Once again, U.S. has most expensive, least effective health care system in survey

[BestDoctorEver]

---

Members do not see this ad.

@DermViser... Get out of the mindset of liberal vs. conservative whenever you are having an thoughtful discussion. This is not an attack on you. You probably don't realize that, but many of your posts give that impression whenever there is a discussion about the status of healthcare in the US.

 

[DermViser]

@DermViser... Get out of the mindset of liberal vs. conservative whenever you are having an thoughtful discussion. This is not an attack on you. You probably don't realize that, but many of your posts give that impression whenever there is a discussion about the status of healthcare in the US.

I realize you're just a starting MS-1 (who believed erroneously he could yell back at attendings during MS-3 if they were unprofessional to him), but there is only one side that consistently advocates for a single payer healthcare system and as the solution to all our ills. Guess which side. And I will bring it up when the group that releases a "report" is the Commonwealth Fund. It would absolutely be no different if PNHP or the Heritage Foundation released a report with statistics. Figures and numbers, esp. when they're used to extrapolate to changing healthcare policy have to be looked at carefully and not just accepted at face value.

 

[oncology2020]

there is no doubt medical care is expensive in the US..however the media and government will be using this to attack physician salaries which is NOT the issue..the average person thinks that physician salary is the cause of high health care costs which is far from the truth..its medical device companies, pharma, insurance companies, government that set these ridiculous prices..not doctors..thats something that needs to be cleared up to the average person..dont let them target physician salary with the excuse that it will bring down costs..it will only shift revenue to these other stakeholders..the real reason the entire system is such a mess is because the government and insurance industry have such a strong hold on the field, neither of which have the patient's best interests in mind..our "leaders" play politics with our health..government is inherently inefficient and billions of dollars go to waste because of these inefficiencies..and defensive medicine for the fear of being sued for malpractice in one of the most litigious nations in the world and the amount of paperwork and administrative work to overcome the ridiculous amount of bureaucracy from both government and the insurance industry are the real drivers of increased health care costs and take away from patient care, but ever notice how none of those things are ever mentioned by the government or media?

I would like to see the following parameters be included in these comparative rankings:

1. # of malpractice lawsuits per year
2. average dollar settlement from malpractice lawsuits and income of malpractice lawyers
3. amount of time physician spends on paperwork/administrative work to get reimbursed from insurance companies and government and ease and speed of getting reimbursed in those nations
4. revenue of pharmaceutical companies
5. revenue of medical device companies
6. costs of drugs
7. costs of purchasing and maintaining medical devices like CT/MRI/Gamma Knife/protons
8. costs incurred by patients for health care insurance vs. how much insurance company actually ends up paying
9. revenue of insurance companies
10. lost revenue by hospitals for providing unreimbursed care
11. costs of medical education and loans..including pre-med years..and how long it takes a physician to pay off this debt in each of those nations
12. length of medical education and training including 4 years of pre-med which none of those countries have as a requirement, 4 years of medical school, 3-6 years of residency, 1-3 years of fellowship
13. work hours spent during training and as attending
14. number of unhealthy fast food restaurants and food options per capita
15. BMI of population
16. life expectancy of population
17. costs of unhealthy food vs. cost of healthy food
18. prevalence of chronic diseases: diabetes, heart failure, COPD, MI/stroke.
19. how each of these societies view death and cost of medical care around the time of death--most of the medical expense in US comes near the time of death when doctors are trying sometimes unnecessarily to prolong life.

I bet you US does not look good in most if not all of those above parameters also. Blaming physicians for bad outcomes that are directly related to personal choices made by patients cannot be blamed on physicians, we cannot force anyone to follow our advice nor can we play the role of G-d..there is only so much physician can do based on law, ethics, and the limitations of scientific knowledge. When those above issues become public health issues such as the obesity epidemic in the US which is conveniently being ignored because of the power of the food lobbying groups, then government and society as a whole is at fault and need to look at themselves in the mirror because those chronic medical issues drastically drive up health care costs more than physician salaries ever will. Fix the above parameters first will save several billions of dollars more in health care costs than trying to cut physician salary. It's time for us to take the lead in changing the focus of the debate from physician salary to the actual issues that drive health care.

 

[deleted500612]

there is no doubt medical care is expensive in the US..however the media and government will be using this to attack physician salaries which is NOT the issue..the average person thinks that physician salary is the cause of high health care costs which is far from the truth..its medical device companies, pharma, insurance companies, government that set these ridiculous prices..not doctors..thats something that needs to be cleared up to the average person..dont let them target physician salary with the excuse that it will bring down costs..it will only shift revenue to these other stakeholders..the real reason the entire system is such a mess is because the government and insurance industry have such a strong hold on the field, neither of which have the patient's best interests in mind..our "leaders" play politics with our health..government is inherently inefficient and billions of dollars go to waste because of these inefficiencies..and defensive medicine for the fear of being sued for malpractice in one of the most litigious nations in the world and the amount of paperwork and administrative work to overcome the ridiculous amount of bureaucracy from both government and the insurance industry are the real drivers of increased health care costs and take away from patient care, but ever notice how none of those things are ever mentioned by the government or media?

Good post, and I completely agree with most of it except for one thing. I have to disagree that over-involvement of government in the healthcare field is the cause of skyrocketing costs in the US. I suppose if the US existed in a vacuum you could argue that, but the fact that every other western nation has even *more* government control over healthcare than the US does but yet most of them spend around half as much money per capita on healthcare with equal outcomes suggests that the problem is definitely not government involvement in healthcare.

 

[NontradCA]

.

 

[DrBodacious]

I

The GDP data isn't susceptible to manipulation, nor is the health expenditures per capita:

As for the rest, it's undeniable that some people in America have terrible healthcare.

I posted this in another thread, but since people are trying to say that the data above is manipulated, here some more hard #'s (Yes, the NYT is often terrible, but these are good objective #'s).

The $2.7 Trillion Medical Bill
Colonoscopies Explain Why U.S. Leads the World in Health Expenditures
(colonoscopy, pregnancy, joint replacements, Rx, ER, Derm, Type 1 diabetes)
http://www.nytimes.com/2013/06/02/h...-health-expenditures.html?pagewanted=all&_r=0

This is exactly how numbers are manipulated. This author is blatantly using irrelevant numbers to heighten concern. This is citing BILLED amounts, not allowable amounts or collected amounts. To avoid getting underpayed, a lot of docs or hospitals bill at 200% of Medicare allowable, with zero expectation that they will get paid that much. $3500 for a facility fee, physician fee and sedation is not cheap, but not absurd.

 

[WhippleWhileWeWork]

Updated report:

https://static.squarespace.com/static/518a3cfee4b0a77d03a62c98/t/534fc9ebe4b05a88e5fbab70/1397737963288/2013 iFHP FINAL 4 14 14.pdf

IFHP’s Chief Executive Tom Sackville explained why he believed to the data to be important. (iFHP is the org. generating these bar graph presentations)

“First, it gives the lie to the idea that some countries spend more on health as a result of higher utilization. It is all about unit price,” he said. “Second, we have looked here at a number of procedures and products which are identical across the markets surveyed. The price variations bear no relation to health outcomes: they merely demonstrate the relative ability of providers to profiteer at the expense of patients, and in some cases reflect a damaging degree of market failure.”

iFHP appears to provide no analysis or justification for the bolded.
http://www.ifhp.com/1404121
If you used this presentation in your research or in an academic setting, you'd probably be flogged, and you'd deserve it. However, it's fair game for blogosphere and NYT, apparently.

 

[oncology2020]

Good post, and I completely agree with most of it except for one thing. I have to disagree that over-involvement of government in the healthcare field is the cause of skyrocketing costs in the US. I suppose if the US existed in a vacuum you could argue that, but the fact that every other western nation has even *more* government control over healthcare than the US does but yet most of them spend around half as much money per capita on healthcare with equal outcomes suggests that the problem is definitely not government involvement in healthcare.

you're making the assumption that all governments are equal. just because the government of switzerland has created an efficient system does not mean that increasing US government involvement will produce the same results. Our leaders from both parties have proven to be ineffective and play politics with some of the most urgent and important issues..they have bankrupted social security, medicare/medicaid, post office, destroyed the middle class and the entire nation and look at the **** show that is the VA..and we really want them to take over health care also? I'd rather have the non-profit private sector take over because the private sector is forced to be efficient or else they will not survive. The government is inherently inefficient and only needs to increase taxes or print out more money and becoem in more debt--there is no pressure or accountability for it to be efficient in its use of tax payer money--hence the issues that we are facing today. Our government is also highly influenced and if not controlled by lobbyists including insurance industry and pharma so I'm sorry I would not want our government to do a take over of our health care system. The government's role should only be to prevent abuses from the various for-profit stakeholders I discussed in my previous post.

I would also like to see the taxes in those other nations--I bet you many of those countries have much higher taxes. And I would like to see a poll about how many people from those other nations would come to the US for health care services if they could. I bet you it would be a high percentage.

And although the US system is not completely government-run, I would still argue that it is one of the most government-regulated systems in the world. The US health care system has much more bureaucracy and unnecessary paperwork/administrative work than those other countries, both on the government-side and insurance industry-side.

 

[syma]

I would also like to see the taxes in those other nations--I bet you many of those countries have much higher taxes. And I would like to see a poll about how many people from those other nations would come to the US for health care services if they could. I bet you it would be a high percentage.

Not from a two tiered nation. Those that prefer the option have insurance. Those that don't or can't afford it use the national health system.

 

[@JackShephard]

I

This is exactly how numbers are manipulated. This author is blatantly using irrelevant numbers to heighten concern. This is citing BILLED amounts, not allowable amounts or collected amounts. To avoid getting underpayed, a lot of docs or hospitals bill at 200% of Medicare allowable, with zero expectation that they will get paid that much. $3500 for a facility fee, physician fee and sedation is not cheap, but not absurd.

I don't think they are irrelevant.

How do we know both figures aren't the billed amounts (The American and the other country)? The reality is that they bill that amount because they can collect that amount sometimes (be it 1 or 10% of the time). They can also sue for that much on non paying patients. If the billing # had no meaning, then they wouldn't bill it - they would bill lower.

I would love to see the actually cumulative collected amount instead of the billing, but this system lacks transparency. Those #'s are not released.

Furthermore, the GDP and per capita spending are NOT billed amounts. They are actual spending totals. The original data I posted was not NYT - and I'll repeat my response from above, forget all the manipulated stats - just look at the GDP, per capita spending - or let's look at the actual collected amounts from real patients. They are STILL much higher. There are no reports saying otherwise. People can respond that the #'s are manipulated, but could someone post a report showing we have a cost efficient system? I don't even care if the #'s are manipulated, just any report finding we aren't over spending!

 

[@JackShephard]

Thanks for the replies by Oncology and Whipple.

I posted this thread to start a discussion to bring about more ideas and to further our thinking, not to have arguments. I think the contributions above are excellent. From the iFHP report:

The International Federation of Health Plans (IFHP) today released its 2013 Comparative Price Report, detailing its annual survey of medical prices per unit. Designed to showcase the variation in healthcare prices around the world, the report examines the price of medical procedures, tests, scans and treatments in nine countries. This year the survey also shows pricing for five specialty prescription drugs. As in prior years, the survey data shows that the United States continues to have the highest fees of those countries surveyed for drugs and various medical procedures.

Some of the larger disparities were in prescription and specialty drugs prices. For example, the price for the cancer drug Gleevec ranged from $989 in New Zealand to $6,214, the average price paid in the United States. The price paid for the drug Copaxone ranged from $862 in England to $3,903 in the United States.

Other more common drugs such as Cymbalta, commonly prescribed for depression, cost less than $100 in Switzerland, Spain, the Netherlands and England. Cymbalta cost an average of $110 in Canada and $194 in the United States. Similarly, a drug prescribed for acid reflux averages from $33 in the Netherlands to $215 in the United States.

IFHP’s Chief Executive Tom Sackville explained why he believed to the data to be important.

“First, it gives the lie to the idea that some countries spend more on health as a result of higher utilization. It is all about unit price,” he said. “Second, we have looked here at a number of procedures and products which are identical across the markets surveyed. The price variations bear no relation to health outcomes: they merely demonstrate the relative ability of providers to profiteer at the expense of patients, and in some cases reflect a damaging degree of market failure.”

Prices examined in the study included those from Argentina, Australia, Canada, England, Netherlands, New Zealand, Spain, Switzerland and the United States. The data for the report was gathered from participating IFHP member organizations in each country. Prices in the U.S. were based on prices negotiated between private health plans and health care providers.

The IFHP was founded in 1968 by a group of health fund industry leaders, and is now the leading global network of the industry, with more than 80 member companies across 25 countries. IFHP aims to assist in the maintenance of high ethical and professional standards throughout the industry.

This report is excellent because it talks about the unit price, look at these:

By the way, these are the negotiated prices! These are NOT billed prices or manipulated data.

Prices for the United States are calculated from a database with over 100 million claims that reflect prices negotiated and paid between thousands of providers and almost a hundred commercial health plans

Average prices

Gleevec:
New Zeland: $989
US: $6,200

Reflux drug:
Netherlands: $33
US: $215

CT scan abdomen:
Spain: $94
US: $896

MRI
Switzerland: $138
US: $1,145

Hospital costs per day:
Spain: $481
US: $4,293
US 95th percentile: $12,726

Appy:
Argentina: $1,723
US: $13,910

Child Delivery:
Argentina: $2,237
US: $10,002

C-section:
Spain: $2,844
US: $15,240

Knee Replacement:
Argentina: $6,015
US: $25,398

No matter how you slice it, America is the most expensive in every single category. And it's not because our physicians are paid so much...

 

[DermViser]

there is no doubt medical care is expensive in the US..however the media and government will be using this to attack physician salaries which is NOT the issue..the average person thinks that physician salary is the cause of high health care costs which is far from the truth..its medical device companies, pharma, insurance companies, government that set these ridiculous prices..not doctors..thats something that needs to be cleared up to the average person..dont let them target physician salary with the excuse that it will bring down costs..it will only shift revenue to these other stakeholders..the real reason the entire system is such a mess is because the government and insurance industry have such a strong hold on the field, neither of which have the patient's best interests in mind..our "leaders" play politics with our health..government is inherently inefficient and billions of dollars go to waste because of these inefficiencies..and defensive medicine for the fear of being sued for malpractice in one of the most litigious nations in the world and the amount of paperwork and administrative work to overcome the ridiculous amount of bureaucracy from both government and the insurance industry are the real drivers of increased health care costs and take away from patient care, but ever notice how none of those things are ever mentioned by the government or media?

I would like to see the following parameters be included in these comparative rankings:

1. # of malpractice lawsuits per year
2. average dollar settlement from malpractice lawsuits and income of malpractice lawyers
3. amount of time physician spends on paperwork/administrative work to get reimbursed from insurance companies and government and ease and speed of getting reimbursed in those nations
4. revenue of pharmaceutical companies
5. revenue of medical device companies
6. costs of drugs
7. costs of purchasing and maintaining medical devices like CT/MRI/Gamma Knife/protons
8. costs incurred by patients for health care insurance vs. how much insurance company actually ends up paying
9. revenue of insurance companies
10. lost revenue by hospitals for providing unreimbursed care
11. costs of medical education and loans..including pre-med years..and how long it takes a physician to pay off this debt in each of those nations
12. length of medical education and training including 4 years of pre-med which none of those countries have as a requirement, 4 years of medical school, 3-6 years of residency, 1-3 years of fellowship
13. work hours spent during training and as attending
14. number of unhealthy fast food restaurants and food options per capita
15. BMI of population
16. life expectancy of population
17. costs of unhealthy food vs. cost of healthy food
18. prevalence of chronic diseases: diabetes, heart failure, COPD, MI/stroke.
19. how each of these societies view death and cost of medical care around the time of death--most of the medical expense in US comes near the time of death when doctors are trying sometimes unnecessarily to prolong life.

I bet you US does not look good in most if not all of those above parameters also. Blaming physicians for bad outcomes that are directly related to personal choices made by patients cannot be blamed on physicians, we cannot force anyone to follow our advice nor can we play the role of G-d..there is only so much physician can do based on law, ethics, and the limitations of scientific knowledge. When those above issues become public health issues such as the obesity epidemic in the US which is conveniently being ignored because of the power of the food lobbying groups, then government and society as a whole is at fault and need to look at themselves in the mirror because those chronic medical issues drastically drive up health care costs more than physician salaries ever will. Fix the above parameters first will save several billions of dollars more in health care costs than trying to cut physician salary. It's time for us to take the lead in changing the focus of the debate from physician salary to the actual issues that drive health care.

You can bet once P4P starts coming into play, physicians will start firing patients left and right.

 

[DermViser]

Thanks for the replies by Oncology and Whipple.

I posted this thread to start a discussion to bring about more ideas and to further our thinking, not to have arguments. I think the contributions above are excellent. From the iFHP report:



This report is excellent because it talks about the unit price, look at these:

By the way, these are the negotiated prices! These are NOT the billed prices or manipulated data.



Average prices

Gleevec:
New Zeland: $989
US: $6,200

Reflux drug:
Netherlands: $33
US: $215

CT scan abdomen:
Spain: $94
US: $896

MRI
Switzerland: $138
US: $1,145

Hospital costs per day:
Spain: $481
US: $4,293
US 95th percentile: $12,726

Appy:
Argentina: $1,723
US: $13,910

Child Delivery:
Argentina: $2,237
US: $10,002

C-section:
Spain: $2,844
US: $15,240

Knee Replacement:
Argentina: $6,015
US: $25,398

No matter how you slice it, America is the most expensive in every single category.

Still not seeing your point. There are many factors that affect prices. For example, a drug that costs a certain amount here vs. somewhere else is bc a Pharma co. has to recoup its R&D costs, esp. for other drugs that never made it to market and got FDA approval.

 

[@JackShephard]

Still not seeing your point. There are many factors that affect prices. For example, a drug that costs a certain amount here vs. somewhere else is bc a Pharma co. has to recoup its R&D costs, esp. for other drugs that never made it to market and got FDA approval.

My point is it's too expensive and our healthcare system can be more efficient and cost effective.

And that it needs to be done fast.

 

[DermViser]

My point is it's too expensive and our healthcare system can be more efficient and cost effective.

And that it needs to be done fast.

Our healthcare system could also be more "efficient and cost effective" by hiring NPs and PAs instead of physicians. Doesn't mean it's good for our healthcare system. Hospitals have to recoup their losses and costs to maintain equipment as well as pay the salaries of nurses, doctors, techs, etc. Your utopia of a lean, mean healthcare system won't last, at least not without consequences - Pharma not putting as much money into research to bring new drugs on the market, bc the govt. has already stated they won't pay for it, due to cost.

You may not like how the healthcare system works for the collective, but as an individual, I am fine with it.

 

[deleted500612]

you're making the assumption that all governments are equal. just because the government of switzerland has created an efficient system does not mean that increasing US government involvement will produce the same results. Our leaders from both parties have proven to be ineffective and play politics with some of the most urgent and important issues..they have bankrupted social security, medicare/medicaid, post office, destroyed the middle class and the entire nation and look at the **** show that is the VA..and we really want them to take over health care also? I'd rather have the non-profit private sector take over because the private sector is forced to be efficient or else they will not survive. The government is inherently inefficient and only needs to increase taxes or print out more money and becoem in more debt--there is no pressure or accountability for it to be efficient in its use of tax payer money--hence the issues that we are facing today. Our government is also highly influenced and if not controlled by lobbyists including insurance industry and pharma so I'm sorry I would not want our government to do a take over of our health care system. The government's role should only be to prevent abuses from the various for-profit stakeholders I discussed in my previous post.

I would also like to see the taxes in those other nations--I bet you many of those countries have much higher taxes. And I would like to see a poll about how many people from those other nations would come to the US for health care services if they could. I bet you it would be a high percentage.

And although the US system is not completely government-run, I would still argue that it is one of the most government-regulated systems in the world. The US health care system has much more bureaucracy and unnecessary paperwork/administrative work than those other countries, both on the government-side and insurance industry-side.

Yeah I was just assuming the US government to be equally competent to other western governments, but I guess if your argument is that they are not then you do have a valid point to argue.

 

[DermViser]

Yeah I was just assuming the US government to be equally competent to other western governments, but I guess if your argument is that they are not then you do have a valid point to argue.

After the VA scandal, this is definitely not the case.

 

[calvnandhobbs68]

They're not available mainly bc it's effectively rationed by their govt. In a completely single payer system, if a treatment is deemed too expensive and the govt. believes that it's not "worth" it, then you don't get it. Not difficult to understand.

Come on dude the rationing argument is BS and everyone knows it. People get effectively "rationed" with insurance companies all the time. I never got how people picture these evil government "death panels" as any different than the "cost efficiency" insurance executives in their Armani suits gleefully cackling as they hit DENY on the pre-approval form,

 

[DermViser]

Come on dude the rationing argument is BS and everyone knows it. People get effectively "rationed" with insurance companies all the time. I never got how people picture these evil government "death panels" as any different than the "cost efficiency" insurance executives in their Armani suits gleefully cackling as they hit DENY on the pre-approval form,

Not when a physician sends in an appeals letter. Then for essentially bad PR and fear of lawsuits, private insurance companies give in. Private insurance has an appeals process for a reason.

 

[@JackShephard]

Our healthcare system could also be more "efficient and cost effective" by hiring NPs and PAs instead of physicians. Doesn't mean it's good for our healthcare system. Hospitals have to recoup their losses and costs to maintain equipment as well as pay the salaries of nurses, doctors, techs, etc. Your utopia of a lean, mean healthcare system won't last, at least not without consequences - Pharma not putting as much money into research to bring new drugs on the market, bc the govt. has already stated they won't pay for it, due to cost.

You may not like how the healthcare system works for the collective, but as an individual, I am fine with it.

If I had to choose between new magic drugs that cost 10 times more than in other countries vs. less that gives us Rx's at 1/10 the cost, I would take the later.

More than half the time these new wonder drugs come out, they aren't any better than our previous therapies and they costs 10 times more.

Here's a few examples:


2nd generation antipsychotic vs 1st gen:
http://www.madinamerica.com/2012/09...trapyramidal-side-effects-as-much-as-1st-gen/

According to researchers from Yale and the U.K., the improvements in extrapyramidal side effects expected from 2nd-generation antipsychotics has not been realized, while the risk of “life-shortening metabolic disturbances” from 2nd-generation is real enough to warrant a place for the use of 1st-generation antipsychotics; a prospect with implications for education because “a generation of psychiatrists how has little or no experience with first-generation antipsychotic prescription.” Full text of the study appears online in the British Journal of Psychiatry.

What are the cost differences? Here's a list someone compiled:

DRUGWalgreens CVS Sam’s ClubIndependent
Risperidone (Risperdal brand), 3mg$339$385$292$295
Risperidone (generic), 3mg$170$203$150$ 46
Quetiapine (Seroquel brand), 25mg$ 85$103$ 82$ 97
Quetiapine (Seroquel brand), 200mg$265$324$262$262
Haloperidol (Haldol brand), 5mg$ 10$ 11$ 4$ 28
Aripiprazole (Abilify brand), 10 mg$449$542$440$450

So people are paying $400 instead of $20-30 for drugs that work similarly (I'm referring to all 1st gen antipsychotics vs 2nd gen in this case).

How about ophthomology using Lucentis over Avastin, which cost $2,000 and $50 respecitively - yet again a
http://www.washingtonpost.com/blogs...ic-medicare-pricing-is-look-to-ophthalmology/

A dose of Avastin costs only $50. A dose of Lucentis costs $2,000.Both Avastin and Lucentis are made by the same company, and they're remarkably effective in treating a form of macular degeneration that was long the leading cause of blindness among the elderly, The Post reported. They are very similar on a molecular level and probably cost about the same amount to manufacture.

Nonetheless, doctors prescribe Lucentis almost as often as Avastin. They also make more money doing so. Medicare is legally obliged to pay for any drug a doctor prescribes, and doctors also receive commissions of 6 percent to cover their own expenses. The commission a doctor collects on each dose of Avastin would be only about $3, as opposed to $120 on each dose of Lucentis. Congress and the courts have refused to allow Medicare to save money by scrutinizing doctors' decisions.

NIH-funded study finds Avastin, Lucentis equivalent in treating AMD

As part of the study, one-year data from which were published in the NEJM in May 2011, patients were randomised to receive either monthly doses of Avastin or Lucentis or either of the drugs dosed only when signs of active neovascularisation were present. At two years, results showed that visual acuity with monthly treatment was slightly better than with as-needed dosing, regardless of the drug, the NIH said. As measured on an eye chart, monthly treatment resulted in a mean improvement of about half a line more than as-needed dosing. Switching to as-needed treatment after one year of monthly treatment yielded outcomes nearly equal to those obtained with as-needed treatment for the full two years, the agency added.

So we have 2 drugs that are working similarly and have been shown to be similarly effective, yet we buy the $2,000 drug in droves and forget the $50 drug. Why? Because there are no cost controls. The doc makes more for Rx'ing the $2,000 drug, the patient doesn't care because they have insurance, the insurance company has to pay it because they included it in their plan, on and on... no cost control.

So yes, if you're talking about keeping scams like this going on for the purpose of more R&D, no thanks. If R&D can be done without scamming Americans (btw, we're paying for all this, this is all going to the national debt!), THEN I'm all for it.

As for NPs and PAs, our system is forcing the government to hire cheap labor. Costs are out of control. I don't want to see NPs playing doctor either, but do I understand the $ play the government is making? Yeah. They are running out of money and the train is about to fly off the cliff.

 

[@JackShephard]

Come on dude the rationing argument is BS and everyone knows it. People get effectively "rationed" with insurance companies all the time. I never got how people picture these evil government "death panels" as any different than the "cost efficiency" insurance executives in their Armani suits gleefully cackling as they hit DENY on the pre-approval form,

I agree with this also.

We use a different form of rationing here.

 

[DermViser]

If I had to choose between new magic drugs that cost 10 times more than in other countries vs. less that gives us Rx's at 1/10 the cost, I would take the later.

More than half the time these new wonder drugs come out, they aren't any better than our previous therapies and they costs 10 times more.

Here's a few examples:


2nd generation antipsychotic vs 1st gen:
http://www.madinamerica.com/2012/09...trapyramidal-side-effects-as-much-as-1st-gen/


What are the cost differences? Here's a list someone compiled:

DRUGWalgreens CVS Sam’s ClubIndependent
Risperidone (Risperdal brand), 3mg$339$385$292$295
Risperidone (generic), 3mg$170$203$150$ 46
Quetiapine (Seroquel brand), 25mg$ 85$103$ 82$ 97
Quetiapine (Seroquel brand), 200mg$265$324$262$262
Haloperidol (Haldol brand), 5mg$ 10$ 11$ 4$ 28
Aripiprazole (Abilify brand), 10 mg$449$542$440$450

So people are paying $400 instead of $20-30 for drugs that work similarly (I'm referring to all 1st gen antipsychotics vs 2nd gen in this case).

How about ophthomology using Lucentis over Avastin, which cost $2,000 and $50 respecitively - yet again a
http://www.washingtonpost.com/blogs...ic-medicare-pricing-is-look-to-ophthalmology/


NIH-funded study finds Avastin, Lucentis equivalent in treating AMD



So we have 2 drugs that are working similarly and have been shown to be similarly effective, yet we buy the $2,000 drug in droves and forget the $50 drug. Why? Because there are no cost controls. The doc makes more for Rx'ing the $2,000 drug, the patient doesn't care because they have insurance, the insurance company has to pay it because they included it in their plan, on and on... no cost control.

So yes, if you're talking about keeping scams like this going on for the purpose of more R&D, no thanks. If R&D can be done without scamming Americans (btw, we're paying for all this, this is all going to the national debt!), THEN I'm all for it.

As for NPs and PAs, our system is forcing the government to hire cheap labor. Costs are out of control. I don't want to see NPs playing doctor either, but do I understand the $ play the government is making? Yeah. They are running out of money and the train is about to fly off the cliff.

No one's talking about drugs that are just coming off the market. Great strawman.

Also newsflash, NPs are fighting for reimbursement ON THE SAME LEVEL as physicians. So no savings there - better look elsewhere.

 

[DermViser]

If I had to choose between new magic drugs that cost 10 times more than in other countries vs. less that gives us Rx's at 1/10 the cost, I would take the later.

More than half the time these new wonder drugs come out, they aren't any better than our previous therapies and they costs 10 times more.

Here's a few examples:


2nd generation antipsychotic vs 1st gen:
http://www.madinamerica.com/2012/09...trapyramidal-side-effects-as-much-as-1st-gen/


What are the cost differences? Here's a list someone compiled:

DRUGWalgreens CVS Sam’s ClubIndependent
Risperidone (Risperdal brand), 3mg$339$385$292$295
Risperidone (generic), 3mg$170$203$150$ 46
Quetiapine (Seroquel brand), 25mg$ 85$103$ 82$ 97
Quetiapine (Seroquel brand), 200mg$265$324$262$262
Haloperidol (Haldol brand), 5mg$ 10$ 11$ 4$ 28
Aripiprazole (Abilify brand), 10 mg$449$542$440$450

So people are paying $400 instead of $20-30 for drugs that work similarly (I'm referring to all 1st gen antipsychotics vs 2nd gen in this case).

How about ophthomology using Lucentis over Avastin, which cost $2,000 and $50 respecitively - yet again a
http://www.washingtonpost.com/blogs...ic-medicare-pricing-is-look-to-ophthalmology/


NIH-funded study finds Avastin, Lucentis equivalent in treating AMD



So we have 2 drugs that are working similarly and have been shown to be similarly effective, yet we buy the $2,000 drug in droves and forget the $50 drug. Why? Because there are no cost controls. The doc makes more for Rx'ing the $2,000 drug, the patient doesn't care because they have insurance, the insurance company has to pay it because they included it in their plan, on and on... no cost control.

So yes, if you're talking about keeping scams like this going on for the purpose of more R&D, no thanks. If R&D can be done without scamming Americans (btw, we're paying for all this, this is all going to the national debt!), THEN I'm all for it.

As for NPs and PAs, our system is forcing the government to hire cheap labor. Costs are out of control. I don't want to see NPs playing doctor either, but do I understand the $ play the government is making? Yeah. They are running out of money and the train is about to fly off the cliff.

Have you looked at the safety profile of Avastin and why opthalmalogists are sometimes weary about using it??

http://www.nytimes.com/2014/04/10/b...aller-than-medicare-data-makes-them-look.html

http://www.bbc.com/news/health-17956425

 

[BestDoctorEver]

You may not like how the healthcare system works for the collective, but as an individual, I am fine with it.

I don't think this should be an individual thing... If you think our healthcare system does not need MAJOR overhaul, I guess the other posters are wasting their time arguing with you... I don't presume to know what these changes should be, but if we are spending twice as much more than other industrialized nations with no better outcomes, we must be doing something wrong.

 

[DermViser]

I don't think this should be an individual thing... If you think our healthcare system does not need MAJOR overhaul, I guess the other posters are wasting their time arguing with you... I don't presume to know what these changes should be, but if we are spending twice as much more than other industrialized nations with no better outcomes, we must be doing something wrong.

Yes, and like I said those outcomes are calculated differently in different countries , thus messing up the numbers (i.e. infant mortality) as well as confounded by different factors: lifestyle, eating habits, heterogeneous population, etc.

 

[@JackShephard]

Have you looked at the safety profile of Avastin and why opthalmalogists are sometimes weary about using it??

http://www.nytimes.com/2014/04/10/b...aller-than-medicare-data-makes-them-look.html

http://www.bbc.com/news/health-17956425

Are you serious?

Is this what you're referring to?

'Serious safety concerns'
The greatest debate over the differences between the two drugs is likely to be over safety when used to treat wet AMD. Academics say overall, both drugs are extremely safe.

As they both target blood vessels, the IVAN researchers particularly looked at whether there was an increased risk of heart attack or stroke.

Professor Chakravarthy said the IVAN team was surprised to see a very slight increase in risk from Lucentis, but when the data was combined with the US research it became insignificant.

"Both drugs were equally safe, and the small differences that were found in terms of heart attack and strokes were cancelled out when we looked both at our study and the American study.

"In terms of other adverse events which put patients in hospital - these differences were consistent in both studies and we did observe a slight increase with Avastin."

Novartis argues that Lucentis has a safety profile proven in clinical trials and approved by the regulators.

It says the US research, which has just published data from the second year, highlights what it describes as "serious safety concerns" about the use of Avastin in this unlicensed treatment of eyes.

It points, for example, to a higher rate of stomach and gut disorders in patients given Avastin.

Tim Wright, the global head of development for Novartis pharma, said: "This underscores the importance of drug design and development with the patient and disease process in mind."

So we pay $2,000 instead of $50 for slight differences that were "cancelled out when looking at both studies"?

Not to mention the average onset of the disease being treated is 65 years old. We need to make serious choices about cost savings, and YES - paying $2,000 instead of $50 for minimal or even non existent benefits on patients in their 60's and 70's are things that need to be considered.

The reality is, if there is ANY benefit, then it's considered better - regardless of the cost, regardless of practicality. Let's spend $20,000 on this patient because it may be better than this $500 treatment. Insurance will pay for it (i.e. the national debt).

Atul Gawande has a new book coming out on this very topic: Being Mortal. Is it ok for us to make decisions to stop doing every possible thing in the book at any possible cost on elderly patients? This is a critical debate because it has the ability to bankrupt our entire system.

http://us.macmillan.com/beingmortal/AtulGawande

Anyway, I'm done for now. It's very clear the American system is way out of control, there is nothing to control costs, and that we're going to be in a huge pickle in 10 years. Paying $2000 for eye drugs on seniors when there are $50 drugs that work equally as well and likely as safe, is a perfect example. As are all these:

By the way, these are the negotiated prices! These are NOT billed prices or manipulated data.



Average prices

Gleevec:
New Zeland: $989
US: $6,200

Reflux drug:
Netherlands: $33
US: $215

CT scan abdomen:
Spain: $94
US: $896

MRI
Switzerland: $138
US: $1,145

Hospital costs per day:
Spain: $481
US: $4,293
US 95th percentile: $12,726

Appy:
Argentina: $1,723
US: $13,910

Child Delivery:
Argentina: $2,237
US: $10,002

C-section:
Spain: $2,844
US: $15,240

Knee Replacement:
Argentina: $6,015
US: $25,398

 

[DermViser]

Are you serious?

Is this what you're referring to?


So we pay $2,000 instead of $50 for slight differences that were "cancelled out when looking at both studies"?

Not to mention the average onset of the disease being treated is 65 years old. We need to make serious choices about cost savings, and YES - paying $2,000 instead of $50 for minimal or even non existent benefits on patients in their 60's and 70's are things that need to be considered.

The reality is, if there is ANY benefit, then it's considered better - regardless of the cost, regardless of practicality. Let's spend $20,000 on this patient because it may be better than this $500 treatment. Insurance will pay for it (i.e. the national debt).

Atul Gawande has a new book coming out on this very topic: Being Mortal. Is it ok for us to make decisions to stop doing every possible thing in the book at any possible cost on elderly patients? This is a critical debate because it has the ability to bankrupt our entire system.

http://us.macmillan.com/beingmortal/AtulGawande

Anyway, I'm done for now. It's very clear the American system is way out of control, there is nothing to control costs, and that we're going to be in a huge pickle in 10 years. Paying $2000 for eye drugs on seniors when there are $50 drugs that work equally as well and likely as safe, is a perfect example. As are all these:

No, if you research it, Avastin has to be sent to compounding pharmacies to deal with sterility issues involved with repackaging Avastin for injection into the eye as it was not made for AMD originally but for cancer.

 

[mirabelle]

" What’s true of the eight-hundred-pound gorilla is true of the colossus that is the pharmaceutical industry. It is used to doing pretty much what it wants to do. The watershed year was 1980. Before then, it was a good business, but afterward, it was a stupendous one. From 1960 to 1980, prescription drug sales were fairly static as a percent of US gross domestic product, but from 1980 to 2000, they tripled. They now stand at more than $200 billion a year.6 Of the many events that contributed to the industry’s great and good fortune, none had to do with the quality of the drugs the companies were selling."
"State governments, too, are looking for ways to cut their drug costs. Some state legislatures are drafting measures that would permit them to regulate prescription drug prices for state employees, Medicaid recipients, and the uninsured. Like managed care plans, they are creating formularies of preferred drugs. The industry is fighting these efforts—mainly with its legions of lobbyists and lawyers. It fought the state of Maine all the way to the US Supreme Court, which in 2003 upheld Maine’s right to bargain with drug companies for lower prices, while leaving open the details. But that war has just begun, and it promises to go on for years and get very ugly."
"In 2000, Congress passed legislation that would have closed some of the loopholes in Hatch-Waxman and also permitted American pharmacies, as well as individuals, to import drugs from certain countries where prices are lower. In particular, they could buy back FDA-approved drugs from Canada that had been exported there."
"Clearly, the pharmaceutical industry is due for fundamental reform. Reform will have to extend beyond the industry to the agencies and institutions it has co-opted, including the FDA and the medical profession and its teaching centers"


Source: http://www.nybooks.com/articles/archives/2004/jul/15/the-truth-about-the-drug-companies/?page=3

 

[DrBodacious]

I don't think they are irrelevant.

How do we know both figures aren't the billed amounts (The American and the other country)? The reality is that they bill that amount because they can collect that amount sometimes (be it 1 or 10% of the time). They can also sue for that much on non paying patients. If the billing # had no meaning, then they wouldn't bill it - they would bill lower.

You are just making it apparent that you don't have perspective here. The reality is that billed amounts are not high because docs are expecting to get paid that amount, but so that you don't have to maintain fee schedules for hundreds of Cpt codes for 20 different payors that change at different times. Payor A pays well for procedures 1, 2 and 3, and payor B pays well for procedures 4, 5 and 6. Then in 6 months they revise to be the opposite.

It would be exceedingly rare to sue a non-paying patient. They go to collections and then the collection company takes 30% or more. Usually cash pay is a different discounted fee schedule. If the patient is poor you usually get paid nothing, regardless.

There is a lot of charity care that goes on in the US.

 

[@JackShephard]

You are just making it apparent that you don't have perspective here. The reality is that billed amounts are not high because docs are expecting to get paid that amount, but so that you don't have to maintain fee schedules for hundreds of Cpt codes for 20 different payors that change at different times. Payor A pays well for procedures 1, 2 and 3, and payor B pays well for procedures 4, 5 and 6. Then in 6 months they revise to be the opposite.

It would be exceedingly rare to sue a non-paying patient. They go to collections and then the collection company takes 30% or more. Usually cash pay is a different discounted fee schedule. If the patient is poor you usually get paid nothing, regardless.

There is a lot of charity care that goes on in the US.

The discussion moved to data with actual payed amounts - not billed amounts. I don't think it's beneficial to argue about what we both don't know or can prove (i.e. you state that "billed amounts are not high because docs" (docs don't even set the billed amounts, btw - hospitals do) "are expecting to get paid that amount, but so that you don't have to maintain fee schedules for hundreds of Cpt codes for 20 different payors".

Anyway, this is a side issue at this point, my recent list posted above included the actual amount paid by insurers - not billed amounts. Which strangely enough, were very similar to the #'s quoted earlier in some categories.

 

[Trek19]

This is one of the worst "studies" I've ever read. With garbage like this being pumped out constantly is there any surprise that we are awash in climate-deniers and anti-vaxxers? People are getting the sense that they are being lied to and manipulated- that the statistics are being massaged to further some agenda.

And to try to pass off the UK as the highest ranked healthcare system...with the highest wait times in the past 6 years, incentives for killing off tens of thousands of patients, and fraudulently screwing with waitlist times to give the illusion of swift care. May as well throw the VA in at number 2, given that they share notes.

To anyone who sees this study and decides to share it as a "fellow traveler" - stop it. You are destroying our credibility.

 

[DermViser]

This is one of the worst "studies" I've ever read. With garbage like this being pumped out constantly is there any surprise that we are awash in climate-deniers and anti-vaxxers? People are getting the sense that they are being lied to and manipulated- that the statistics are being massaged to further some agenda.

And to try to pass off the UK as the highest ranked healthcare system...with the highest wait times in the past 6 years, incentives for killing off tens of thousands of patients, and fraudulently screwing with waitlist times to give the illusion of swift care. May as well throw the VA in at number 2, given that they share notes.

To anyone who sees this study and decides to share it as a "fellow traveler" - stop it. You are destroying our credibility.

When you put your healthcare system under the control of the govt. (the NHS or the VA) you give up certain things. Notice the ones (politicians and bloggers) who used to trumpet LOUDLY how great the VA was and should be a model for healthcare are shutting their mouths now. Even an MS-3, who usually knows nothing about healthcare economics, knows how bad VA healthcare is.

 

[Trek19]

When you put your healthcare system under the control of the govt. (the NHS or the VA) you give up certain things. Notice the ones (politicians and bloggers) who used to trumpet LOUDLY how great the VA was and should be a model for healthcare are shutting their mouths now. Even an MS-3, who usually knows nothing about healthcare economics, knows how bad VA healthcare is.

It's true. No healthcare provider should work under administrators with as much power over them as we see with the VA and NHS. It is an environment that breeds atrocity. I hear people making fun of fat-cat insurance execs, but they apparently have never heard of immoral admins hungry for bonuses. The insurance execs don't control our employment opportunities and license the way the admins can.

 

[DrBodacious]

The discussion moved to data with actual payed amounts - not billed amounts. I don't think it's beneficial to argue about what we both don't know or can prove (i.e. you state that "billed amounts are not high because docs" (docs don't even set the billed amounts, btw - hospitals do) "are expecting to get paid that amount, but so that you don't have to maintain fee schedules for hundreds of Cpt codes for 20 different payors".

Anyway, this is a side issue at this point, my recent list posted above included the actual amount paid by insurers - not billed amounts. Which strangely enough, were very similar to the #'s quoted earlier in some categories.

Again you are demonstrating your ignorance. I am in practice and I set my billed amounts where I want to. Hospitals do the same with facility fees. It is all irrelevant.

The other examples from the 2013 report you picked are not very impressive. They need to be thought of in a much larger context. I don't really care how much a c-section costs in Finland, I am not taking my wife there for our delivery.

And frankly, most of the average prices are fairly reasonable when you look at what goes in to them.

The main inefficiencies on how to cut costs are from oversight.

One example : My surgery center gets dinged on an inspection because they don't purchase single dose packages of otic antibiotics, which costs 20 times more per dose than the already expensive 15 ml bottle. It is apparently "safer" to use the single dose package.

Another example: The whole EHR initiative is expensive for everyone. CMS pays incentives, docs pay for licenses, subscriptions, hardware, IT, training. Productivity decreases as far as patients per day for many docs, while clinic visits are upcoded due to useless computer generated notes, so payors pay more for the same work. The main people who like this: information technology, EHR, and hardware companies.

You get people who think they know what they are talking about yapping about this problem or that problem, and that creates more and more costly regulations that supposedly "create a more efficient health care system. "

 

[@JackShephard]

The other examples from the 2013 report you picked are not very impressive. They need to be thought of in a much larger context. I don't really care how much a c-section costs in Finland, I am not taking my wife there for our delivery.

Ok, so let's use an example:

C-section:
Spain: $2,844
US: $15,240

I care that our average is $15,240 compared to $2,844 because that means it's likely possible for us to lower our costs of our system. That's not irrelevant when the same country is spending a large percentage less of GDP.

The main inefficiencies on how to cut costs are from oversight.

Ok, I agree.

Having too much oversight can be inefficient and not cost effective. Those were the two things I stated. I'm not sure how you think that oversight would be excluded from these two areas.

One example : My surgery center gets dinged on an inspection because they don't purchase single dose packages of otic antibiotics, which costs 20 times more per dose than the already expensive 15 ml bottle. It is apparently "safer" to use the single dose package.

Another example: The whole EHR initiative is expensive for everyone. CMS pays incentives, docs pay for licenses, subscriptions, hardware, IT, training. Productivity decreases as far as patients per day for many docs, while clinic visits are upcoded due to useless computer generated notes, so payors pay more for the same work. The main people who like this: information technology, EHR, and hardware companies.

Again, these are good examples of inefficiency. I've stated this on other threads too that our EHR initiative is poor and one of the major problems are there are so many different systems and they can't communicate with each other. Alongside the things you've stated above.

And yes, having stringent rules that impede productivity is inefficient... and charging 20 times more per dose than an already expensive 15 mL bottles screams not cost effective.

So I agree with everything you said, and it is supporting the very arguments I've made. I don't care to talk about billed amounts as you said, they are irrelevant. The fact that our unit prices cost 2, 5, 0r 10 times more is very relevant when you consider we don't have enough money for healthcare.