Can Hospital Chains Improve the Medical Industry?
m.newyorker.com
m.newyorker.com
I don't see what "innovation" and "quality" has to do with anything but their many ways to utilize HFCS and massive calories/portion sizes. Supply chain, perhaps. But the food output is absolutely terrible in the international chains. Cheesecake Factory, TGIFriday's, Bennigan's all make consistent dishes, but consistently ~bad~.
Here's a real world example: Three weeks ago I slipped on some ice and I sprained my arm. Hundreds of thousands of people sprain their arms every year and go through the same process:
1) Go to a doctor, 90% of time they will recommend an xray
2) Get an xray, bring it back to the doctor
3) Go back to doctor, who 90% of the time reads back what the xray tech, radiologist or whoever said on the notes.
4) Pay $800-$1200 for four people to 'investigate' your arm when in reality they just passed confirmation down the pipe
Here's what I wanted: I wanted to start with the xray and have a radiologist or nurse practitioner read it back to me. I WANTED to go to the McDonalds of Arm Sprains; a low cost clean environment that serves one job with a 99.999% success rate.
I called dozens of places and only one was be willing to do the xray first. All of the other places said the same thing (yeah you'll probably need an xray, no you'll have to visit the doctor first, yes it will cost around a thousand dollars).
There's times you want a doctor and there's times when you just want a problem solved.
Much and all as the internet is awash with stories of "I diagnosed something my doctor didn't!", the vast bulk of times the doctor has a better idea. In my previous career as a medical tech, I've seen quite a few people who ended up suffering far worse because they didn't want to take their issue to a doctor because they 'knew' what the issue was.
I will agree that the price is ridiculous, but the basic process isn't. Some people say that a GP's role is to deal with the morass of 'coughs, colds, and sore holes' while acting as a filter looking for the really serious stuff.
Lack of data and transparency are the two huge factors holding back health care.
You can find a doctor and book an appointment but if you need a surgeon what matters is the Complication Rate and not the no of reviews of office visits.
This kind of decision making data is simply lacking or un-avialble to the public.
there is a lot of depth to this discussion as always with health care but simply put in the current state of affairs Health Care is too fragmented and non-communicative in itself.
We need to create a single platform of interconnected technologies the communicate among each other to solve this and use patient engagement to help doctors provide more personalized medicine.
If you want the absolute best return in units of health care per dollar spent then the New Zealand system was the most efficient last time I looked.
"socialized medicine"
"communism"
"free private enterprise"
etc.
Any change in legislation will result in intense lobbying (ie politician funding) because so many vested interests benefit from the current structure.
As with many things in American politics, the issue isn't so much about what the objectively best thing to do is, but rather how that could happen with the current political process. There is some light at the end of the tunnel in pushing things to individual states. There is no need to come up with perfection - let 50 states do their own thing and see what works best.
We could also get into the further perverse incentives specific to the US healthcare system, but I've yet to see a fundamental argument about how efficient market forces can work Adam Smith's magic on healthcare.
The market could work in healthcare. It should be our goal to make that a reality, because the alternatives sucks.
UK, US - sorry but that sucks.
These system are worse than what the market could provide with proper deregulation. We did that for airplanes. We can do it for healthcare.
For example you get this with BUPA in the UK - you pay extra and get quicker services plus more luxurious accommodation on hospitalization. Or a private organisation could provide services over night to the government (eg get a CT scan at 3am for cheap - the government could give people a paid incentive to take that instead of using daytime services).
It would be really great if there was a baseline service - eg you know that if you get a broken arm or cancer you would be sensibly taken care of, but beyond that a great flowering of experimentation (which markets do) in how things are provided and how they are paid for.
http://healthland.time.com/2013/02/20/bitter-pill-why-medica...
From what I gather so far (haven't quite finished), there are large costs that are incurred by dealing with insurance. The USA's billing system -- matching diagnoses to codes, and codes to billable amounts -- seems like it makes sense on the face of it, but once you start digging in, its a rat's nest.
There are several disparate coding ontologies, many of which are proprietary. Different insurance companies accept different ontologies, meaning clinics need to pay for access several times over.
The ontologies don't necessarily match up one to one with diagnoses, and clinicians often don't care to match them up themselves. So, clinicians diagnose a patient, and then back-office staff need to go through and match those diagnoses to codes.
The insurance companies will reject anything that doesn't match their own data. So, if an payment request comes through for John Q. Bloggs, they won't issue payment if the name they have on file is Jonathan Q. Bloggs. So, you need more back-office staff to deal with the rejections, marry the data up properly, and send it again (in order to save time and money, there are apparently clearing houses now; middle-men between the clinics and the insurance company who can advise staff more cheaply if a given request will be rejected for invalid data, or unbillable codes).
Then, they can reject certain codes that a patient doesn't have insurance for, even if its covered by some other code. So, again, the back-office staff need to go through and retry the payment request with more relevant codes (which are now further from the diagnosis, but hey, whatever).
Finally, once it's all been hashed out, insurance companies often won't pay the full amount anyway -- so the patients sometimes need to be chased up for the remaining payment.
Wrapped around all that are all the requirements for dealing with fraud, auditing, etc. which make it all the more difficult.
It's massively inefficient, and somewhat self-fulfilling: the complexity of it requires more staff, which drives costs up. There's no direct way to bill for staff time, so charges to patients go up (hence the $10 aspirin or whatever the famous example is). Which leads to more complexity in billing, which leads to more staff, and on and on.
It needs new perspectives, I think. I posted this article because I was recently told of a doctor who made close to a $1M last year....making housecalls. He did it by eliminating his office, downsizing his staff to just basic support staff, and using proprietary software to track patients, bill, and schedule. I find this extremely interesting, so much so that I've asked to interview this doctor to gain more insight.
I feel his "reverse innovating" approach is what the industry needs. To look back at what worked and why we moved away from it, and maybe see if there's a potential for going back to it with a better system.