Hacker News Reader

Comment by rogerbinns | Hacker News Reader

The US healthcare "market" is completely distorted ranging from no one having any idea what anything actually costs, multiple layers of disintermediation from consumers to payments, a doctor's cartel that keeps numbers low thereby increasing compensation, but giving an incentive to replace them, income not based on outcomes, the government spending ~50% of all healthcare money but everyone ignoring it, and the list goes on.

Atul Gawande's articles in the New Yorker are fascinating insight into how things really work - full list at http://www.newyorker.com/magazine/bios/atul_gawande/search?c...

Some highlights:

Reliably delivering care (and cheaper) http://www.newyorker.com/reporting/2012/08/13/120813fa_fact_...

Pit crews http://www.newyorker.com/online/blogs/newsdesk/2011/05/atul-...

Hot spots http://www.newyorker.com/reporting/2011/01/24/110124fa_fact_...

Costs http://www.newyorker.com/online/blogs/newsdesk/2010/12/the-c...

View on HN

Hey man!

You forgot the fact that despite the push to fix insurance, the price of pharmaceuticals won't be pushed down anytime soon. Since the cost of health care has much more to do with the drugs than what hospitals/doctors charge, but nobody likes it when that is mentioned.

http://www.nytimes.com/2009/08/08/us/08lobby.html

If anybody can find a relatively recent estimation of how much our medicare obligation is pharmaceutical spending, I'd love to see it.

According to [1] we spend only 16% on drugs and devices. Maybe they didn't include meds you get at a hospital but still it seem that medical services take a big share of the cost.

Also, assuming technology can give better treatments , it can lower the drugs needed and their costs.

[1]http://www.examiner.com/article/health-care-reform-historica...

Pharmaceuticals represent approximately 10% of total health care expenditures versus hospital, physician and clinical services representing approximately 51% of total health care expenditures (for the latest estimated year of spending, 2010) [1].

Within Medicare, prescription drugs account for 11% of total Medicare expenditures and are projected to be 13.5% of total expenditures by 2021 [1].

Further, the prescription drug benefit ("Part D") has cost about 30% less than estimated by the CBO when the Medicare Modernization Act was passed (2003) [2]. This is due to a variety of factors, but a huge one has been lower-than-expected growth rates in per capita spending on prescription drugs, estimated at 4% per year since 2006 [2], much lower than overall growth in health spending.

[1] http://www.cms.gov/Research-Statistics-Data-and-Systems/Stat...

[2] http://www.kff.org/medicare/upload/8308.pdf

One thing I've been thinking of lately is whether there are technologies that could fundamentally change the incentive structure of the US healthcare market to be more in line with patient interests. Are there technologies or attitudes or approaches that could make feasible new business models that would accomplish such a change?

I don't know, but it's something that's been on my mind.

studying the process that resulted in https://questions.cms.gov could give you some insight into what makes up the health care costs of today. Lookup coding for a first look at why things are the way they are.

It isn't just individual patient interests but rather everyone. For example providing sporting facilities at schools and exercise/active activity facilities for everyone would do a lot to improve overall group health. Making cities more walkable would do a lot too.

But right now my primary care doctor (who is most valuable to me) gets paid zero when I am healthy and more the more tests and procedures she does. Other specialists only get paid when I am referred to them. Drug manufacturers only get paid when their items are prescribed. Essentially compensation is based on consumption not on wellbeing which is why the system is so messed up.

The US market definitely needs to be split into two. A baseline coverage that is based on wellbeing, effectiveness and does take price into account, done by the government available to all residents. It is easiest to gather the money via taxes (which already happens to a large degree) and to provide the actual care via combinations of government employees/facilities and contractors. And a top up private system where the people who want to pay for or provide gold plated coverage and procedures can do so (in addition to the base).

Most countries have different systems which amounts to running experiments in effectiveness and efficient. Heck worst case just do what the French do http://en.wikipedia.org/wiki/Health_care_in_France

Your primary care doctor does not get paid for tests and procedures. Labs and specialists do.

Are there technologies that give advantages to large groups of doctors over small clinics or make it preferable to doctors to create large groups ? Large groups have access to a large pool of customers so they can offer different business models.

Are there technologies that enable medical "self-service" or less dependance on doctors ?

I think medicare has started a "fee for package" program(instead of paying for services, you pay for a complete treatment around a single medical event - let's say knee surgery + including all services - for a single fee). Are there technologies that can help such implementations ?

Are there any technologies that can help places more receptive to medical change(like africa[1])? with time the experience gained there could be integrated in other places.

How can you make medical tourism a more popular choice or better choice? if it would be popular , more insurance companies would offer it and would pressure the medical establishment for improvement.

Reply on news.ycombinator.com