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Comment by InclinedPlane | Hacker News Reader

Because in the US there are vastly more MRI machines and they are newer.

France has 1/3 the number of CT machines per capita and 1/5th the number of MRI machines per capita compared to the US. And the US has the highest number of MRI scans per capita per year in the developed world (4 times more than French citizens).

Stats: http://www.oecd-ilibrary.org/sites/health_glance-2009-en/04/...

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A doctor I was talking to recently told me that they do way too many scans in America because of liability concerns that don't exist in other countries.

If there is a tiny chance that a condition might actually be something more serious than the obvious diagnosis they will send you in for a scan to be sure even though the doctor "knows" that it's not.

Wait a minute... Are you saying that because French doctors can't be sued for making a mistake they don't order MRIs?

What? you're not saying that? Then why would American doctors order more MRIs? Perhaps to detect those tiny chance conditions, that might actually be more serious? So you're saying that sometimes the MRIs reveal something important about the patient's health? And you're wanting to blame US doctors to find that out? How does the doctor "know" that it's not? Should they not "make sure" instead of just "know"?

I think I prefer the US system in that regard.

Your uncalled-for sarcasm is burying several important points.

First, when doctors in the US are sued they need to show they met the "standard of care." If every other doctor in your community is doing MRIs, you have to do them to, even if they provide no health benefit to the patient. Even if you think that MRIs are leading to worse patient outcomes, that's not the standard you are being judged by.

Second, being sued is a very expensive proposition, even if you did nothing wrong, and doctors are very risk averse of going to court even if they are perfectly confident they did nothing wrong and can prove it.

How does the doctor "know" that it's not? Should they not "make sure" instead of just "know"?

While they can have benefits, all medicare procedures have costs as well as side-effects. In fact, some procedures can decrease patient outcomes, meaning even if they were absolutely free you wouldn't do them. They still get done, because whenever anyone talks about effectiveness research, someone else has a fit. (If Democrats suggest it, Republicans talk about the government getting between you and your doctor. If Republicans suggest it, Democrats talk about how they are putting profits over patient health.)

We can't have the grown-up conversations about what procedures are and aren't worth spending money on, because someone insists that all doctors should "make sure."

I lived in France, and I have relatives, including my sister, who lives in France now (and is a recipient of the French medical establishment's services). I worked for a US HMO for 5 years. I also worked for a US medical malpractice insurance company for 1 year. The points you make are valid, and I agree the system is messed up. Alas, I recognize that all massive systems are messed up and cost a lot more than they should, because large systems introduce inefficiencies. It is possible that the US system is less cost-effective than systems in Europe because of the size of the US population versus that of other European countries. Japan seems to be a hybrid system, and has a population of 125 million or so, but I don't know much about it despite the fact that my wife is Japanese.

In the other large-population countries such as China, India, Indonesia, I don't know that things are any better.

(As an aside, I don't think sarcasm is ever "called-for".)

Japan slightly contradicts your points, having much cheaper MRI scans (~$200), many more MRI machines and scans per capita than the US. But yes, they tend to be less advanced MRI machines (not sure about older/newer). This is all put out in the Planet Money podcast linked just above.

http://www.npr.org/templates/story/story.php?storyId=1205455...

Japan is an interesting example of how interpreting statistics can be difficult. Japan is MRI crazy. It has a ton of MRI machines and people get scans all the time. However, does this lead to better care? As it turns out, a lot of Japan's MRI machines are older and cheaper and in many cases not as diagnostic as newer machines (for any given condition). But Japanese doctors give these scans because it makes people feel like they are being cared for, even when they're not. To a certain degree the same effect is taking place in the US, but I don't think it's nearly as significant.

Perhaps someone should do a study on the placebo effects of MRIs on outcomes...

So the price should be lower in the US because supply is greater right?.

These numbers alone don't tell the whole story either. In the US total spending on MRIs is higher than in France because there are more machines (per capita) and those machines are generally newer. And this gives patients in the US greater access to MRIs and increases the likelihood of an MRI scan being diagnostic (due to the machines being newer and more sensitive). But note that the number of scans per machine is actually lower in the US than in France, even though you are 4x more likely to actually receive a scan in the US.

So essentially the MRIs cost less in France because they use older, less accurate machines longer. Right?

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