Amazon Care to launch across U.S. this summer, offering access to medical care
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I would much rather be able to request services in the way Amazon allows you to buy products than continue to engage in the current opaque system.
No? I want it separated from employment and universally and freely available like the rest of the developed world.
(At half our costs, and similar outcomes!)
Sorry, I’m not following.
So under that definition what you’re describing isn’t relevant to whether it’s a commodity or not.
Also, health care isn’t a commodity right now but I’d argue it should be (a high quality one).
Amazon Care does not provide emergency surgery at the moment.
Health care is far more than just emergency services.
Water, for example, is a commodity. It doesn't matter where you get it, because water from one tap is mostly indistinguishable to water from a different tap. When you need water, you simply just go to the closest tap and you can be happy that you're getting the same quality water as anywhere else. That's exactly what you want with healthcare, too.
In fact, commoditization of healthcare is probably one of the best steps towards making it a public utility. So if that's what you want, then you probably do want healthcare to be commoditized.
Different hospitals have different facilities as well. You’re better off having a type of procedure at one place than another for example. And even if you somehow made it so every hospital had the same high quality equipment you still wouldn’t have the same quality of specialists, surgeons, etc. This matters a lot.
There’s probably a baseline we could get to but the experience will never be a commodity overall.
But for more common things like an annual wellness exam, or blood tests, mending a broken arm, treating the flu, or even doing surgery on a burst appendix, those are things that I think can reasonable be commoditized across any healthcare providers.
The next day I was on a flight from SFO to Singapore, and it was extremely apparent I had strep. Upon landing in Singapore, I went to a clinic where they diagnosed the strep, gave me antibiotics, decongestants, sudafed (the good kind), throat lozenges, and ibuprofen. Total cost? $20 USD.
But I don't see the US government being able to do anything serious in the near term, with the forces of overpowered lobbying and general insanity working against it.
We’ve picked the worst of each approach in the US and combined them.
In the US, most health plans include co-pays for various services, annual deductibles that delay the point that the insurance actually starts paying for things, and lifetime limits on the total amount the insurance can be required to pay. So people in the US usually have incentives to avoid using medical services unless they absolutely must. These incentives magically morph otherwise reasonable insurance plans into rather expensive versions of catastrophic insurance plans with a prescription benefit.
Is a system where n% of the care is provided by unqualified/unlicensed providers masquerading (indistinguishably) as other, qualified providers, where the reviews are invariably fake, and from which both customers and providers can be banned from the system with no recourse for arbitrary reasons really something we want?
Not to mention that people are different in their health needs, responses both physiological and psychological to treatment, and in their goals for healthcare.
I didn't think much could make the US's current health system less transparent or effective, but on reflection I think Amazon taking their current marketplace strategy and applying it to the health industry with a wide brush might just do the trick.
I think their thesis is aligned with Amazon: to decouple primary care from insurance as much as possible.
Another interesting care provider is Curai which (like Amazon) mostly focuses on tele-health: https://curaihealth.com/
Full disclosure: while I don't work for either of these companies, I do work on healthcare pricing and payments, and adjust claims; so I generally find news like this to be interesting and cool.
If he can do that with healthcare, it could be a godsend for a great many people currently suffering under the opaque, private-equity-rigged healthcare system the US currently has. Such a system is ripe for disruption.
It seems to largely depend on what kind of healthcare quality and health outcomes Amazon can deliver while pushing prices down, as well as how Amazon can deal with the edge cases that currently account for the bulk of healthcare expenses in the current system.
One litmus test for where they're heading with this is whether they publish fixed costs for medical procedures or not. That seems to be one necessary-but-maybe-not-sufficient requirement for getting this mess under control.
(after dealing with "normal" health insurance I can only think "well, it can't be any worse, can it?")
American healthcare is truly a mess.
It isn't like they can go to Bob's Online College and then it's a free-for-all after that.
Third - there are about 28 states where nurse practitioners can work independently of any supervising physician. Also, in many cases "supervision" is a joke, with the supervising physician hundreds of miles away and simply signing charts without reviewing them.
> It isn't like they can go to Bob's Online College and then it's a free-for-all after that.
It actually is, though. You would be very, very surprised.
My Dad became a board-certified FNP when I was in high school. I've seen enough of the books, the reading, the studying, the records reviews, the toil, and the anxiety to know you're wrong about this.
Currently, certain nurse practitioner schools are better than others, but the fact remains that the minimum requirement for clinical training hours is 500. [1] That's literally 3 months working a 40-hr/week job. That's less than the number of hours Petsmart trains their dog groomers for (over 800). [2] Furthermore, many nurse practitioner schools are not even finding placements for their students, instead forcing them to beg others to take them on for what are mostly shadowing experiences.
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[1] https://www.nccwebsite.org/content/documents/cms/2020323_fin...
"A meta-analysis of 38 studies, comparing a total of 33 patient outcomes of NPs with those of physicians, demonstrated that NP outcomes were equivalent to or greater than those of physicians. NP patients had higher levels of compliance with recommendations in studies where provider assignments were randomized and when other means to control patient risks were used. Patient satisfaction and the resolution of pathological conditions were greatest for NPs. NP and physician outcomes were equivalent on all other outcomes."
https://www.aanp.org/advocacy/advocacy-resource/position-sta...
Compared with dermatologists, PAs performed more skin biopsies per case of skin cancer diagnosed and diagnosed fewer melanomas in situ, suggesting that the diagnostic accuracy of PAs may be lower than that of dermatologists. https://www.ncbi.nlm.nih.gov/pubmed/29710082
Advanced practice clinicians are associated with more imaging services than PCPs for similar patients during E&M office visits. https://jamanetwork.com/journals/jamainternalmedicine/fullar...
Nonphysician clinicians were more likely to prescribe antibiotics than practicing physicians in outpatient settings, and resident physicians were less likely to prescribe antibiotics. https://www.ncbi.nlm.nih.gov/pubmed/15922696
The quality of referrals to an academic medical center was higher for physicians than for NPs and PAs regarding the clarity of the referral question, understanding of pathophysiology, and adequate prereferral evaluation and documentation. https://www.mayoclinicproceedings.org/article/S0025-6196(13)...)
Further research is needed to understand the impact of differences in NP and PCP patient populations on provider prescribing, such as the higher number of prescriptions issued by NPs for beneficiaries in moderate and high comorbidity groups and the implications of the duration of prescriptions for clinical outcomes, patient-provider rapport, costs, and potential gaps in medication coverage. https://www.journalofnursingregulation.com/article/S2155-825...)
Antibiotics were more frequently prescribed during visits involving NP/PA visits compared with physician-only visits, including overall visits (17% vs 12%, P < .0001) and acute respiratory infection visits (61% vs 54%, P < .001). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5047413/
NPs, relative to physicians, have taken an increasing role in prescribing psychotropic medications for Medicaid-insured youths. The quality of NP prescribing practices deserves further attention. https://www.ncbi.nlm.nih.gov/m/pubmed/29641238/
(CRNA) We found an increased risk of adverse disposition in cases where the anesthesia provider was a nonanesthesiology professional. https://www.ncbi.nlm.nih.gov/pubmed/22305625
NPs/PAs practicing in states with independent prescription authority were > 20 times more likely to overprescribe opioids than NPs/PAs in prescription-restricted states. https://pubmed.ncbi.nlm.nih.gov/32333312/
Both 30-day mortality rate and mortality rate after complications (failure-to-rescue) were lower when anesthesiologists directed anesthesia care. https://pubmed.ncbi.nlm.nih.gov/10861159/
Only 25% of all NPs in Oregon, an independent practice state, practiced in primary care settings. https://oregoncenterfornursing.org/wp-content/uploads/2020/0...
96% of NPs had regular contact with pharmaceutical representatives. 48% stated that they were more likely to prescribe a drug that was highlighted during a lunch or dinner event. https://pubmed.ncbi.nlm.nih.gov/21291293/
85.02% of malpractice cases against NPs were due to diagnosis (41.46%), treatment (30.79%) and medication errors (12.77%). The malpractice cases due to diagnosing errors was further stratified into failure to diagnose (64.13%), delay to diagnose (27.29%), and misdiagnosis (7.59%). https://pubmed.ncbi.nlm.nih.gov/28734486/
Advanced practice clinicians and PCPs ordered imaging in 2.8% and 1.9% episodes of care, respectively. Advanced practice clinicians are associated with more imaging services than PCPs for similar patients during E&M office visits .While increased use of imaging appears modest for individual patients, this increase may have ramifications on care and overall costs at the population level. https://jamanetwork.com/journals/jamainternalmedicine/fullar...
APP visits had lower RVUs/visit (2.8 vs. 3.7) and lower patients/hour (1.1 vs. 2.2) compared to physician visits. Higher APP coverage (by 10%) at the ED‐day level was associated with lower patients/clinician hour by 0.12 (95% confidence interval [CI] = −0.15 to −0.10) and lower RVUs/clinician hour by 0.4 (95% CI = −0.5 to −0.3). Increasing APP staffing may not lower staffing costs. https://onlinelibrary.wiley.com/doi/full/10.1111/acem.14077
When caring for patients with DM, NPs were more likely to have consulted cardiologists (OR = 1.29, 95% CI = 1.21–1.37), endocrinologists (OR = 1.64, 95% CI = 1.48–1.82), and nephrologists (OR = 1.90, 95% CI = 1.67–2.17) and more likely to have prescribed PIMs (OR = 1.07, 95% CI = 1.01–1.12) https://onlinelibrary.wiley.com/doi/10.1111/jgs.13662
Ambulatory visits between 2006 and 2011 involving NPs and PAs more frequently resulted in an antibiotic prescription compared with physician-only visits (17% for visits involving NPs and PAs vs 12% for physician-only visits; P < .0001) https://academic.oup.com/ofid/article/3/3/ofw168/2593319
More claims naming PAs and APRNs were paid on behalf of the hospital/practice (38% and 32%, respectively) compared with physicians (8%, P < 0.001) and payment was more likely when APRNs were defendants (1.82, 1.09-3.03) https://pubmed.ncbi.nlm.nih.gov/32362078/
There was a 50.9% increase in the proportion of psychotropic medications prescribed by psychiatric NPs (from 5.9% to 8.8%) and a 28.6% proportional increase by non-psychiatric NPs (from 4.9% to 6.3%). By contrast, the proportion of psychotropic medications prescribed by psychiatrists and by non-psychiatric physicians declined (56.9%-53.0% and 32.3%-31.8%, respectively) https://pubmed.ncbi.nlm.nih.gov/29641238/
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Although evidence-based healthcare results in improved patient outcomes and reduced costs, nurses do not consistently implement evidence based best practices. https://pubmed.ncbi.nlm.nih.gov/22922750/
I work in healthcare and have determined that there's no difference in care outcomes between NPs and Others in our organization.
I and my teams have wasted tons of man hours trying to convince MDs of this fact instead of working to help our patients.
I stand corrected
But I'm open to any approach to bring insane US health care costs into line. Americans spent nearly 18% of the US GDP on health care in 2020. Healthcare spend increased 4.6% in 2019 alone[0]. It's out of control.
[0] https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta...
That said, it's frustrating that consumers need to go through their employers to get their healthcare.
Example: Hospitals are generally the source / hub of medicine in an area. So you subscribe to a hospital and pay them 5% of your income.
Hospital then negotiates rates with other hospitals or all hospitals maybe set common-rates for things. Whether you're in an injury locally or across the globe they cover the cost.
Hospital gets recurring income monthly to budget by. PCP's and specialists might get a cut of that as well maybe they get shares of the income based on office visits/year?
Just last week I had to deal with offices _faxing_ each other back and forth with one insisting they sent it and the other insisting they never received it. I constantly have to be the one making an active effort to keep on top of things or suddenly I find it's going to take me a week to get a medicine that I have only 5 days left on
If amazon does nothing else but makes making an appointment as easy as ordering a tube of toothpaste, I'll celebrate.
When I ask my insurance company to pay for some health care, they might pay.
The point is that it's not a commodity, because it's often the product of the skills of a single physician, whether manual or mental.
I want to pay more to choose a better physician if he's going to cut my -something- open, not choose the lowest price based on bogus "Amazon recommends" reviews.
Unless you don't plan to read it as an individual but as part of an effort, like EFF does, to point out it's shortcomings.
HIPAA compliance probably means that while other care providers aren't allowed to sell your medical history to marketers, Amazon doesn't even have to do that, and can send you personalized offers based on your medical history all day long without violating HIPAA.
Furthermore, this may give them data they can use to correlate medical history with other behavior, and thus potentially infer medical events about other customers that aren't Amazon Care patients.