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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.? "
We have a medical-industrial complex. Money's gotta flow.
Fuck systemd. Fuck Redhat. Fuck Soylent, too. Wait, scratch the last one.
all goes to someone's profit, not someone's care.
75% of money spent on health care in the U.S. is for self-inflicted diseases or the consequences thereof. That might be a good place to start looking.
I'm not saying that people that need dialysis or bypass surgery shouldn't be helped; I'm saying we should be spending money on ways to help them not get there in the first place.
The answer is no. Next question?
I don't have a sig.
5% of the population (15 million people) account for 50% ($1 trillion) in spending.
http://www.ahrq.gov/research/ria19/expendria.htm
Or perhaps you aren't an American.
Still #1 -- Lonely Gay Geek
The last months of a persons life are overwhelmingly the most expensive, but the outcomes are predicable. There was a great article in the WSJ on this called Why Doctors Die Differently - http://online.wsj.com/article/SB10001424052970203918304577243321242833962.html . The basic point is that doctors understand death, and when their condition makes death inevitable. They almost always opt for more life in their years than more years in their life. From a healthcare point of view, doctors have much less expensive end-of-life care.
Food-safe plastics do exist. I cannot say whether this particular plastic used was food-safe or not, but its at least possible.
There's nothing wrong with living under a rock. It's energy efficient, quiet and affordable. And, no unwanted guests.
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.
Hi grub! You're back! We missed you!
Unfortunately, this time you're more correct than insane. (We won't talk about the adjustments - those should be done with a framing hammer for most people).
The little article quoted to support the argument that 'more spending is better healthcare' is illustrative.
mortality rate was 12.7% vs 12.8% for AMI, 10.2% vs 12.4% for CHF, 7.7% vs 9.7% for hip fracture, and 3.3% vs 3.9% for CHF
Note those big differences folks. Right down there in the noise floor.
In the US we spend WAY too much doing things to people that gives very little benefit to them. The major culprit is the 'free market' system where profit (at multiple levels) is considered the appropriate metric. Although everyone and their little sister will go on about how 'patient care is first', everyone in the system realizes that this is just a sop to the weak of mind.
It's been an interesting experiment, but the results are all too clear. Going to be a bit longer before the folks who stand to benefit from this mess get forced to clean it up (just like a couple of other industries, isn't it?).
Faster! Faster! Faster would be better!
... for the US having a government not basing its policies on adages, witticisms and one-liners.
You sure about that bro?
Are you now, or have you ever been, a member of the Communist Party?
An enigma, wrapped in a riddle, shrouded in bacon and cheese
The purpose of the US health care system is to provide return on capital, it does that very well, what's the problem ?
That IS the problem.
Someone has to be severely messed up in the wetware to think that a "moral society" and a capitalist approach to the easing and comfort of human suffering are compatible concepts.
What are we doing different in the U.S.?
We're throwing our money at CEOs the same way school girls throw wet panties at Justin Bieber at concerts. Next question.
#fuckbeta #iamslashdot #dicemustdie
Depends on the plastic. Some are tested pretty carefully and have various certifications.
Of course you could take the word of internet chain letters over the Harvard Medical School.
http://www.health.harvard.edu/healthbeat/HEALTHbeat_081606.htm
It's your choice as to whether or not you want to behave rationally.
this was raw pork covered with what looked like saran wrap and tied with kitchen string outside the plastic and the instructions were to cook it in the oven with the plastic on
What do health care costs, housing costs (pre-bubble bursting), and college tuition costs all have in common?
1) They all have risen much faster than inflation.
2) They are all subsidized by government.
If you hide the cost of a good from people via the tax code and you subsidize the good, you will get no mechanism to control costs. The tax code hides the cost of insurance since employees don't see or feel the employer's payment.
Oddly enough Lasik surgeries haven't gone up in price. It isn't covered by insurance.
Granted, there's a lot more nuance and information to bear on this topic. But it is a dynamic that can't be ignored. If you hide the price from someone, costs will go up. Unless you want to ration. Which when the HMOs tried to do it in the 1990s was about as popular as a skunk crashing a party.
Except for ending slavery, the Nazis, communism, & securing American independence, war has never solved anything.
It is really disturbing how ready today's generation is to ship grandpa to a nursing home. What happened to family taking care of their own? Dying in bed, surrounded by your loved ones? Or just plain not spending the last decade of your life abandoned in abject loneliness. If only you had enough compassion and gratitude to your parents to take care of them in their old age as they took care of you in your youth. You know it's the right thing to do. It's even in the ten commandments.
http://www.businessweek.com/magazine/content/10_11/b4170032321836.htm
This is something of a counterpoint. Amanda Bennett wrote an article about her husband's death. He had cancer and was expected to live a year or 2 more. Aggressive, and expense, treatment, meant that he live for 7 more - some of them good - some of them bad. So he beat the odds and thus can be considered a success. On the other hand, Bennett tries to weigh the cost of treatment, quality of life, and how the health care system should be structured. She does not come to concise answer, but she writes very well about the struggle.
That's what is happening with my grandma, unfortunately. Probably Alzheimer's in her case. Whatever the case, her mind is almost gone. She requires a full time care taker at home now, and before long will need to move to a complete managed care facility. Fortunately she's got the money, it is no problem. However it is going to cost a boatload of money, particularly since other than that she's in pretty good health for a 85 year old. She could live 5 more years (maybe more).
So what do you do in cases like that? I mean the perfect answer is to find a cure for dementia but it isn't like we can just snap our fingers. For now we have to deal with it. The only cheap solution is basically to just ignore people with it and let them die a horrible death. If you want to be civilized about it you have to care for them and it is damn expensive.
These are new problems on the scale we face now. People didn't used to live long enough on average for this to happen a lot. Now, instead of just dying fairly quick, many people have a downward slide that can last a long time. That is damn expensive and not a situation where yo can "Just pull the plug," unless by that you mean "Ignore the person and let them die of starvation."
That doesn't sound like a problem. If I need healthcare, I don't want to be sold on more expensive procedures or extra procedures. I want what is necessary.
there needs to be a top to bottom evaluation of the entire medical system.
And, of course, that won't ever happen. This country can't even come to grips with simple things like Daylight Savings Time. Rejiggering a quarter of the economy at one time?
Coding for diseases and symptoms in the US is done with a system called the ICD-9 (International Classification of Diseases, version 9). This was codified in the 1980s (the ICD has been going on since around 1900). This was superceeded by the ICD-10 in 1992 and is now used in every country except the US (and I think North Korea). It's just a database. We can't even get ourselves arsed to upgrade a bunch of tables, much less completely reframe how health care delivery is done.
We're doomed.
Faster! Faster! Faster would be better!
1) Mortality rate != quality of life. My "health care" is about the latter, while the former also plays a role.
2) Insurance Scheme != Free Market. If you went to an old lady and said you can either have the $90,000 that a hip replacement costs, or you can get the replacement, THAT is free market. People would be more diligent about the VALUE of their treatment. Can $90K buy more quality of life than the replacement? I suppose that depends on the situation, but at least the person getting the treatment could actually have "informed consent"!
The states with some of the lowest Health Care spending (compared to other US states) have the best outcomes. You look at a state like Minnesota which is highly regulated, mandates Health Insurance Companies are not for profit and allows "never pay events" (medical mistakes neither the patient nor insurance company have to pay) and they have some of the best outcomes.
I'd also point out that high medical costs are often attributed to lawsuits. I would point out that Texas passed Tort reform a long time ago and the highest cost counties in the US are in Texas.
Bottom line, you want lower cost health care you restrict profiteering and you don't reward bad behaviors by doctors or insurance companies.
If your only motivator to go into medicine is to make money, then you have no business being an MD. Medical professionals should a.) recieve *adequate* compensation for their skills (likely resulting in a middle to upper middle class income, depending on their job and capabilities), and b.) should not be charged ridiculous amounts of money up front for their education. Unfortunately, since we do not properly socialize health or higher education in the US, we have a feedback loop which incentivizes all the wrong things.
> In the US we spend WAY too much doing things to people that gives very little benefit to them. The major
> culprit is the 'free market' system where profit (at multiple levels) is considered the appropriate metric.
How exactly is our healthcare anything like free market? Do you get any real choice in provider? Do you know the prices? Do you evaluate cost vs. benefit before buying the service? Does anyone even perceive healthcare as buying a service?
The reason we have this problem is precisely because healthcare isn't a free market. People see things as being "free" (and will complain bitterly if they're not), and never bother to ask whether or not dropping $10+k on a pointless treatment really matters. (Hell, half the time it's difficult to impossible to figure out what the cost is anyway. Good luck getting a straight answer on that, when the quoted "price" is 4x what would be normally be paid by a healthcare provider.) If there's no cost, there's no competition and no cost-benefit analysis.
When it comes down to it, even thought the service is technically provided by the private sector, the only choice you have in it is, essentially, who your employer is (to the extent you can call that a choice). Even in an illegal conspiratorial oligopoly you can at least pick your poison. As it is you pretty much get what get and nothing if you don't want it (but you'll still be paying for it anyways). If that's a free market then so was communist Russia.
The difference these days is dementia. I can speak from experience that it is far easier to care for a terminally ill family member without any mental incapacity than with. With people living longer, there is far greater rate of dementia among our old and ill. And to watch someone you have known and loved fade away from you is heartbreaking.
On a more selfish level, just having someone show appreciation for your care is also very important, and caring for someone that doesn't know you any more can be hard.
This question is irrelevant. The real question is: should people be able to spend their money in any way they chose, even if what they spend it on is pointless. If you think that we should be living in a free society then yes, people should be able to spend their money on a $100k cancer treatment that only has a 5% chance of giving them another year to live. It's their money.
Healthcare costs are skyrocketing for a few very simple reasons:
1. a terrible patent system that gives companies exclusive rights to certain drugs, chemicals and procedures when often that company did little to develop what they patented.
2. a terrible legal oversight system in which these same companies can hide flaws in their drug/device until the patent is about to expire, then leak the information, get the drug/device banned and immediately release an alternative under a new patent, there-by allowing them to extend their patents almost forever.
3. The marriage of the insurance and medical industries via the HMO/PPO networks. Now the doctors basically work for the insurer. The insurer demands test after test, sending the patient back and forth between doctors and specialists so they can collect as many co-pays as possible before treating. Closed Pharmacy plans force patients to buy from the HMOs pharmacy which conveniently does not carry many alternative drugs, and the patients are forced into buying drugs with a high co-pay or buying outside the network which, again, comes with a high co-pay.
4. Add all of the above to the simple fact that it's human nature to want to live forever. They have what you need to live, they are the only ones allowed to sell it to you by law. They control the means to get it, the amount you can get, when you can get it and the price. That right there is the ultimate situation to ensure price gouging.
I've not seen a single point I've made above addressed by congress. The simple fact is they are in the pocket of the healthcare industry, any plan that our government has regarding healthcare you can be sure will do nothing but make it even more profitable for the industry.
What happened to family taking care of their own?
You need a house with an extra bedroom.
Someone at home around the clock.
So...you need a single income family in a house with extra rooms... In an age of dual income families who both have to work just to afford living in a small condo.
Living in Canada, I can tell you - our healthcare system SUCKS. Have a broken arm? Go to the emergency room and sit there for 4 to 6 hours for someone to attend to you...
The exact same thing happens in the US (triage is triage, after all), and then you get a $3000 bill in the mail.
Sounds great, right?
With the first link, the chain is forged.
Still want to put that $90k under her nose and offer to have her sign her death certificate to get it? No, I didn't think so.
While I don't think that's the best solution, I think it's much more equitable than what we have today. As long as she is informed of all the ramifications.
No one that has any training in chemistry will seriously suggest that you actually heat plastic together with your food.
Had that fight with the spouse for years before the whole BPA thing hit the news.
The risks are far too great if your wrong and the benefits are far too trivial even if you're right.
A Pirate and a Puritan look the same on a balance sheet.
The reason we have this problem is precisely because healthcare isn't a free market
OK. You seem convinced of this position, and I'm genuinely curious. Can you give an example of a country where there exists a genuine free market in health care, that achieves better health results than the USA does? There are roughtly 200 countries to pick from, and I know some have neither socialized medicine nor insurance systems, so throw me an example please.
In this particular case he needed round-the-clock care which could not be provided in our home. He had a serious brain injury which left him totally incapacitated (as I mentioned in my original post).
He had to have a foley inserted for urine collection which he would routinely remove himself, he wore a diaper for feces, for a short while when he was first admitted he had a feeding tube. He needed to be moved frequently to avoid bedsores. He had to undergo physical therapy regularly.
Yeah, my parents could have added an addition on to the house and made it handicapped accessible. They should have brought in a team of nurses to tend to him round-the-clock in our home. My father could have quit his head-of-household wage-earning job while I was in college (I was on an athletic scholarship but still had expenses) in order to help care for him.
Unfortunately, in this instance, the best option both for my grandfather's quality of life and my parents' was to keep him in a nursing home instead.
YMMV.
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.
The closest thing you will get to a free market in health care was the in the U.S...a long time ago. Don't confuse old technology with old policy when comparing the two by saying "we'll go back to using leaches". I believe the first major change to this was in 1973. The GP is completely correct in that the major problem in health care today is that people don't pay directly. There are proxies and no one knows the price.
If gas prices were hidden and the government (or insurance company) paid for them, people would drive all over the place without care. Demand for gas would go up and prices would go up. No one would challenge the price change because they don't even realize it and accept it as "normal".
The reason we have this problem is precisely because healthcare isn't a free market.
I'm not a total free-marketer, but I have to agree at least this far: the problem is that we have built a system that is neither a free market nor a socialist system, but instead borrows from the worst qualities of both.
Most people don't have a choice in healthcare nor do they have a clear idea of what costs they're paying, or what costs they would be expected to pay if they faced an emergency. Health insurance has been heavily subsidized by the federal government for decades. On the other hand, it isn't regulated very well, the costs aren't made transparent, and it's run as a for-profit venture. You basically have a subsidized government monopoly without serious regulation or even the supposed motive of helping people.
In my view, we should basically pick one road or the other. The way we have things set up right now is just corporate welfare, but nobody really wants to end it. Conservatives like corporate welfare because their economic theory boils down to "give rich people more money, and they'll fix everything." Liberals want the socialized system but want to hide behind some free-market trappings.
Exactly. Insurance disconnects market forces that would otherwise put downward pressure on price and consumption of services.
Here's a personal example:
During a recent visit to the dermatologist, he casually says he's sending me down to get some blood drawn to run some tests. The nurse takes my blood, and I go home. Three weeks later, I get the bill, for over $1,670 for the "labs." If I had known, that was how much they were going to charge, I would have never allowed them to draw my blood. And this is the problem.
They compel you to consume a service, without ever knowing the price before you as a consumer are allowed to make the purchasing decision. No ability to shop around, or incentive for competition on price. And you are legally obligated to owe the debt, before even knowing what it will cost you. They just send you the bill for whatever amount they want weeks later. Talk about a business model.
Dude,
Everybody benefits from ridiculous quoted prices. The hospital increases prices 10%. The insurance company negotiator negotiates some of that price increase away. Because the discount for his company is now 55% of list price, rather then 50%, he gets a bonus. The hospital gets a) 5% more profits for no extra work, or b) 5% more to waste on sexy prestige-bringing, low-revenue crap like brain surgeons; so their executives get a bonus. The insurer can jack up premiums and 'prove' they're justified to the Insurance Commissioner because they're paying more for the same medical care, so that guy gets a bonus...
And the people who end up paying for the jacked-up rices, and executive bonuses, don't notice because their health insurance is a "fringe benefit." The bad guy to them isn't the health system, it's their boss who had to gut the budget for raises this year to keep their health plan.
You think all the pharma companies do it because they care, deep down?
That statement is silly. Whatever motivates people to provide good health care of another is fact.
It doesn't matter if you don't like why. When you dive in the psyche for a lot of people, regardless if they're doing something nice or not, often when you find their reasons for doing so, you won't like it.
Ideally, sure it would be nice if people's motivation was simply 'to be better and care for others as a human being'. Wake up, we're not in a fantasy world.
What makes you think greedy doctors provide good health care? I can't speak for every field, but as a software developer I can tell you that 95% of the devs I worked with that didn't like coding were also not good at coding. I have to imagine it's the same way with every profession, including medicine.
But if that's the case, then one of the many many countries with no socilization of their health care system at all ought to have better outcomes than the US. So show me one.
Here, I'll even do a little of the legwork. The World Health Organization ranked countries by healthcare efficency here. The USA ranked 37th (of about 190). So if the real culprit, as you folks are claiming, is how "free market" the system is, then which of those 36 more efficient countries has a free-er healthcare market than us?
Except until that young person get's an expensive illness or has an accident. Then they are in a position of being destroyed financially. That's how ALL insurance works. You aren't supposed to get the same amount out that you put in. You pay insurance because you generally can't afford the worst case scenario.
Just who are you to determine how much someone should get paid for whatever job they take? I'd like to know what job you have and how much you get paid and let me see what you own, I'll also decide what you do and do not need to live a life of such means to match your skills.
Well, I'm a federal employee, FV-I, making the minimum for my pay band ($68k/year), working as a lead developer and project manager. Go look it up if you care, since my income is a matter of public record. I work to support myself and my family, but I could make a *lot* more at one of the local oil companies, assuming I was willing to vote how I'm told, participate in employee prayer sessions, and never, ever say anything disparaging about the state of our energy system in this country.
If you want to know how much a federal MD makes, they usually get hired on here as FV-L or FV-M, which starts around $120k and tops around $170k. Apparently you think that's grossly unfair, but I think that's a reasonable salary for the field, and quite a bit more than you can make anywhere else with the same level of difficulty.
"The same group of researchers conducted a similar study of the US health care system about 10 years ago, and the findings were quite the opposite of the 2012 Ontario-based study."
Using different studies that may have used different criteria and were 10 years apart is not a good way to compare health systems. Unless they were designed to compare the same metrics in the same period, this data should be taken with a grain of salt.
That said, i think it is good that this kind of comparative study is being discussed. Considering that a large part of our GDP is being spent on health care, either by insurance or taxes, we should definitely be looking at what works and what does not.
Unfortunately, in my opinion it is the national culture here in the US that drives the cost up. Examples:
Primary physicians in the US are underpaid only in comparison to specialty physicians. They are paid more than primary care physicians in other countires and much more than the average citizen with equivalent education.
Laws are structured to uphold patents and contracts that do not benefit the general populace.
A substantial portion of the populace is happily inflicting diabetes, heart disease, and drug addiction (alcohol and tobacco, etc) upon themselves and anyone that tells them different are tree-hugging hippies.
Doctors and executives are technophiles who will spend millions of dollars on the newest equipment.
oldhack: "Security is a waste of money until shit hits the fan. 5 minutes later, it becomes waste of money again. "
Actually - making money should be your ONLY motivator in being a doctor.
If you want to save people, go be a minister.
I'm really glad you're not my doctor. Who knows what kind of ineffective, overly expensive treatment you'd recommend just to line your pockets.
Living in Canada, I can tell that you have zero experience with a health care system outside of our own.
Yeah, it's crummy. I've been hit by two cars in my life, and I've spent my time in my share of emergency rooms while bleeding and hurt. But once I left the emergency room, I didn't pay for any of the care I received. And, on the grand scale, it wasn't so bad.
I remember sitting in the waiting area, and one of the hospital volunteers came around to talk to me. He asked if he could get me anything, and apologised for the wait (I was obviously pretty badly hurt; I ended up with 23 stitches in my lip to effectively sew a chunk of it back on, and two broken teeth). I told him it wasn't so bad, since there were people literally dying while I waited. I saw families walking out of private rooms crying.
But that's triage. My injuries weren't life threatening, no matter how uncomfortable they were. If you've broken your arm and you're not going to bleed out, sit down, shut up, and cope. The reason why nobody is currently helping you is because there are other emergencies that need to be taken care of in advance of your concerns. They'll get to you when they can.
And you still won't have a bill to pay when you leave.
Sorry, but I couldn't find any comprehensive statistics that made a valid comparison.
First, the chunk is too big: There is no valid way to statistically say that money is evenly distributed among health providers and/or patients.
Second, in order too be valid, we would need a large sample of all medical services and statistics comparing similar ailments, the cost of treating each ailment, and the outcome. As far as I can tell, vaccinations have the only well-defined statistical data, and even that is controversial in some areas.
Ask a better question.
"The mind works quicker than you think!"