Hacker News Reader

Comment by click170 | Hacker News Reader

This is maybe a little bit off topic, but I am glad to see that Doctors on Demand would be doing general medical house calls in the US. This seems like a good idea, I hope it spreads.

I don't live in the US myself, but I've always wondered why doctors doing house calls was a UK thing but wasn't a North American thing, even in Canada.

Are there real obstacles preventing doctors from making house calls in the US, or is it just tradition to "go see your doctor" instead of them coming to see you?

View on HN

I've never heard of house calls in Scandinavia either, unless it's strictly necessary (immobile elderly patient, etc.). It takes more of the doctor's time, therefore is more expensive, and generally we don't want medical care to get more expensive when it's possible to avoid it. For example a typical GP in Denmark sees 6 patients per hour, which seems difficult to do with house visits unless the patients live in the same building or something.

In Finland, at least in Helsinki, they have a "home hospital" system (http://www.hel.fi/www/Helsinki/en/socia-health/health/hospit...) for "patients who do not need the services of emergency units or specialist care". In case the patient is "healthy" enough to go home and has somebody to look after him there, they arrange for a nurse to visit e.g. even four times per day, to give meds, provide IV, and even take blood tests. Also sometimes a doctor visits the patient, though not as often as the nurses. Staying at the hospital is very expensive (for the country), so I have heard that the outpatient care ends up being cheaper.

Lets say a doctor charges $1,000/hour and each trip takes 20 minutes, plus 10 mintues to egress a building and parking garage/pick up a taxi. The overhead for a single visit is...$1,000 give or take...

You can adjust the numbers around a bit but the point remains the same unless you radically change the transit time and the wage by a factor of 10.

No GP is making $1k/hour.

Swap in any number that you think is reasonable. The reasoning and conclusion is the same.

You said it'd have to change by a factor of 10, but your estimation of a GP's salary is off by at least a factor of 10 - $100/hour would be a much more reasonable estimate. A bit high, even. http://www.bls.gov/oes/current/oes291062.htm

It still halves the efficiency of a critical, expensive workforce that is already in high demand.

The number doesn't matter - it's still suggesting that it's feasible for doctors to be half as productive as their potential. That seems absurd to me.

This makes the assumption that home visits are the same level of productivity as office visits. For the elderly, infirm, those who work during normal doctors' office hours, etc., home visits might reach a population that isn't getting good care currently.

Couldn't the price of a house call just be increased to account for this?

Or rather, a health care system where visiting a doctor is free, but house calls are only included in the health care plan if your have a disability that restricts your movement, allowing you to pay for house calls out of pocket if you chose to.

Reply on news.ycombinator.com