NYT: Health care is expensive because we spend it on the system, not patients

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drusso

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Why Is U.S. Health Care So Expensive? Some of the Reasons You’ve Heard Turn Out to Be Myths

“We know we spend a lot more than everyone else, and we have looked for easy explanations — things like greed in the system, fee-for-service medicine, overutilization,” he said. But the research, he said, didn’t match his expectations. “I’ve been looking at other countries and seeing there’s a lot of fee-for-service in other countries, and other countries are struggling with overutilization.”

Health Care Spending in the United States and Other High-Income Countries

"The data also suggest that some of the more common explanations about higher health care spending in the United States, such as underinvestment in social programs, the low primary care/specialist mix, the fee-for-service system encouraging high volumes of care, or defensive medicine leading to overutilization, did not appear to be major drivers of the substantially higher US health care spending compared with other high-income countries. Instead, the data suggest that the main driving factors were likely related to prices, including prices of physician and hospital services, pharmaceuticals, and diagnostic tests, which likely also affected access to care. In addition, administrative costs appeared much higher in the United States. These findings indicate that efforts targeting utilization alone are unlikely to reduce the gap in spending between the United States and other high-income countries, and a more concerted effort to reduce prices and administrative costs is likely needed."

Bottom line: Administrative costs including site of service differentials, and health-system based revenue arbitrage are driving up costs not private practice doctors. If you're "feeding the machine" and fluffing hospital admins by doing E/M visits in HOPD venues, doing simple IPM procedures in hospital OR's, ordering urine tox's for your hospital-owned de-prescribing clinic YOU are the problem. The patient's EOB's prove it.

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here's the original article, with the author's conclusion:

Health Care Spending in the United States and Other High-Income Countries

Conclusions and Relevance The United States spent approximately twice as much as other high-income countries on medical care, yet utilization rates in the United States were largely similar to those in other nations. Prices of labor and goods, including pharmaceuticals, and administrative costs appeared to be the major drivers of the difference in overall cost between the United States and other high-income countries. As patients, physicians, policy makers, and legislators actively debate the future of the US health system, data such as these are needed to inform policy decisions.


the rest are libertarian musings
 
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Why Is U.S. Health Care So Expensive? Some of the Reasons You’ve Heard Turn Out to Be Myths

“We know we spend a lot more than everyone else, and we have looked for easy explanations — things like greed in the system, fee-for-service medicine, overutilization,” he said. But the research, he said, didn’t match his expectations. “I’ve been looking at other countries and seeing there’s a lot of fee-for-service in other countries, and other countries are struggling with overutilization.”

Health Care Spending in the United States and Other High-Income Countries

"The data also suggest that some of the more common explanations about higher health care spending in the United States, such as underinvestment in social programs, the low primary care/specialist mix, the fee-for-service system encouraging high volumes of care, or defensive medicine leading to overutilization, did not appear to be major drivers of the substantially higher US health care spending compared with other high-income countries. Instead, the data suggest that the main driving factors were likely related to prices, including prices of physician and hospital services, pharmaceuticals, and diagnostic tests, which likely also affected access to care. In addition, administrative costs appeared much higher in the United States. These findings indicate that efforts targeting utilization alone are unlikely to reduce the gap in spending between the United States and other high-income countries, and a more concerted effort to reduce prices and administrative costs is likely needed."

Bottom line: Administrative costs including site of service differentials, and health-system based revenue arbitrage are driving up costs not private practice doctors. If you're "feeding the machine" and fluffing hospital admins by doing E/M visits in HOPD venues, doing simple IPM procedures in hospital OR's, ordering urine tox's for your hospital-owned de-prescribing clinic YOU are the problem. The patient's EOB's prove it.

Nice try. How many of your midlevels' opioid refill patients end up at the big hospital after their insurance doesn't cover your needling anymore? What are they supposed to do?
 
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Nice try. How many of your midlevels' opioid refill patients end up at the big hospital after their insurance doesn't cover your needling anymore? What are they supposed to do?

That would be compelling if it were true, but I'm the only pain clinic I know that will see take ED referrals, and get them in on the same day if possible, for payers that we're contracted.

Do you think Big Hospitals should be tax-advantaged not-for-profits too? You're greedy.
 
I see them too.

ED colleagues refer them to me all the time. I’m missing the point...


Tho I do notice you thought it important to mention “to the payers we’re contracted”. As a hospital practice, I take all patients and have a good number of FINA... at least 20-30
 
I see them too.

ED colleagues refer them to me all the time. I’m missing the point...


Tho I do notice you thought it important to mention “to the payers we’re contracted”. As a hospital practice, I take all patients and have a good number of FINA... at least 20-30

I'm jealous. I would *LOVE* to have the same contracts that the hospital does--wraps fees, etc. It's pretty much "take it or leave it" in the private world. Even if "take it" means financial ruin. Many health systems negotiate "narrow network" or exclusive provider network deals. Greedy bastards.
 
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I'm jealous. I would *LOVE* to have the same contracts that the hospital does--wraps fees, etc. It's pretty much "take it or leave it" in the private world. Even if "take it" means financial ruin. Many health systems negotiate "narrow network" or exclusive provider network deals. Greedy bastards.

Come over to the dark side then. You wouldn't have to prescribe as much either to keep the lights on
 
I'm not a team player.

Just saw a self referral from ED for LBP in working aged male seeking disability. Sending him your way for some true multimodal therapy...may need sedation for procedures
 
Why Is U.S. Health Care So Expensive? Some of the Reasons You’ve Heard Turn Out to Be Myths

“We know we spend a lot more than everyone else, and we have looked for easy explanations — things like greed in the system, fee-for-service medicine, overutilization,” he said. But the research, he said, didn’t match his expectations. “I’ve been looking at other countries and seeing there’s a lot of fee-for-service in other countries, and other countries are struggling with overutilization.”

Health Care Spending in the United States and Other High-Income Countries

"The data also suggest that some of the more common explanations about higher health care spending in the United States, such as underinvestment in social programs, the low primary care/specialist mix, the fee-for-service system encouraging high volumes of care, or defensive medicine leading to overutilization, did not appear to be major drivers of the substantially higher US health care spending compared with other high-income countries. Instead, the data suggest that the main driving factors were likely related to prices, including prices of physician and hospital services, pharmaceuticals, and diagnostic tests, which likely also affected access to care. In addition, administrative costs appeared much higher in the United States. These findings indicate that efforts targeting utilization alone are unlikely to reduce the gap in spending between the United States and other high-income countries, and a more concerted effort to reduce prices and administrative costs is likely needed."

Bottom line: Administrative costs including site of service differentials, and health-system based revenue arbitrage are driving up costs not private practice doctors. If you're "feeding the machine" and fluffing hospital admins by doing E/M visits in HOPD venues, doing simple IPM procedures in hospital OR's, ordering urine tox's for your hospital-owned de-prescribing clinic YOU are the problem. The patient's EOB's prove it.
Just so I get this straight, the NUMBER ONE cost driver is that physicians charge too much? In other words, $80 for a LESI as a professional fee should be lowered before addressing HOPD fees, insurance/Medicare admin costs, malpractice and defensive medicine costs? Okay "health policy experts", keep up the great "research"...
 
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