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Comment by kfriede | Hacker News Reader

Cost could be minimized if the particular doctor does not have to pay for a facility. I can't even begin to imagine what the cost per sq/ft of a generic doctor's office is, given all the regulation and equipment requirements. Having them mobile may remove a significant cost (though probably won't come close to the added opportunity-cost you mentioned).

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My point wasn't just about cost, but rather care. People need doctors, and "there isn't enough doctors" seems to be a common problem in health care. The cost could also be mitigated by simply charging more, but having doctors spend their time driving instead of treating patients means that the number of doctors needed for the same quality of care goes way up, and in many cases doctors are not a resource that you can simply get more of because you need more.

For every doctor's appointment serviced by Heal, ~3 appointments are taken away from a community clinic somewhere.

>For every doctor's appointment serviced by Heal, ~3 appointments are taken away from a community clinic somewhere.

It sounds to me like you may be making unjustified assumptions to get to that conclusion. Citation?

I outlined my reasoning in my post above, unless heal is creating new doctors they are hiring away doctors from more efficient types of care.

Your reasoning is based on assumptions that there is no evidence for. Not all doctors are employed in providing care, you don’t know what Heal doctors are doing between seeing patients, you don’t know how Heal sources or compensates doctors, medical efficiency is not measured in patient-minutes, you don’t know how many patients a Heal doctor sees vs a clinic doctor, you don’t know the bottlenecks of community clinics, etc. etc.

> Your reasoning is based on assumptions that there is no evidence for.

I have no horse in this race, but I found it interesting that the above was followed by four “you don’t know…” statements.

You’re making assumptions as well. The person to whom you are responding may know a great deal more than they have revealed.

https://en.m.wikipedia.org/wiki/Tu_quoque

Do I contradict myself? Very well then I contradict myself, (I am large, I contain multitudes.)

You’re actually right about this. My primary care doctor tried one of these “visit people instead” services and absolutely hated it. Her days are usually 100% full at her office but driving around SF all day cut her throughput down to something like 30%.

Maybe the economics work somehow for others, but they didn’t for her (car + gas + parking + large drop in number of patients seen).

> doctor does not have to pay for a facility

> given all the regulation and equipment requirements.

Um, so how does not having a facility, which is probably required to give care, all of the sudden eliminate all of the equipment and regulatory requirements? I mean, don't you think the equipment and the regulation is probably there for a reason..?

Well, if you build a clinic it needs to be wheelchair accessible, and have access to parking for all the patients that might be present at one time, for example. If you visit patients then they either live somewhere accessible or not and you just need to get one car to their place.

> Um, so how does not having a facility, which is probably required to give care

It's required for certain levels of care, but not every encounter requires those.

Same way a taco truck is cheaper to operate than a sit down restaurant. You still have to follow the local health codes but your fixed costs would be less.

I can’t see how there would be any cost savings except if you dump equipment that would otherwise be available; making the entire contents of a clinic mobile is surely more costly and complicated than paying rent.

Test kits are mobile, vaccines and bloodwork are mobile, basic diagnostic equipment is mobile. Most people do not need the vast majority of things a clinic contains; nothing you couldn't solve with a small refrigerable unit in a vehicle.

That being said, the downsides of travel time are so negative it's hard to see how they could be overcome.

> I can’t see how there would be any cost savings except if you dump equipment that would otherwise be available

Compared to an urgent care facility, they pretty clearly have to be doing that.

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