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Comment by nradov | Hacker News Reader

Artificially limiting the supply of doctors is one way of rationing healthcare and holding down costs. Healthcare in the UK is largely funded through the NHS. Voters are already financially struggling and don't want to pay higher taxes. In some cases, even emergency patients are waiting hours in ambulances because hospitals are so overloaded.

https://www.bbc.com/news/uk-england-cornwall-68171254

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Artificially limiting the supply of doctors drives the wages up. It's a common demand of doctors worldwide

Not if you're in the universal system where the government sets the payments.

I do know that limiting the number of doctors is one of many mechanisms to limit healthcare spending. A doctor can only see so many patients in one day.

I’m in Canada. If there were enough doctors that doctor unemployment was 2%+, like a normal job, doctors here would get paid less. Also doctors might not burn themselves out working crazy hours.

Instead, we have a dire shortage of doctors and people in government employed full time trying to recruit the limited supply.

Doctors can’t move to the next hospital for more pay, but they can move to the next province, or to the US.

Doesn't Canada (or maybe individual provinces) also have artificially imposed limits on how many new doctors there can be each year?

> hospitals are so overloaded

How do you suggest we limit the demand for healthcare?

In the US, anyone can walk into the emergency room for treatment, but people who don’t have insurance are very unlikely to participate in preventative care.

The way to decrease demand For complicated and expensive interventions to preventable problems is to increase access to preventative care.

I'm not sure what you mean by preventative care.

In New Zealand "poor" might be a synonym for uninsured? However my peer group is middle aged professionals (not poor) with as variety of healthcare issues. Only a very few would preventative care help. Prevention would help many of my friends. A friend with a cancer scare that keeps smoking. A friend with gout that doesn't change habits. Multiple friends with issues from drugs that continue to take drugs. All my friends and me that are unfit and eat poor diets. I've given up drinking recently but I'm most definitely an outlier.

Prevention is often the cure.

Assuming you mean prevention when you say preventative care?

Prevention and preventive care are typically classified separately, although it's a bit of a gray area. US residents on health plans receive free access to preventive services including immunizations, screening tests, etc.

https://www.healthcare.gov/coverage/preventive-care-benefits...

But prevention is largely outside the scope of medical care. For issues like diet, exercise, and avoidance of substance abuse patients may be able to get help from a variety of other sources including public health agencies, therapists, social workers, dieticians, personal trainers, etc.

I support increasing access to preventative care, but I doubt that will do much to decrease demand. Currently about 92% of US residents have medical coverage, and that gives them free access to preventive care services which are proven to be a net benefit.

https://www.healthcare.gov/coverage/preventive-care-benefits...

But demand is increasingly driven by chronic medical conditions caused by lifestyle issues and local environments: obesity, substance abuse, sedentary lifestyles, toxin exposure, excess stress, lack of sunlight, etc. Those issues will have to be addressed through social policy rather than the healthcare system.

In the UK they severely limit access to any diagnostics, and your GP just gives you antibiotics and/or anti depressants.

At the hospital, they just classify your symptoms as “not critical”, refuse to admit you and kick you back to your GP, who then refuses to refer you for any investigations, I imagine because there is a gun to their head over targets etc

If your levels are high, you’re told oh it’s not severe. If it’s severe, you’re told oh it’s not critical etc

We have a system where everyone just gaslights you that you’re in fact not sick because you aren’t 3 seconds from death

That reduces access but it doesn't affect the demand for healthcare.

I'm in New Zealand: not a heap better than you describe. Here GPs are overworked and getting an appointment is difficult. The health system has waitlists to control access to a limited number of procedures performed in each specialty. You need to be healthy enough to pass the access requirements and for acute surgery you need to live long enough to get to the front of the queue.

Depends how you define demand. People who need and seek care, or just those who need care?

Some people absolutely don't bother seeking care because they know they'll be denied care without a huge battle

This doesn't make a lot of sense as an explanation for the policy—if there were more doctors trained that doesn't require that they find jobs, but it does make it easier for hospitals to replace their doctors if and when they need to, and likely at a lower price. If healthcare costs were the reason I'd expect the government to cap the number of doctors they employ now, not try to guess how many doctors they'll wish they could employ in six years.

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