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Comment by eru | Hacker News Reader

If there's such a long queue, why don't doctors raise prices until the queue goes away? Do doctors not like money?

> If you're rich, you have concierge medicine, and you'll see a great specialist whenever you want.

You don't need to be that rich to go see a doctor privately in eg the UK. And, yes, they have crazy queues for the NHS, while the same doctor can be had for a bit of money quickly when seen privately.

In that case, the price restriction comes from what the NHS is willing to pay. And because patient don't directly pay for the NHS, at least not proportional to the usage, instead of rationing via price the system rations via wait times.

> [...] the amount of medical care that would be medically useful for the population.

I'm not sure there's such a thing. There's no clearly defined amount that is 'medically useful'. There are just gradually diminishing returns to more medicine (in a statistical sense).

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> If there's such a long queue, why don't doctors raise prices until the queue goes away? Do doctors not like money?

You do understand the 'queue' are sick people who need treatment? If the 'queue' goes away then they're just untreated and potentially die. Doctors like money but, at least where I come from, you don't go into medicine for cash. You do it for ideals or respect or to have a job that means something.

> I'm not sure there's such a thing. There's no clearly defined amount that is 'medically useful'. There are just gradually diminishing returns to more medicine (in a statistical sense).

there is actually such a thing as overtreatment. There's this really interesting statistical point where too much testing can actually cause harm, even if the test it self is harmless, because it discovers things that wouldn't have really been a problem ('incidentalomas').

And, unfortunately, there does come a point at times where a patient cannot be helped and it is better to just let them enjoy what time they have left rather than subject them to more treatment and recovery time and all that.

> You do understand the 'queue' are sick people who need treatment? If the 'queue' goes away then they're just untreated and potentially die.

Huh? How does having a queue help the doctor see more patients?

Let's assume our doctor can handle X patients a day. Having a six months long wait list does not increase X.

(If, for compassionate reasons, you want to always run the doctor at full capacity X, you will want some short waitlist, so that when a patient cancels you can backfill. But you don't need a six months waitlist for that.)

So you can carefully raise prices a bit, so that you can still see the same number of patients a day as before. But the doc gets more money, and the waitlist (almost) disappears.

(It's the exact same logic as congestion charging.)

They can eg use the money to make their life easier, eg by having their houshold chores done by a professional.

> Doctors like money but, at least where I come from, you don't go into medicine for cash.

Or they can donate the extra money to an efficient charity.

> there is actually such a thing as overtreatment. There's this really interesting statistical point where too much testing can actually cause harm, even if the test it self is harmless, because it discovers things that wouldn't have really been a problem ('incidentalomas').

Agreed.

But my argument even works without harm of overtreatment: extra testing only does you statistical good. And if you eg do colonoscopies every day instead of every year, you aren't gonna catch that many extra cancers.

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