The disability/chronic illness community has been pushing back against this idea for a long time. If you approach lowering costs with the assumption that people are getting "too much healthcare,"...
The disability/chronic illness community has been pushing back against this idea for a long time. If you approach lowering costs with the assumption that people are getting "too much healthcare," disabled and chronically ill people will be denied medically necessary tests and treatment in the name of cutting costs. Prior authorization, drug formularies, step programs - these methods all deny things that doctors think their patients need. And it happens both with private insurance and Medicaid/Medicare.
There's so much wasted time and resources in the current system. I have yearly MRIs for a genetic predisposition to breast cancer that will obviously never change. And yet every year I have to go through the prior authorization steps, which my insurance contracts out to another company. When I get approved, it's only valid for 30 days - if I'm unable to get my MRI in that time span, I have to get it approved again. Breast MRIs have to be done at a certain point in your period (if you menstruate) to decrease false positives, and when your cycle isn't regular it's very easy for approval to expire before the proper time.
I'm still at high risk for breast cancer after 31 days - why is there even a time limit at all? Why do I have to ask each year for permission to monitor for breast cancer, when my family's medical history and my literal DNA aren't going to change?
I also recently met my out-of-pocket maximum for my subsidized plan, but I had to keep paying for an MRI and doctor appointments. Why? Because the system hasn't updated. I'll just have to wait to see if I get a refund, or follow up with my providers in a month or two if I don't. More phone calls, more people wasting their time patching holes in a broken system.
It's perverse that anyone could ever have thought that overutilization of healthcare was driving up costs when underutilization is actually one of the key factors. Namely the way Americans, even...
It's perverse that anyone could ever have thought that overutilization of healthcare was driving up costs when underutilization is actually one of the key factors. Namely the way Americans, even insured Americans, will skip doctor's visits for small illnesses until they become big ones that are much more expensive to treat. Cancers that would've been caught in stage one or two get caught at stage three or four and necessitate a six figure crash treatment program.
Per the article, I suppose overutilization was just a convenient idea that didn't challenge anyone's assumptions, that came about at exactly the right time, and had only the minor defect of being dead wrong.
It's not perverse. The problem is thinking in binary terms where theories are entirely right or wrong, when they often get at one part of the problem. (The linked article is too binary as well,...
It's not perverse. The problem is thinking in binary terms where theories are entirely right or wrong, when they often get at one part of the problem. (The linked article is too binary as well, but I shared it because it has an interesting perspective.)
Health care is vast and complicated and none of us are in a position to observe what's going on everywhere else. There is more than one way to pad expenses. Atul Gawande's work seems well done and it appears there was a problem with overutilization in McAllen, Texas [1]. But apparently it doesn't generalize?
Technically this is called "external validity". You can do a study, and what it finds may be true where you did it, but it's not true elsewhere.
Yeah, healthcare is a complicated topic. I'm sure overutilization happens, at least occasionally, but I seriously doubt it compares to a deficiency in preventative medicine as a factor in why...
Yeah, healthcare is a complicated topic. I'm sure overutilization happens, at least occasionally, but I seriously doubt it compares to a deficiency in preventative medicine as a factor in why American healthcare is so expensive, and the attempt to solve the former problem exacerbated the latter.
But I honestly think that when you get right down to it, most of the million-and-one problems with the American healthcare system can be traced back to it being run for-profit, and our inability to deal with these problems is because politicians awash in lobbyist dollars are reluctant to do more than tinker around the edges of a fundamentally broken system. And I'm pretty sure that was the article's point as well; ending overutilization was pushed as a way of reducing healthcare costs regardless of its efficacy, because policy makers didn't want to admit to themselves or their constituents that the for-profit private insurance mode of healthcare was a disaster, and until we're willing to look at things from the funding side, similar policy mistakes are probably going to keep happening.
To be clear, there's two distinct kinds of over utilization: Unnecessary ordering of labs, tests, and other diagnostics. This is what has primarily been talked about in this thread. Insurance...
I'm sure overutilization happens, at least occasionally
To be clear, there's two distinct kinds of over utilization:
Unnecessary ordering of labs, tests, and other diagnostics. This is what has primarily been talked about in this thread. Insurance companies set arbitrary rules on these kinds of things to try and discourage excessive use of health care at the request of the patient, but the unfortunate outcome is that for patients that actually do need these in order to manage their conditions, we send them through billing hell.
Over-utilization of health care in general. A good example of this gets floated around every so often when hospitals look into "frequent flyers" - people who show up in the ED, a lot. At one hospital I worked at, there was an individual who was in the ED over 400 times in the course of a single year. That means they were in the ED more than once in the same day!. These individuals are over-utilizing precisely because they aren't getting the preventative care and appropriate follow-up that we should be giving these patients and it wasn't until we had a report to tell us that they showed up >400 times in a year that we realized we needed to talk with this person to find out why they were showing up so often. I would argue this is a failure of how the incentives are set up in the health care world more than anything else.
Yeah, I don't know how to fix it, but I'm still skeptical of simplistic explanations. It seems like it would be easy to screw up a non-profit system too? For-profit and non-profit hospitals don't...
Yeah, I don't know how to fix it, but I'm still skeptical of simplistic explanations. It seems like it would be easy to screw up a non-profit system too?
For-profit and non-profit hospitals don't seem dramatically different. Either way, revenue needs to exceed expenses or you're in trouble. The same seems true of insurance plans?
I mean yeah, it's possible to screw up non-profit healthcare, and it comes with its own distinct set of problems, but this isn't some hypothetical. Every other developed country on Earth has...
Yeah, I don't know how to fix it, but I'm still skeptical of simplistic explanations. It seems like it would be easy to screw up a non-profit system too?
I mean yeah, it's possible to screw up non-profit healthcare, and it comes with its own distinct set of problems, but this isn't some hypothetical. Every other developed country on Earth has universal healthcare, overwhelmingly publicly funded, and every single one of them provides better or equivalent care at significantly lower overall cost. It's long past time the US learned from their examples.
For-profit and non-profit hospitals don't seem dramatically different. Either way, revenue needs to exceed expenses or you're in trouble. The same seems true of insurance plans?
A non-profit entity doesn't have the incentive to squeeze more money than operating costs out of those it serves, whereas charging as much as possible for as little as possible is the MO of any for-profit entity.
Obamacare caps how much health insurers can make. If they make more, it has to be returned to their customers as a rebate. So, regulated for-profit isn't really the same as unregulated. It doesn't...
Obamacare caps how much health insurers can make. If they make more, it has to be returned to their customers as a rebate. So, regulated for-profit isn't really the same as unregulated.
The disability/chronic illness community has been pushing back against this idea for a long time. If you approach lowering costs with the assumption that people are getting "too much healthcare," disabled and chronically ill people will be denied medically necessary tests and treatment in the name of cutting costs. Prior authorization, drug formularies, step programs - these methods all deny things that doctors think their patients need. And it happens both with private insurance and Medicaid/Medicare.
There's so much wasted time and resources in the current system. I have yearly MRIs for a genetic predisposition to breast cancer that will obviously never change. And yet every year I have to go through the prior authorization steps, which my insurance contracts out to another company. When I get approved, it's only valid for 30 days - if I'm unable to get my MRI in that time span, I have to get it approved again. Breast MRIs have to be done at a certain point in your period (if you menstruate) to decrease false positives, and when your cycle isn't regular it's very easy for approval to expire before the proper time.
I'm still at high risk for breast cancer after 31 days - why is there even a time limit at all? Why do I have to ask each year for permission to monitor for breast cancer, when my family's medical history and my literal DNA aren't going to change?
I also recently met my out-of-pocket maximum for my subsidized plan, but I had to keep paying for an MRI and doctor appointments. Why? Because the system hasn't updated. I'll just have to wait to see if I get a refund, or follow up with my providers in a month or two if I don't. More phone calls, more people wasting their time patching holes in a broken system.
It's perverse that anyone could ever have thought that overutilization of healthcare was driving up costs when underutilization is actually one of the key factors. Namely the way Americans, even insured Americans, will skip doctor's visits for small illnesses until they become big ones that are much more expensive to treat. Cancers that would've been caught in stage one or two get caught at stage three or four and necessitate a six figure crash treatment program.
Per the article, I suppose overutilization was just a convenient idea that didn't challenge anyone's assumptions, that came about at exactly the right time, and had only the minor defect of being dead wrong.
It's not perverse. The problem is thinking in binary terms where theories are entirely right or wrong, when they often get at one part of the problem. (The linked article is too binary as well, but I shared it because it has an interesting perspective.)
Health care is vast and complicated and none of us are in a position to observe what's going on everywhere else. There is more than one way to pad expenses. Atul Gawande's work seems well done and it appears there was a problem with overutilization in McAllen, Texas [1]. But apparently it doesn't generalize?
Technically this is called "external validity". You can do a study, and what it finds may be true where you did it, but it's not true elsewhere.
https://www.vox.com/2015/5/6/8560365/health-care-gawande-mcallen
Yeah, healthcare is a complicated topic. I'm sure overutilization happens, at least occasionally, but I seriously doubt it compares to a deficiency in preventative medicine as a factor in why American healthcare is so expensive, and the attempt to solve the former problem exacerbated the latter.
But I honestly think that when you get right down to it, most of the million-and-one problems with the American healthcare system can be traced back to it being run for-profit, and our inability to deal with these problems is because politicians awash in lobbyist dollars are reluctant to do more than tinker around the edges of a fundamentally broken system. And I'm pretty sure that was the article's point as well; ending overutilization was pushed as a way of reducing healthcare costs regardless of its efficacy, because policy makers didn't want to admit to themselves or their constituents that the for-profit private insurance mode of healthcare was a disaster, and until we're willing to look at things from the funding side, similar policy mistakes are probably going to keep happening.
To be clear, there's two distinct kinds of over utilization:
Unnecessary ordering of labs, tests, and other diagnostics. This is what has primarily been talked about in this thread. Insurance companies set arbitrary rules on these kinds of things to try and discourage excessive use of health care at the request of the patient, but the unfortunate outcome is that for patients that actually do need these in order to manage their conditions, we send them through billing hell.
Over-utilization of health care in general. A good example of this gets floated around every so often when hospitals look into "frequent flyers" - people who show up in the ED, a lot. At one hospital I worked at, there was an individual who was in the ED over 400 times in the course of a single year. That means they were in the ED more than once in the same day!. These individuals are over-utilizing precisely because they aren't getting the preventative care and appropriate follow-up that we should be giving these patients and it wasn't until we had a report to tell us that they showed up >400 times in a year that we realized we needed to talk with this person to find out why they were showing up so often. I would argue this is a failure of how the incentives are set up in the health care world more than anything else.
Yeah, I don't know how to fix it, but I'm still skeptical of simplistic explanations. It seems like it would be easy to screw up a non-profit system too?
For-profit and non-profit hospitals don't seem dramatically different. Either way, revenue needs to exceed expenses or you're in trouble. The same seems true of insurance plans?
I mean yeah, it's possible to screw up non-profit healthcare, and it comes with its own distinct set of problems, but this isn't some hypothetical. Every other developed country on Earth has universal healthcare, overwhelmingly publicly funded, and every single one of them provides better or equivalent care at significantly lower overall cost. It's long past time the US learned from their examples.
A non-profit entity doesn't have the incentive to squeeze more money than operating costs out of those it serves, whereas charging as much as possible for as little as possible is the MO of any for-profit entity.
Obamacare caps how much health insurers can make. If they make more, it has to be returned to their customers as a rebate. So, regulated for-profit isn't really the same as unregulated.
It doesn't seem to have fixed things?