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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.
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
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!
Yes, but if there is a profit, it's not going to care for someone, it's lining someone's pocket.
Plus the mechanism you use to gather the profit is horrendously inefficient - for that 15% margin you are essentially doubling your costs by paying for all the insurance bureaucracy on one side and the bureaucracy on the healthcare side designed to interface with it.
The USA pays double per capita what it's next nearest neighbour among the G8 nations spends on healthcare, for comparable outcomes.
... 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
What if spending money isn't the answer? What if the answer deals more with a change in social values?
Do you know how you change social values, especially regarding health? You spend money on health programs and preventative care. If people only go to the doctor when they have a serious illness, then only serious illness will be treated and preventative care will be ignored. Make care free or close to it then spend on getting people to care about health. It will save money in the long run.
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.
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.
Citation please. Those are numbers pulled out of various nether regions. Yes, people can do much for themselves to decrease / delay morbidity (not mortality so much). And yes, we should encourage and teach people to watch their weight, not smoke, drink alcohol in vast moderation, do yoga, clean their rooms and brush their teeth twice daily (floss once) but health care still is going to cost quite a bit of money - maybe more as the number of frail elderly that need increasing care climbs dramatically.
Remember, one entertaining factoid in all of this - with all the 'bad things' we're doing (pollution / plastics / obesity / diabetes / whatever disease is popular this month) the average longevity of the population is slowly and steadily INCREASING. Now most of us think that's a good thing. Not many want to go back to the pre medical days of a 35 year average longevity, but it does have it's consequences....
Faster! Faster! Faster would be better!
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."
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"!
> 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.
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 $3000 bill in the mail.
Sounds great, right?
With the first link, the chain is forged.
That's a rather accurate and complete description.
I only have a couple things to add.
The quoted price is what you risk paying if you don't have insurance. So a high quoted price is something good for the insurer as it will scare you into buying their overpriced services.
Some insurers might pay more than others for the same service, so one could think they would want to reduce the "quoted price" so they all benefit by paying less. But I am more and more convinced they actually benefit too much from the absence of reasonable public prices and therefore are trying to keep the non-transparent pricing in place.
I am not familiar with many drugs, but the few I know make it clear that your insurer doesn't care about getting you a good price for drugs. The copay of drugs can be 2 to 3 times more than the list price or quoted price of the same drug in France (whereas food, clothing, gas and many other commodities are rather cheaper in the US). This is a clear indication that the insurance company acts like a broker that helps you buy services but it actually doesn't care if you get ripped off. The only meaningful difference is that in France, the insurance company negotiates the list price down. So everybody, even those who don't have insurance benefit from the negotiation.
If we were able to switch insurance providers easily, we would be able to choose the best brokers and also the best coverage. The only issue is that you don't want freeloaders in the system, so you need a minimum level of coverage that people must get. Otherwise they can just go with a dummy insurance for 2$ 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 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.