A new kind of doctor's office could lead to cheaper prescriptions | Hacker News Reader

A new kind of doctor's office could lead to cheaper prescriptions

businessinsider.com

55 pointswalterbell22 comments

Reminds me of my grandfather's office -- he was the only doctor in town and he dispensed all the drugs.

I think this is great. Like many things it can have scale problems: in countries where doctors dispense drugs directly (like Japan), prescriptions are higher. But that's hardly the problem in this case!

(After my GF died my mum collected all this stuff. He had a file for re-sharpening his needles after they had been boiled. Ouch! He opened his practice around 1930 and worked for a subsequent 50 years, through wars and foreign occupation.)

Sounds interesting, but still misses the point of having a modern nation where every single citizen has free health care. Sigh.

Curious, how do other nations with free health care handle the homeless that treat hospitals like a free hotel/bed and breakfast (free food and service!). Anecdotally, this is what I'm hearing from my nurse friends in the US recently.

Send them to a more appropriate healthcare provider or give them outpatient treatment if they don't have a problem that requires them to be admitted to a hospital?

Sounds great to me, but (anecdotally, from nursing friends) it doesn't currently work that way. Maybe that can change.

The reason it doesn't work that way is because we don't offer those services. In nearly every study where supportive services were offered to homeless people, they were cheaper and more effective over the long run.

I'm not sure how a system everyone is required to pay into can be described as "free." It may be the better system, but it certainly isn't free.

> free health care

someone has to pay for it...

> On a recent visit, Ciarlo estimated she had saved at least $100 on prescriptions for standard generic steroids and antibiotics that in total cost her $6.

I'd say that's practically free.

Prescriptions are not the highest cost item within healthcare. [1] Perhaps it is just the title that is misleading however, because this would likely affect the number of people needing to go to a hospital or other care facility as well.

[1] - https://www1.aetna.com/assets_aetnaCom/images/aetnaCom_rebra...

What is "hospitals" in that graph? Like real estate? Equipment? Secretaries?

Hospitals = real estate + admin staff + operational expenses.

Liability insurance for example will come under this and so will the retainer for the lawyers who will help you understand complexities of ACA.

Don't forget about hospital EMRs, which can cost as much as the hospital itself (hundreds of millions of dollars)... [ http://www.beckershospitalreview.com/healthcare-information-... ]

Mostly admin salaries/profit. Hospitals suffer from a similar issue as universities. The prices are high but the doctors complain about reduced pay.

This is very similar to a new trend: Concierge medicine[1]

I know of several doctors moving towards this model. It's quite disruptive to patients who can't use their insurance for their doctor anymore, and must find new providers.

1 - https://en.wikipedia.org/wiki/Concierge_medicine

I've been thinking about writing something about 'the predicaments of doctors and patients', based on stories from my various taxi passengers.

I don't think doctors appreciate how the system is rigged against them. Patients just want to feel better - sometimes their problem gets solved, sometimes they get fed to the medical machine.

Why are prescriptions expensive in the US over wholesale ? it's pretty easy to open a pharmacy and margins should go towards zero, right ?

They're physical retail locations zoned commercial which, by law, have to be staffed by people making 6 figures.

Since going to the pharmacy is a monthly deal and an expensive one, won't people be willing to settle on retail locations and density, to save significant amount of money(Maybe doing a family purchase) ? So that takes care of all the store fixed costs. And such a store would get an high density of customers, so it could always sell them something else.

And as for the cost of the pharmacists, in a well run pharmacy, with lower cost employees helping as much as they can, pharmacists can do their jobs very fast, a few short minutes per customer. And even if their salary salary is $1/min(six figures), that isn't much money.

EDIT: and btw, in Israel, with our national healthcare, pharmacies are pressed on margins by government/HMO's - and they lose money on drugs(or so the newspapers claim), but profit by selling other stuff(OTC/herbal/cosmetics/etc).

Between actually doing their jobs, helping patients and arguing with drug companies and/or doctors, I'd be astonished if the average time/patient for a pharmacist was a few short minutes. My guess is that has a very long tailed distribution.

benefit managers have employed legal kickbacks.

Ah "Direct primary care" meaning someone who is not intent on fleecing you at every possible opportunity?

Seems like a "business opportunity" that was missed until recently (mildly ironic statement)

Edit: I actually like the idea and hopefully it will help people priced out of health plans

Reply on news.ycombinator.com