainment and efficiency and monitoring the effect. Check out http://www.who.int/health-systems-performance/about.htm http://www.who.int/health-systems-performance/about.htm This is more or less directly concerned with measuring the performance of healthcare systems. It would, however, be completely fair to argue how effective this measure is, as it's very difficult to try to quantify something as complex as healthcare. That's why the WHO stopped making this index in 2000 apparently.

by paulgb 17y ago

yummyfajitas 17y ago

You are asking the wrong question. The question is not, "how much does Germany spend compared to the US?" The relevant question is, "how much could Germany save if they put a greater effort into weeding out waste and fraud?" My point is that you simple can't look at administrative costs alone, since there is an important tradeoff between admin costs and waste/fraud costs. To determine who is closer to the optimum, we need data on (admin+waste+fraud), not simply admin. Similarly, you can't say "GM spends 1% of costs on programmers, while 37signals spends 95% on programmers, therefore GM is more efficient." You have to know what those programmers produce.

Retric 17y ago
No, it's "how much would Germany spend weeding out waste and fraud compared to how much it would save?" The most effective system for detecting fraud is to investigate a low but random number of cases in depth, and build an algorithm find the most likely cases of waste and fraud and then weed them out. Look at how the IRS operates for a good example of this. PS: If anything the best number to look for would be the quality of care vs cost. The fastest way to save money on US heath care would be to ban or more tightly regulate medical advertising in the US. In one day you could save 8+ billion a year in direct costs and far more than that in indirect costs. (If a drug company is spending a 100 million on advertising they think it's driving more than 100 million in extra sales + 20% over head from insurance companies etc.)
- yummyfajitas 17y ago
  Your question is the correct one. That's actually what I was thinking, if not what I said. :) Concerning quality of care vs cost, that's also irrelevant. I don't want health care, I want health. Health outcomes vs cost are the relevant quantity, but it has not actually been shown that quality of care significantly affects health outcomes. I submitted an article on this topic previously: http://news.ycombinator.com/item?id=775284 http://news.ycombinator.com/item?id=775284
m0th87 17y ago
* As of 2000 (the latest report with country ranking) the WHO rates America #37 in overall effectiveness in healthcare, whereas Germany is #25 (#1 is France, which also has universal coverage): http://www.who.int/whr/2000/en/ http://www.who.int/whr/2000/en/ * According to the CIA world factbook, we're ranked #35 in life expectancy, Germany #23: http://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy http://en.wikipedia.org/wiki/List_of_countries_by_life_expec... * Again according to the CIA world factbook, the US is ranked #46 in lowest infant mortality rate, Germany #15: http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate http://en.wikipedia.org/wiki/List_of_countries_by_infant_mor... In terms of production, as well as in spending, Germany kicks our butt (as does the UK, France, etc.) If we can reduce costs and at the same time get free spa visits, I'm all for it!
- yummyfajitas 17y ago
  The WHO rankings do not measure effectiveness in health care. They measure a weighted average of many factors, most of which are unrelated to health care effectiveness: 25% health 25% health equality 12.5% responsiveness 12.5% responsiveness equality 25% financial equality Near as I can tell, only 12.5% of the score (responsiveness) is directly related to health care effectiveness. Remarkable fact: an improvement in health care can actually lower a score if it is unequally distributed (e.g., half the country gets better health care at higher cost, half the country stays the same).
  - m0th87 17y ago
    Outlining the factors without showing how they are measured is misleading. According to the WHO, the HSP (health system performance) is measured via: * measuring the health system's contribution to socially desirable goals; * measuring the health system and non-health system resources used to achieve these outcomes; * estimating the efficiency with which the resources are used to attain these outcomes; * evaluating the way the functions of the system influence observed levels of attainment and efficiency; * designing and implementing policies to improve attainment and efficiency and monitoring the effect. Check out http://www.who.int/health-systems-performance/about.htm http://www.who.int/health-systems-performance/about.htm This is more or less directly concerned with measuring the performance of healthcare systems. It would, however, be completely fair to argue how effective this measure is, as it's very difficult to try to quantify something as complex as healthcare. That's why the WHO stopped making this index in 2000 apparently.