

How a $1,500 Start-up Changed Health Care - bbarthel
http://www.inc.com/articles/201108/jay-parkinson-how-a-start-up-is-changing-health-care.html

======
entangld
His $1500 dollar startup is just the store front for his $100k+ medical
education. There is already a staggering demand for any and all medical
services.

Not as innovative as the headline made it sound.

~~~
narrator
What's interesting about the economics of all this is that the cost of an
office and staff overhead is now greater than the benefit from taking
insurance. Complexity has benefits but it also has a cost that tends to
deliver negative marginal returns after a certain point and the U.S health
care insurance industry passed that point long ago.

~~~
muzz
No, not in general but only for this _one_ particular doctor. He is basically
providing the simplest of medical services to the most well-paying patients.
This is a teeny tiny market, one whose consumers' needs and means are not
reflective of the average consumer of medical care. He may have success doing
this in two zip codes in a metropolitan area, but this business can't be
replicated to any meaningful scale.

~~~
pessimizer
I don't think one or two hundred a visit is very much higher than in any other
context.

~~~
muzz
It's not a high amount for that type of service. I was referring to the
ability to pay the entirety of it, presumably up front, and the willingness to
do so in some cases despite having insurance.

The more significant of the two points I made was the type of cases he could
possibly be seeing. The article refers to only the most basic of equipment
such as an otoscope, no mention of a lab (for blood chemistry, bacterial
tests, etc), so it's hard to see how he could handle only the absolute
simplest of cases.

Essentially he is practicing medicine the way it was done in a previous era.
It's not really "innovative", a better term would be "retro" or "throwback".

------
elliottcarlson
Unless the statement in this posting[1] has changed in the few years since it
was posted, this guy could lose his medical license over this... I'm all for
using technology to make things easier, but something as regulated as the
medical and pharmaceutical industry needs to be thought through and can't just
use any third party tool to do what you want with.

[1]
[http://support.formstack.com/index.php?pg=forums.posts&i...](http://support.formstack.com/index.php?pg=forums.posts&id=80&pc=2)

~~~
Bud
To me, this is just yet another argument to add to the gigantic stack of
arguments against the current way of doing things in medicine.

Lately, I've been doing a side job in which I transcribe focus groups for
various businesses, including several large health insurance firms. I am
consistently stunned at the money they spend on this, and the cynical nature
of the questions they ask, and how completely unrelated they are to anything
even resembling patient care. They just aren't concerned with patient care.
They are concerned with developing "innovative insurance products" to compete
with the supposedly "innovative" offerings from other health care
conglomerates.

People don't want "innovative insurance products". They want affordable health
care, provided by physicians who are not driven to distraction by the
bureaucratic requirements of dealing with ten different insurers who are all
trying to pay out as little as possible.

------
pavel_lishin
Sounds like it changed health care for the people living in those two zip
codes who don't want to go through the insurance company. Woohoo, but I'm
still hosed.

~~~
ars
BTW the patient can still submit the bill to insurance and request to be
reimbursed.

It might be an interesting model to push all insurance work from the doctors
to the patients. I think it may even have some benefits: people will actually
know what they are paying for.

~~~
pavel_lishin
I'll admit outright that I don't know enough about this to have a valid
opinion, but shifting the work from the doctor to me automatically makes me
want to say "no".

On the other hand, a little bit of work done by a lot of people vs. a lot of
work being done by one office, the "crowdsourcing" sounds like a better
solution. The obvious down side is that I have no leverage against the
insurance company - a doctor's office does.

~~~
ars
Actually I think you have more leverage than the Dr. If you are not happy with
the insurance company you cancel the policy or complain to your employer (you
are paying them, the insurance company does not want to loose the business).
The doctor can do nothing - they want to get paid, they have nothing to hold
against the insurance company.

------
muzz
Several questions immediately pop up from the article:

* "He watched doctors treat up to 40 patients a day". Is the article implying that is somehow bad in and of itself? If the doctor has staff to handle paper work, and doesn't travel to each patient, this seems to be more efficient. In economic terms, the doctor is maximizing his comparative advantage (treating patients)

* "It wasn't like this decades ago. ... there was so little overhead." What is the cause of this recent overhead? Certainly doctors had offices and staff decades ago, as they do now. Is it just the insurance part? If that's the case, then just simply perform fee-for-service; doctors are free to do that.

~~~
rdouble
_What is the cause of this recent overhead?_

Salaries for administrators and managers. Like universities, health care
organizations have dramatically expanded the number of administrative staff.

~~~
muzz
Most are private businesses-- they should be run efficiently.

------
dugmartin
We have a doctor here in our little town in Western Massachusetts that is
doing the same but set it up as a non-profit. He accepts barter as payment and
supports other small providers with an open source EMR system:

[http://www.cottagemed.org/index.php?option=com_content&v...](http://www.cottagemed.org/index.php?option=com_content&view=article&id=8&Itemid=9)

------
relix
Interesting observation: the permalink swaps "changed" with "is changing".

