How a $1,500 Start-up Changed Health Care | Hacker News Reader

How a $1,500 Start-up Changed Health Care

inc.com

37 pointsbbarthel18 comments

His $1500 dollar startup is just the store front for his $100k+ medical education. There is already a staggering demand for any and all medical services.

Not as innovative as the headline made it sound.

What's interesting about the economics of all this is that the cost of an office and staff overhead is now greater than the benefit from taking insurance. Complexity has benefits but it also has a cost that tends to deliver negative marginal returns after a certain point and the U.S health care insurance industry passed that point long ago.

No, not in general but only for this one particular doctor. He is basically providing the simplest of medical services to the most well-paying patients. This is a teeny tiny market, one whose consumers' needs and means are not reflective of the average consumer of medical care. He may have success doing this in two zip codes in a metropolitan area, but this business can't be replicated to any meaningful scale.

I don't think one or two hundred a visit is very much higher than in any other context.

It's not a high amount for that type of service. I was referring to the ability to pay the entirety of it, presumably up front, and the willingness to do so in some cases despite having insurance.

The more significant of the two points I made was the type of cases he could possibly be seeing. The article refers to only the most basic of equipment such as an otoscope, no mention of a lab (for blood chemistry, bacterial tests, etc), so it's hard to see how he could handle only the absolute simplest of cases.

Essentially he is practicing medicine the way it was done in a previous era. It's not really "innovative", a better term would be "retro" or "throwback".

I'm not particularly well informed on the issue, but a local doctor who would prefer to make house visits like in the old days, informed me that the hindrance wasn't taking insurance, but liability. According to him America is too litigious these days to visit people in their house, and the cost of malpractice insurance for home visits was prohibitive.

The innovation is the method of delivery of that $100k medical education. The article actually sold me.

Unless the statement in this posting[1] has changed in the few years since it was posted, this guy could lose his medical license over this... I'm all for using technology to make things easier, but something as regulated as the medical and pharmaceutical industry needs to be thought through and can't just use any third party tool to do what you want with.

[1] http://support.formstack.com/index.php?pg=forums.posts&i...

To me, this is just yet another argument to add to the gigantic stack of arguments against the current way of doing things in medicine.

Lately, I've been doing a side job in which I transcribe focus groups for various businesses, including several large health insurance firms. I am consistently stunned at the money they spend on this, and the cynical nature of the questions they ask, and how completely unrelated they are to anything even resembling patient care. They just aren't concerned with patient care. They are concerned with developing "innovative insurance products" to compete with the supposedly "innovative" offerings from other health care conglomerates.

People don't want "innovative insurance products". They want affordable health care, provided by physicians who are not driven to distraction by the bureaucratic requirements of dealing with ten different insurers who are all trying to pay out as little as possible.

Sounds like it changed health care for the people living in those two zip codes who don't want to go through the insurance company. Woohoo, but I'm still hosed.

BTW the patient can still submit the bill to insurance and request to be reimbursed.

It might be an interesting model to push all insurance work from the doctors to the patients. I think it may even have some benefits: people will actually know what they are paying for.

I'll admit outright that I don't know enough about this to have a valid opinion, but shifting the work from the doctor to me automatically makes me want to say "no".

On the other hand, a little bit of work done by a lot of people vs. a lot of work being done by one office, the "crowdsourcing" sounds like a better solution. The obvious down side is that I have no leverage against the insurance company - a doctor's office does.

Actually I think you have more leverage than the Dr. If you are not happy with the insurance company you cancel the policy or complain to your employer (you are paying them, the insurance company does not want to loose the business). The doctor can do nothing - they want to get paid, they have nothing to hold against the insurance company.

Several questions immediately pop up from the article:

* "He watched doctors treat up to 40 patients a day". Is the article implying that is somehow bad in and of itself? If the doctor has staff to handle paper work, and doesn't travel to each patient, this seems to be more efficient. In economic terms, the doctor is maximizing his comparative advantage (treating patients)

* "It wasn't like this decades ago. ... there was so little overhead." What is the cause of this recent overhead? Certainly doctors had offices and staff decades ago, as they do now. Is it just the insurance part? If that's the case, then just simply perform fee-for-service; doctors are free to do that.

What is the cause of this recent overhead?

Salaries for administrators and managers. Like universities, health care organizations have dramatically expanded the number of administrative staff.

Most are private businesses-- they should be run efficiently.

We have a doctor here in our little town in Western Massachusetts that is doing the same but set it up as a non-profit. He accepts barter as payment and supports other small providers with an open source EMR system:

http://www.cottagemed.org/index.php?option=com_content&v...

Interesting observation: the permalink swaps "changed" with "is changing".

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