

Can Hospital Chains Improve the Medical Industry? - phreanix
http://m.newyorker.com/reporting/2012/08/13/120813fa_fact_gawande

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illuminate
Restaurant chains flash freeze, then microwave their entrees.

I don't see what "innovation" and "quality" has to do with anything but their
many ways to utilize HFCS and massive calories/portion sizes. Supply chain,
perhaps. But the food output is absolutely terrible in the international
chains. Cheesecake Factory, TGIFriday's, Bennigan's all make consistent
dishes, but consistently ~bad~.

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michaelhoffman
They don't taste great, but they are consistently safe and produced at a low
cost. Which is much more than can be said for U.S. health care.

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illuminate
By your description a "McDonalds" of health care, available at low price to
all is abstractly a pleasant idea, though I don't think the analogy has any
practical advice that we can take from franchise fast food operations.

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yen223
How is quick, consistent, low-cost health care a bad thing?

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healthenclave
Web based technologies will play a vital role in standardizing at-least
primary care and routine procedures. Will also help doctors provide more
quality and personalized medicine.

Lack of data and transparency are the two huge factors holding back health
care.

You can find a doctor and book an appointment but if you need a surgeon what
matters is the Complication Rate and not the no of reviews of office visits.

This kind of decision making data is simply lacking or un-avialble to the
public.

there is a lot of depth to this discussion as always with health care but
simply put in the current state of affairs Health Care is too fragmented and
non-communicative in itself.

We need to create a single platform of interconnected technologies the
communicate among each other to solve this and use patient engagement to help
doctors provide more personalized medicine.

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aychedee
I dunno, it seems like so much heat and light is wasted in America trying to
'figure out' health care. There are lots of countries that have figured out
health care. Just study the best practice and put together a viable system.

If you want the absolute best return in units of health care per dollar spent
then the New Zealand system was the most efficient last time I looked.

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mgkimsal
but but but....

"socialized medicine"

"communism"

"free private enterprise"

etc.

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nhashem
It is tough to compare a healthcare "market" to any other market.
Fundamentally, healthcare is a good that _nobody will voluntarily want,_ but
that _everyone is going to need_ at some point. Furthermore, it does not lend
itself for easy consumer evaluation. Imagine if doctors were reviewed on Yelp,
and you saw a review that said, "My sister had cancer and this doctor
performed the surgery to remove her tumor. Six months later, she died. One
star." Did the doctor botch the surgery? Did the doctor actually perform a
miraculous operation, giving someone on death's door and full six months of
life? And is this something you really feel equipped to compare like whether
you want the double cheeseburger at McDonalds or Wendy's?

We could also get into the further perverse incentives specific to the US
healthcare system, but I've yet to see a fundamental argument about how
efficient market forces can work Adam Smith's magic on healthcare.

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rogerbinns
We don't need a situation where everything is either a market, or not a
market. For example we could have a government standardised healthcare product
that is sensibly funded (eg taxation). But, and very importantly, not preclude
others from providing that product or different products via any funding model
they want.

For example you get this with BUPA in the UK - you pay extra and get quicker
services plus more luxurious accommodation on hospitalization. Or a private
organisation could provide services over night to the government (eg get a CT
scan at 3am for cheap - the government could give people a paid incentive to
take that instead of using daytime services).

It would be really great if there was a baseline service - eg you know that if
you get a broken arm or cancer you would be sensibly taken care of, but beyond
that a great flowering of experimentation (which markets do) in how things are
provided and how they are paid for.

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RougeFemme
Within the individual restaurants, the Cheesecake Factory hires people who
consider themselves "cooks", not "chefs". "Chefs" would not/could not work
there, except possibly in the corporate kitchens, developing restaurants. It's
tougher for health care chains, especially when dealing with those who
consider themselves "specialists" after years of specialized training. And
what about the demi-gods also known as surgeons?

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pkulak
It doesn't seem to me like it's the PhDs who are driving costs. I recently
spent a week in the hospital and I had contact with my physician for maybe 10
minutes total. I saw my nurses constantly. But I don't think it's the nurses
either. They don't seem overpaid to me at all. So... I don't have an answer.
Maybe it's the billions in uncompensated ER care? I just don't think it's the
staff that's the problem.

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frio
If you're interested in this kind of thing, try reading the book Hacking
Healthcare.

From what I gather so far (haven't quite finished), there are large costs that
are incurred by dealing with insurance. The USA's billing system -- matching
diagnoses to codes, and codes to billable amounts -- seems like it makes sense
on the face of it, but once you start digging in, its a rat's nest.

There are several disparate coding ontologies, many of which are proprietary.
Different insurance companies accept different ontologies, meaning clinics
need to pay for access several times over.

The ontologies don't necessarily match up one to one with diagnoses, and
clinicians often don't care to match them up themselves. So, clinicians
diagnose a patient, and then back-office staff need to go through and match
those diagnoses to codes.

The insurance companies will reject anything that doesn't match their own
data. So, if an payment request comes through for John Q. Bloggs, they won't
issue payment if the name _they_ have on file is Jonathan Q. Bloggs. So, you
need more back-office staff to deal with the rejections, marry the data up
properly, and send it again (in order to save time and money, there are
apparently clearing houses now; middle-men between the clinics and the
insurance company who can advise staff more cheaply if a given request will be
rejected for invalid data, or unbillable codes).

 _Then_ , they can reject certain codes that a patient doesn't have insurance
for, even if its covered by some other code. So, again, the back-office staff
need to go through and retry the payment request with more relevant codes
(which are now further from the diagnosis, but hey, whatever).

Finally, once it's all been hashed out, insurance companies often won't pay
the full amount anyway -- so the patients sometimes need to be chased up for
the remaining payment.

Wrapped around all that are all the requirements for dealing with fraud,
auditing, etc. which make it all the more difficult.

It's massively inefficient, and somewhat self-fulfilling: the complexity of it
requires more staff, which drives costs up. There's no direct way to bill for
staff time, so charges to patients go up (hence the $10 aspirin or whatever
the famous example is). Which leads to more complexity in billing, which leads
to more staff, and on and on.

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devicenull
This sounds an awful lot like things that have been going on with
development/operations lately. Standardize configs, record best practices,
etc.

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DaniFong
This is, in my opinion, a very very good idea for someone with the guts to
crack it.

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illuminate
There are plenty of people with the "guts to crack it", finding people to
listen and care and implement without roadblocks is the issue.

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DaniFong
Roadblocks are a given; guts implies being crafty enough to overcome them ;)

