Medical costs

[ultrarunner]

It is a moral question because at what point can you compel another to provide service?

Going all the way back to our founding a large part of medical care was provided by religious organizations... in recent years this has come under severe attack regarding "Family" planning to the point where religious have closed up shop...

If nuns don't believe in abortion should they just keep quiet and provide the service?

Each county has a hospital system... the county system has always taken care of those with no or modest means...

I managed a lot of low income Housing... one of the tenants was a Grandmother at 31... her 15 year old daughter gave birth to son with a severe heart defect... required multiple surgeries over 10 years...

Over a million dollars of care provided at NO COST to the family... the surgeries were performed at top Hospitals including Stanford... the family was put up at no charge through the Ronald McDonald House each time...

I've worked a year in Europe in Austria and it was very common among those I came to know that people in America without money simply die in the streets...

They had no idea of Shriners, Saint Jude, plus countless other providers that require nothing from the family... they had no idea the amount of free care provided by the finest University Hospitals in the Country... even in places like the SF Bay Area... the Lucile Packard Center or Zuckerburg have provided millions for Health Care.

No one is turned away in America... but something is wrong when 78% of ER patients pay nothing... and the others pay exorbitant...

I had very high hopes for the Affordable Health Care Act... everyone would be covered, the cost of insurance would go down and individuals could keep their plans...

Everyone knows it has failed...

Its Saturday and one of our Doctors has an open door each Saturday from 8 AM to Noon... anyone is welcome no questions asked... in fact Doctor doesn't even want to know if a patient has insurance or not... said he wants no outside influence in his assessment on what is medically necessary...

I also think it is important to know that few American born Docs encourage their kids to go into medicine... they are very disillusioned and the days of the county Doc and sole practitioner are nearly over and a large part of that is attributed to the complexity not of medicine but the medical system... if you don't have the latest computer, software, a specialist well versed in nuances forget about reimbursement for services provide... you also need to fill mandated positions such as Compliance Officers for medical records etc... makes little difference if you are a Hospital Chain, a Medical Group or a sole provider...

I do think it also speaks volumes that most of all are new Docs are foreign born... one would certainly think there would be no shortage of domestic new Docs if things were so rosy...

 

[Agvg]

Nice to get some info, lot of missunderstanding when it comes to is healt care. How is it Even IT comes to birth and cost?

 

[ultrarunner]

Unless the practice is cash and sees no medicare patients the rules are quite precise when it comes to reimbursements.

ICD 10 is the latest for coding as each procedure must be coded to submit... even after received payment... any funds disbursed are subject to review.

HIPAA requirements medical records and protected information... and older systems were deemed a security risk so everyone was required to upgrade and for a sole practitioner all the costs fall to that single individual.

In other words they could have a fully paid for office system with costly software that by a date certain was no longer compliant... one of our Docs had to buy 5 new computers with medical software, etc... and he is a sole practitioner.

There are still a few specialties that have avoided the government requirements... mostly high end plastic surgeons that specialize in cash pay cosmetic cases...

Billing is wacky for lack of a better term... there are billed charges and approved charges... and quite a few Doctors have refused to add new medicare patients because the cost of providing service is more than reimbursement...

How it works in a Hospital setting is medicaid patients will be woven into the surgical schedule... in other words a Doc might have 5 procedures in a given day... and limit the medicaid or medical to 2 per day... economy of scale as the Doc and Anesthesiologist and Staff are already in place... where as coming in for just Medicaid Cases would not be worth it...

Some say the take over of Health Care is imminent... and that the Affordable Healthcare Act was a necessary step along the way...

Small examples of how costs rise... we have an outpatient surgical wing and I would turn back the HVAC over the weekend starting at noon Friday for a significant saving as we have many 100% outside air exchanges hourly and it is like cooling/heating your home with windows open...

A new requirement is to provide round the clock HVAC even if the area is not used... so my costs just increased proportionately for unused space...

Another is we have expertly maintained emergency power generators... as they should be... they are low hours and tested weekly... will provide 100% reliable back up power for many decades...

New rules say that we must replace/retrofit with new units because of new Diesel Emission requirements... no small task and costly and keep in mind they are emergency back up and not subject to hours daily or even weekly...

A huge one for my region and quite sensible on many levels is mandatory phase out of non seismic complaint hospitals buildings... many are not old and the are well built but do not meet the latest codes... the cost of building a new Hospital and removing the old one is mind boggling... so we are actually loosing beds as older facilities are shuttered with no new facilities or ones with less beds being built...

Even with the new codes there are no guarantees... it could be an earthquake like no other.

Many of the kids of our Docs go into business... tech and a surprising number into Real Estate... our Chief of Staff had mentioned his 29 year old son made more than are Chief of Staff brokering Real Estate... no staff to speak of... almost no oversight or auditors compared to medicine... it is not life or death... etc... said his boy could do anything with that brilliant mind and our Chief of Staff couldn't be more happy for him...

 

[PossumHound]

Just to give some perspective on how much things have changed since Medicare and insurances took over the payment for medical services, check out this actual bill from 1953 for an uncomplicated baby delivery:

 

[ultrarunner]

Just to give some perspective on how much things have changed since Medicare and insurances took over the payment for medical services, check out this actual bill from 1953 for an uncomplicated baby delivery:

Yep... and exactly to my point... the best and most affordable hospitals were often those associated with religious groups and sadly mandates have forced many out... especially in California.

Here is link at what Alta Bates charged in 1948 for labor and delivery... and it is one of the Hospital slated to close due to new earthquake code.

Ah, the carefree days of childbirth: $18.36 bill from 1948

 

[Luke'sScreenName]

What outcomes are you talking about? I had outpatient hip surgery and was back to work in 2 weeks. To me that is a great outcome. Could I expect the same outcome in another first world country? I'm not trying to be a smart azz. Just asking for clarification.

I'm glad you had a good outcome but I think you can probably see that your individual, one-time, experience is not a reliable way to measure a healthcare system of several hundred million people. You make population level judgments from population level data.

I am an informed consumer and health care professional, not a politician or policy maker/expert. Here's some non-challenged statistics.

This thread is on cost so lets start there:
Per capita the US spends almost twice what THE NEXT HIGHEST country spends! Wow. We should have the best health care in the world.

We have the 31st highest life expectancy (Cuba is #32). Our infant death rate fits in better with third world countries than other first world nations (truly frightening). Maternal morality too. Hospital readmissions, infections after surgery, unnecessary procedures are all very poor. Outcomes for many cancer treatments too. There is more. Again, I am not an expert but I am knowledgeable.

The World Health Organization ranks the US healthcare system as #37 in the world (Canada is #30).

I know people like Two Bit will nit pick something I've written to try and discredit the overall argument but there is a huge amount of evidence that we do not get what we pay for.

From what I can tell, it is primarily the insurance, drug, durable goods, and administrative support companies who are really profiting from our incredibly inefficient system.
:2cents:

 

[ultrarunner]

One of the studies cite a huge contributing factor to the cost of Health Care is the high use of ER compared to others...

It could be waiting until a problem becomes acute or using the ER for convenience for every little thing.

My Doctor friends in Europe cannot fathom the Liability Premiums their California counter parts pay... it is beyond comprehension to them... so that is one huge cost.

 

[milkman]

Hey, from '43 to '52, the total cost of delivery for my four sisters and one brother was exactly 1 country ham per kid. The last three brothers were born in hospital, don't know what that cost.

 

[k0ua]

One of the studies cite a huge contributing factor to the cost of Health Care is the high use of ER compared to others...

It could be waiting until a problem becomes acute or using the ER for convenience for every little thing.

My Doctor friends in Europe cannot fathom the Liability Premiums their California counter parts pay... it is beyond comprehension to them... so that is one huge cost.

You have hit upon one of our problems. Until we have Tort reform in this country (which will never happen), we will never be able to control medical costs. The many other items you mentioned all factor in as well.

 

[PILOON]

I know a few MDs that have weighed the pros and cons of Canada vs USA practice.
The US MD earns piles more that the Cdn MD (like 2x-3x) but the malpractice premiums take the net earnings down below a Canadian MDs take consequently not many leave for the US.

Older MDs welcomed the current Canadian MEDICARE scheme because it meant that EVERY procedure would be reimbursed while B4 they had to overcharge some to compensate for the deadbeats or simply poor ones.

Another point is upon admission in a Canadian hospital patients have to sign a waiver otherwise no treatment.
Suing the gov't medicare system, I suspect, would be quite a challenge.