Comment by Procrastes | Hacker News Reader

Comment by Procrastes | Hacker News Reader

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A friend of mine studied healthcare management for his thesis. One of the hidden costs in US Healthcare is the waste and duplication that comes from competition. His example was a town with enough population to support a single CT machine. They are expensive to maintain, but there was enough use to justify it.

One hospital bought a CT machine. Doctors who are the most important customers for any commercial hospital, began to sign contracts with that hospital because it made access to the CT machine for their patients easier. The other two local hospitals had to compete and bought their own. Now there were three machines and only enough patients to support one of them. That didn't reduce the maintenance costs. The cost inevitably is passed on to all patients. This is only one example from hundreds where competition led to unnecessary cost from duplication. Add to that the overhead for people who specialize in insurance billing because the competing companies are different and very complex, add to that the profit for the investors in the hospitals, the profit for the investors in the insurance companies and that's not even touching the similar stack for pharmaceuticals and supplies. That's not even adding in the cost of delayed and emergency treatment due to lack of preventative medicine for the uninsured and the under insured. All of that adds up to the $99 bag of $0.99 saline that comes out of your pocket one way or the other.

It would be difficult to create a more wasteful or expensive system if you set out to do it on purpose.

CT scanners and all the shit you need to run them don't cost that much.

The insurance I used to have negotiated with the hospital to charge ~$2000 for a five minute CT. The radiologist charged like $30 to interpret it. You can a buy a brand new machine every year with 5 or 6 patients a day.

The anecdote may have been true in 1982 or something.

Meanwhile, no one else can buy a CT because the state regulates who gets to own one.

Actually the maintenance costs less than $60 per patient and most of it is in autoinjector, some in coolant and checks. You're being gouged. Source: in Poland, checked the costs.

The cost of a new full size CT machine with surrounding equipment is quarter of a million USD though. Some are more expensive than others, but you can get a new good one for this much.

USG costs few tens of thousands, and maintenance is super cheap, mostly consumable gel, some $8 per patient.

MRI machines are more expensive at half million USD and $120 per patient. (cooling costs)

This includes salaries.

Hospital bed is like $12 per night, staff included.

Germany and Sweden have even better healthcare, mostly due to larger number of doctors and nurses. Not that much more expensive too. Our education and salaries don't keep up.

Even in russia you can get MRI for $50 (depending on body part and resolution it might go as far as $300).

Possible solution to duplication: decouple tech (test labs) from doctors (hospital)

Yeah, in the tiny town I grew up in we only had a single hospital and still had a (private) radiography clinic that was shared between the public hospital and private surgeries.

Oddly enough, it seems like tech is closer to doctors in Germany than in the US. Just about every Hausarzt (general practitioner) and every internist and ob/gyn has an ultrasound machine in their practice and uses it themselves. When I've been in the emergency room, the doctor does the ultrasound, not a technician, though nurses set up and run EKGs.

And it's all amazingly cheap compared to the US, even as a private pay patient. An overnight hospital stay is about 200 EUR, including the attending doctor's fee.

That's interesting. In the US, these things go for $10K or so. Maybe they lease them? At $500/mo if it got used every day, that's be under $20 per use.

No idea, but there's a lively enough market that I've seen older ultrasound machines at veterinarians' offices.

Vet services, by the way, do cost approximately as much as they do in the US, at least for birds.

I‘d like to know the source of your numbers. For reasons I buy Ultrasonic gel quite regularly, and it costs me about 1€ per litre, delivered to my doorstep. If you use it for its intended purpose, I highly doubt that you use more than 0.10€ worth of gel.

There's essentially a gentlemen's agreement between health systems and insurers to make patients pay for imaging and charge lots for it.

Some of the newest CT machines are more like $2 million.

> One of the hidden costs in US Healthcare is the waste and duplication that comes from competition

Sure the problem is lack of information? Other industries do well with competition.

Almost all medical / dental procedure in Australia has an item number with a roughly known cost. Providers know they can't charge much more than that without losing customers.

The general complaints I read are about the lack of specialized equipment. E.g. https://reason.com/2017/01/25/virginia-certificate-of-need-h... about the lack of neonatal care units (in southwest Virginia). It seems hard to argue that there should only be one hospital per town that offers common services such as delivery, but the only other solution is buying more units since the lack of neonatal units leads to substandard care.

And of course competition leads to unnecessary duplication, inefficiency is a well-known criticism of capitalism. But this inefficiency is like the inefficiency that comes from using Python instead of C; it is slower and uses more resources, but it actually gets things done, unlike health care where the inefficiency seems to come primarily from government regulation and lack of transparency.

It works pretty well here in the uk in each major town you get specialist hospitals with a number of general ones that don’t have the specific equipment specialists need.

It does mean you sometimes have to travel further but it works out better for everyone, even for you as the specialist care is within one “centre of excellence” (whether it is excellent is a different point but they could potentially be)

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