Interesting, so the hospitals spend their money on making things better for the very rich. Sooner or later someone somewhere somehow is going to figure out a way to get decent health care at a reasonable price to the rest of us. This profit motive thing doesn't seem to be doing the best job in helping this to happen.
You missed a little there. There are some hospitals that create suites like I described above for the rich. Those are rare and mainly found in large health care centers such as in New York City or Houston. The rest of them are just trying to create a nice experience for those with hprivate health insurance since they reimburse better than Medicare/Medicaid. They want to increase their market share from the slightly more profitable patients.
Since profit margins are razor thin, even a 5% boost in managed care patients can be the difference between staying in the red vs in the black.
I wonder how their incentives would change if each procedure cost the same regardless of who the patient was?
I'm not sure I understand the question. Different procedures require different tools, people, time, and expertise and therefor they can not all cost the same to perform.
http://www.msn.com/en-us/news/opinion/the-slow-motion-collapse-of-the-american-health-care-system/ar-BBQicMB
I thought this article was interesting, mainly for the graphs it contains. They clearly show that healthcare utilization in the US, particularly inpatient care, is actually declining while the total cost continues to skyrocket. This would imply that the unit cost is rising even more steeply than the total cost. So much for the argument that over-utilization (i.e., unnecessary tests and procedures) is driving our cost increases.
Despite abundant evidence that US health care costs roughly twice as much as it should, when an observer tries to finger a particular part of the health care system as costing too much, howls of protest erupt about how that particular segment of the system is not overpaid, and in fact, they are barely squeaking by. (And I'm not just ragging on the health care professionals who post in this forum - that reaction seems to be universal wherever the discussion is taking place.)
Why is it that no one in the healthcare-industrial complex can provide a credible answer to this question: where the fuck is all that extra money going?
Thanks for sharing. The article I believe is a bit misleading regarding utilization. The reason why inpatient utilization appears to go down is two fold. First hospitals are incentivized to cut length of stay as short as possible. Shorter length of stay means another patient can take the bed. The second is CMS has created such a thing called observation stay. It is an overnight stay in the hospital for observation that is considered as outpatient care. CMS reimburses less for this service but pays $0 if someone is placed as inpatient but does not qualify based on their rules. BTW, a case manager is hired to make sure that patients are placed into the right status of inpatient vs. observation so that the hospital does not lose money. Just one of the places we spend resources on that increases cost but provides no value to patient care.
As for your comments regarding incomes. I will agree that incomes are higher in the US compared to other countries. But, the cost of becoming a doctor is higher as well as the cost of actually practicing medicine is higher. Is that a good enough reason to have higher incomes? The average debt for a physician is starting to get close to $300k coming out of residency with plenty of people looking at $400k and $500k school loans. I doubt many people would go into medicine expecting $300k debt but an income of $100k. Another reason why doctors make significantly more money in the US is because they work longer hours as compared to docs in Europe. 60 hour work weeks are very common in the US. I have a friend who works 7 x 12 hour shifts in a row every other week. On his week "off" he moonlights Monday-Friday for another 10 hours a day. Yes, he works 134 hours every 2 weeks and he makes a very good income.
You want to know where all the money is going. It is going into the pharmaceutical industry, insurance industry, and generally wasted via bureaucracy such as inpatient vs observation stays alluded to above. Sure cutting physician and administrative salaries would help curb those costs some, but it is a tiny fraction compared to the massive elephant in the room
To be 100% honest, I’m far less concerned with the eye-poppingly high deductibles and out-of-pocket maximums in ACA plans, and MUCH MUCH more concerned with the doctor-and-hospital networks that are available through the ACA plans... In my area, they seem to only include the shittiest and lowest rated facilities.
Sadly I see the same thing in our area as well. Plus, non of the good specialists I know take the marketplace plan. Seriously, not a single one. They are all out of network.
In response to the Monkey's Uncle:
It sure looks like we would all be better, doctor's, patients and country if we just eliminated those greedy middlemen.
I fully agree. We should not need a middle man insurance company to act as a payment center for every tiny cost of healthcare utilization. Why should we need insurance to buy a $4 medication? What a bout a $60 doctors visit that now costs $120 because insurance is involved? Why even have a government based middle man for those low cost items? Sure, we still need a way to help those less fortunate to cover healthcare expenses but why does it have to be through the farce of insurance when in fact all it is, is a payment processing center? Disclaimer I am a proponent of government paying for cost effective evidence based healthcare via taxes for those without the resources to pay for it themselves.
Some hospitals have suites for the rich with a private chef. People from around the world get healthcare at such facilities. It is just good business sense in todays market.
wow. I have spent many months sleeping on a couch in a hospital while my son was getting chemo and trying to stay alive, glad to know the 'rich' are getting steaks and foot massages. good business sense, don't worry about saving lives.
@des999, I'm sorry your son required chemo. No parent or child should have to go through such hardship. I hope he is doing well and now fully recovered. People with money will always find ways to spend it while entrepreneurs will keep looking for ways to help them. It makes no difference what industry we discuss and I do not think it is a bad thing. The rich may even be subsidizing some of our expenses. For example: The few first class seats on a plane make over 50% of the profit allowing for cheaper seats in the back. The Tesla Model S payed by the rich paved the way for the 3 series as well as showed the way for other electric car manufacturers. Those fancy suites upstairs in the hospital help cover the cost for areas in the hospital that may be losing money or subsidizing the cost for the underinsured.
Our healthcare industry is an embarrassing mess and screaming socialized healthcare at the top of our lungs will not fix the problem. For one, because healthcare is such a massive part of US spending, completely gutting the system would force millions of people to lose their jobs and may very well put us into a steep recession. Which means, the transition must happen gradually over many many years. I still think it needs to start with lower the cost of delivering care. I don't mean more hoops to jump through so that the middle man pays less. I mean serious policy that starts to brings the cost of delivering care in line with the rest of the world. Just simply decreasing cost by 10% would provide enough resources to cover every American.
Lastly, I believe physicians should be the front line of the solution, but in my experience most physicians are pussies who don't fight back. They either don't fight because they are beat down into submission or they have created a lifestyle that even a 3 month loss of wages is unsustainable and therefor they are forced to accept whatever pile of shit is thrown their way. For most, it is the combination of the two. I hope things improve, but I have yet to see any real policy that is setting us in the right direction. I think it is going to get a whole lot worse before it gets better.