Slashdot Mirror


Does Higher Health Care Spending Lead To Better Patient Outcomes?

First time accepted submitter ericjones12398 writes "If you haven't seen the words 'health care' in news headlines lately, you must be living under a rock. What seems most controversial among the latest research and news is a flawed payment scale that undervalues primary care and overvalues specialty care. There is evidence suggesting that publicly funded health care spending (i.e., Medicare) has not been based on primary health care needs. Rather, In the U.S. Medicare spending relies on a resource-based relative value scale (RBRVS) which seems to promote higher spending without evidence of better patient outcomes. A study comparing spending and mortality rates in Ontario had the opposite findings however, supporting a link between higher spending and better outcomes for patients. What are we doing different in the U.S.? "

9 of 504 comments (clear)

  1. We all know why by oldhack · · Score: 5, Insightful

    We have a medical-industrial complex. Money's gotta flow.

    --
    Fuck systemd. Fuck Redhat. Fuck Soylent, too. Wait, scratch the last one.
    1. Re:We all know why by vlm · · Score: 5, Insightful

      When you spend someone elses money on someone else ... you have no incentive to care about cost or benefit.

      Ah but we're talking about medical care here, and only a microscopic minority of freaks enjoy pain.

      As a thought experiment, put out a sign offering "free" root canals. Yes, yes for about a week you'll get a huge backlog of uninsured people with horrific dental pain who could not get any care before and now will joyously sign up for your free root canal. Once you work thru the backlog, the only people voluntarily going to your free-root-canal office are the same tiny fraction of people who really need one, and a couple of freaks with whip lashes and rope burns all other their bodies who do it for the pain. The price of a root canal seems to have very little correlation with the desire of the population for a root canal.

      I'm thinking the market for prostate exams, mammograms, broken bone casts is kind of the same.

      It's a completely different market from offering, say, free "adult" non-therapeutic massages, or free pr0n pixs, or free movies/music/tv, or addictive drugs, where demand is basically infinite.

      Lets say you offered "free" atmospheric oxygen. Well, first I'd breathe deeply, for free, just because I can, but that would get boring real fast. Then I'd probably have a few bonfires in my backyard, since oxygen is free so why the heck not. Hell I'd probably get a pet cat that breathes "free" oxygen. But extremely rapidly the demand kinda levels off. I had "free" water and "free" heat at my bachelor pad apartment years ago, and there is no fundamental reason to waste it, so I didn't. How much water do you think I can drink per day, anyway?

      --
      "Science flies us to the moon. Religion flies us into buildings." - Victor Stenger
    2. Re:We all know why by Spad · · Score: 5, Insightful

      Just because the US healthcare system can offer a very high quality of care doesn't mean that it's any use to its citizens when the vast majority of them can't afford it.

      If you're fabulously wealthy then the US offers some of the best healthcare in the world, but if you're not, it's a disaster area.

    3. Re:We all know why by dave420 · · Score: 5, Insightful

      Because those countries care about preventative medicine, where doctors can help people without ever seeing them by giving them lots and lots of good advice and support tools (helplines, advertising campaigns, even the lowly pamphlet), which clearly wouldn't work in a place where doctors depend on patients for their income. Surely they make more money healing someone than preventing them getting sick. In UHC countries, exercise, smoking, diet, etc. are all priorities for the healthcare industry, as it saves them (and the taxpayers) money if the public is advised efficiently about various dangers in their lives.

  2. No by Cigarra · · Score: 5, Insightful

    The answer is no. Next question?

    --
    I don't have a sig.
  3. Break it down to the basics by thechemic · · Score: 5, Insightful

    The United States runs a "for profit" model. Canada runs a "for better society" model. In one model the fundamental design of one system dictates that consumers spend as much as possible and receive as little as possible. The fundamentals of the other design dictate that consumers all receive adequate care, and the only reason to spend more is to get more.

    --
    Let's make like a bird... and get the flock outta here.
    1. Re:Break it down to the basics by Anonymous Coward · · Score: 5, Insightful

      The biggest giveaway for me is that in most places in the US, medicine uses the Caduceus (commerce, trickery, and death) as its symbol; in the majority of the world, medicine uses the Rod of Aesculapius (healing and health) as its symbol.

    2. Re:Break it down to the basics by T.E.D. · · Score: 5, Insightful
      Well, actually the US has four different models that it uses simultaniously. I'll list them roughly in order of how "socalized" they are.
      1. Veteran's Aministration. This system is totally government-run. The hospitals and doctors are all on the government payroll.
      2. Medicare/Medicaid. The doctors and hospitals are paid based on services rendered, but the US Government is paying all (or nearly all) of the money. Essentially the US Government is acting like one really large insurance company, with your taxes being the premiums (even if you aren't covered). About 1/4th of US residents are under model 1 or 2.
      3. Private insurance. The doctors and hospitals are paid based on services rendered, but a private insurance company is paying a large portion (if you are lucky the lion's share) of the bill. They in turn get their money from whoever pays their premiums. If that is a company, they are passing the costs of this on to their customers, making them less competitive in a global marketplace that includes companies in other countries that don't have to do this. About 46% of US residents are under this model.
      4. "Free Market". This person has no coverage of any kind. They generally don't go to doctors, because almost none of them can afford it (if they could afford such things, they would have bought into option 3). If they get sick enough that it's obviously life-or-death, they go to the most expensive place in the system (an emergency room) where they have to be treated by law, and then generally don't pay because there's no way a typical person can pay a sudden ER bill in the 10's of thousands of dollars or more. So their treatment ends up being paid by users of option 2 or 3. More than a quarter of US residents are using this model, and the percentage is increasing every year.
  4. Re:"health care" = "disease management" by glop · · Score: 5, Insightful

    That's a rather accurate and complete description.
    I only have a couple things to add.

    The quoted price is what you risk paying if you don't have insurance. So a high quoted price is something good for the insurer as it will scare you into buying their overpriced services.
    Some insurers might pay more than others for the same service, so one could think they would want to reduce the "quoted price" so they all benefit by paying less. But I am more and more convinced they actually benefit too much from the absence of reasonable public prices and therefore are trying to keep the non-transparent pricing in place.

    I am not familiar with many drugs, but the few I know make it clear that your insurer doesn't care about getting you a good price for drugs. The copay of drugs can be 2 to 3 times more than the list price or quoted price of the same drug in France (whereas food, clothing, gas and many other commodities are rather cheaper in the US). This is a clear indication that the insurance company acts like a broker that helps you buy services but it actually doesn't care if you get ripped off. The only meaningful difference is that in France, the insurance company negotiates the list price down. So everybody, even those who don't have insurance benefit from the negotiation.

    If we were able to switch insurance providers easily, we would be able to choose the best brokers and also the best coverage. The only issue is that you don't want freeloaders in the system, so you need a minimum level of coverage that people must get. Otherwise they can just go with a dummy insurance for 2$ and then when they are sick they can just benefit from our humanity (i.e. we are human so we won't let them without care when they show up at the emergency room).

    Overall, healthcare is an issue that is both social and individual. Therefore it can't be simply handled by pure market or pure governmental solutions. But at least we should make sure we have working market components in the solution and working governmental components too.