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Technology and Cost in Healthcare

Discussion in 'Topics in Healthcare' started by QofQuimica, Dec 3, 2005.

  1. QofQuimica

    QofQuimica Seriously, dude, I think you're overreacting....
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    Historically, medical care was relatively cheap, but it was not particularly efficacious. Now that we have the technology and knowledge to perform all kinds of "miracle" procedures, we have problems with the average person being unable to pay for them. I wonder if we will reach a point where we can cure just about any medical problem, but no one could afford to take advantage of that except perhaps Bill Gates. Any thoughts about this?
     
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  3. bananaface

    bananaface Pharmacy Supernerd
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    Having the ability to cure every problem is an unrealistic aspiration.

    There are some biotech drugs out there that are unaffordable for many people. If they become economically unfeasible for drug companies to develop, I suppose they'd just quit developing them. This is what mostly happened with antibiotics.
     
  4. mustangsally65

    mustangsally65 Sally 2.0
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    My mom is 58, and when she has her physical every year her doc always wants her to have a colonoscopy, bone-density scan, and complete blood work as well as a mammogram and pap smear etc. It's not just the treatments that are expensive, but the diagnostic tests.

    I heard her talking about these procedures one day, and she said "Even if I could afford to have all the tests, I couldn't afford to do something about a problem if they found one." My parents don't have health insurance, and it's really sad. Diagnostic tests are so important, but of course a lot of people can't afford them.

    Preventative medicine would probably save a lot of money in the long run, but at the same time, it's expensive too. There's just no easy solution. :thumbdown:
     
  5. Law2Doc

    Law2Doc 5K+ Member
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    There are savings in volume. If everyone had an annual colonoscopy, the machines could be paid off quicker, and the cost per procedure would come down.
     
  6. bananaface

    bananaface Pharmacy Supernerd
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    "If" is a big word.
     
  7. almost_there

    almost_there Senior Member
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    I wrote about this in my Duke secondary. (along with, oh, about 100 other topics :eek: :laugh: )

    Gene therapy, stem cell research, etc., cloning, if and when they get to the therapeutic stage, will be necessarily hugely expensive, as each treatment needs to be tailored to the individual. Consider the possibility of creating perfectly matched organs. There is no way (at least for a good long period of time) that anyone but the very very wealthy will be able to afford these treatments. But they promise the potential to extend life, perhaps even much longer.

    So now we have the wealthy not only having more money, but much longer and healthier lives...?? Ah, my liver is failing because of all the drinking I do? Just get a perfect, YOUNG replacement. Damaged lungs? Easily replaced. Heart? Done. What kind of societal changes will this cause?

    Interesting topic... I'd like to live longer just to see how the world changes over the next 200 years... :)

    a_t
     
  8. MoosePilot

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    To me, technology leads to expectations which lead to unbearable costs. The poor don't expect to get the best car, but they do expect to get medical care on par with everyone else. Unfortunately, when medical care gets to the point where it's routinely delivering miracles, it's unrealistic.

    I think most of our advances in longevity and quality of life have come in the less expensive public health advances. Immunizations, care of pregnant women and babies to give everyone a good start, clean water, and advice on good food. Everything else is bonus.

    I'd like us to acknowledge that not everyone can have the best care available, so we can stop trying and start getting everyone basic care.
     
  9. almost_there

    almost_there Senior Member
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    :thumbup: An interesting observation about our health insurance system vis-a-vis european health insurance systems (from my health services prof):

    In the US, we increase our health insurance scope by deciding who gets it (e.g. kids, poor folks below the poverty line, etc.), but everyone who gets it gets EVERYTHING.

    In Europe, everyone gets health insurance, but they limit which services are covered, or to what degree it is funded (sorry for the overgeneralization of ALL European countries). This seems to lend itself well to what you're saying...

    a_t
     
  10. thinknofu3

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    In terms of how much technology costs, you're right, it is insanely expensive. But I have some academic background on this subject, and it seems to me that one of the problems is that these new technologies (in terms of scans, etc) are developed by engineers at private companies, who then have no incentive to make those machines affordable to hospitals. The hospitals have to fork out millions of dollars, and need the machines in order to say they have the latest technologies so they can attract more patients, but as a result have to charge the patients/insurance companies more to afford those machines. It's a giant catch-22. It'd be nice if there were some governmental (tax, etc) incentives to make these technologies more affordable; however in today's pro-big business political climate, that doesn't seem likely to happen. For the people who make the decisions (and get damn cheap health insurance thru the gov't), there is no incentive to change. It's sad.

    And in terms of preventative care...it is *absolutely* cheaper to have the diagnostic tests and preventative care. It is cheaper to give somebody $20 per month birth control then to pay for all the prenatal, delivery and infant care for a newborn. In addition, a mammogram, colonoscopy, etc is far cheaper than the surgeries, chemo etc needed to treat advanced stages of cancer. In addition, in purely economic terms, the more preventative medicine, the longer you keep people alive, and the longer you keep people alive, the longer they will continue to consume health care. So it's financially advantageous both short and long term.
     
  11. MoosePilot

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    But we're a capitalist nation. Why don't those private companies deserve what the market will bear? The took the risks, did the hard work, etc.
     
  12. Law2Doc

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    There are actually a ton of research credits and tax incentives for companies to develop medical technologies and drugs. It has been a hot topic in a number of elections (Bill Clinton drew ire from a lot of the medical community when he targetted pharmaceutical company incentives (especially the Puerto Rican R&D tax haven/credit) as the big problem in controlling health care costs yet at the same time embraced the insurance industry.) All the technologies you mention cost a lot at the start and then become cheaper either because they can be done at high volume or because they save money as preventative. The first MRI machine was prohibatively expensive and only major hospitals had one, but now many hospitals have several, and for many it is now a fairly routine diagnostic test covered by most insurance policies. Far more expensive cures, treatments and devices will soon emerge in the areas of genetic engineering - a field that is really just starting to net benefits, and is sure to take the lead in high-end priced medicine during our careers. Additionally, only with more research expense will be ever be able to get to cheaper and better solutions. We are on the right road, but people are going to have to accept, at least for the foreseable future, that the best medical care they can afford may not be the best medical care in existence. I see no benefit in making everybody, rich or poor, suffer through antiquated but cheap medical treatment if a cure is out there and they have the $. Rum was a cheaper anesthetic than ether, but thank goodness we did not halt anesthesiology at that juncture. The goal should be to forge on with research in the hopes that either cheaper alternatives will emerge, or the savings to the health care system from bona fide cures of things like cancer will someday allow the field to pass on savings to poorer consumers.
     
  13. bananaface

    bananaface Pharmacy Supernerd
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    That's not true at all. Many health plans wobble on whether they include specific services like dental, vision, preventative care, prescription coverage, lab tests (mine doesn't include those), and so forth. There are major medical only plans with enormous deductibles, and plans designed to cover everything under the sun. We are seeing more and more coinsurance where that patient pays a set percentage per service instead of a copay. Plans are definitely not all or nothing.

    In the last few years plan premiums have climbed while benefits have seemingly decreased. These plans, which are basically risk sharing groups, are being threatened by huge expenses from both new, expensive therapies and increased plan utilization. Those therapies which would be less expensive if more people were to use them are often becoming formulary exclusions.
     
  14. thinknofu3

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    The point about insurance being risk-sharing is a great point, which begs a different point. Personally, I believe that everybody should be required to have/purchase health insurance, the same way they do with car insurance. This would allow the risk to be spread over more people, which should bring down the overall cost to individuals. There are tons of young people in their 20s who choose not to have health insurance because they feel they are healthy. This may be true, but what about when they get in car accidents, etc and end up with $100,000 in medical bills?

    In addition, in terms of preventative care again, as of right now, insurance companies care only about how much money they can make/save in the short term, especially when it comes to HMOs. I agree that *all* people may not necessarily be "entitled" to the best possible care, but they are entitled to adequate care. And in my mind, waiting until somebody actually cancer to start giving a damn can never be considered adequate.
     
  15. almost_there

    almost_there Senior Member
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    Sorry, should have clarified -- I was talking about governmental safety net plans... (medicaid), not private health insurance plans. The characteristic I was trying (and clearly failing) to communicate was what we do in changes in amount of funding for medicaid: reduce or increase the population eligible for medicaid, vs. alter the covered services while keeping constant the eligible population.

    A sidebar is that the diversity of health insurance plans and what they cover and don't, and under what circumstances, is a big factor of what drives overhead in hospitals and doctors' offices...

    a_t
     
  16. jebus

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    Beyond cost and ability (and I'm sorry for going on a tangent, Q) I wonder just where priorities are. After talking with paraplegics, they think being able to walk again would be great, but they would be more content with smaller gains. Bladder and bowel control are chief among them - & they are more concerned with getting dignity back on those levels.
    Being able to cure everything is an admirable goal, but I think sometimes people miss the forest for the trees. (Of course, I have the opposite problem, and being able to focus would be really cool.)
     
  17. QofQuimica

    QofQuimica Seriously, dude, I think you're overreacting....
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    I wonder if this is really true, b/c if it were, wouldn't the insurance companies DO it? I mean, my health insurance will pay for me to have prenatal care, or even an abortion. But it will NOT pay for me to have BCPs. I can't fathom how it could be cheaper doing it this way. But evidently it is, or they'd be encouraging me to use BCP instead of covering me after I'm already pregnant. ;)

    NP, Desired; you bring up a good point. If we all agree (as we seem to) that we as a society can't have everything we desire in terms of health care, then what things should we focus on having for everyone (or at least as many people as possible)? I'd also cast my vote for focusing on preventive care and quality of life issues. But these things are not glamorous and do not make the evening news like dramatic face transplants do.
     
  18. bananaface

    bananaface Pharmacy Supernerd
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    There is quite a bit of variability in the Medicaid programs too. Each state gets to pick how it spends it's medicaid dollars, although there are some basic services which they are required to cover. In WA medicaid eligible patients are often assigned to or can pick from various HMOs. Not all medicaid programs are directly state administed.
     
  19. Scintillation

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    I imagine insurance companies are assuming that covering the cost of BCPs will probably become really expensive for them, in that, all the women on birth control will then opt to have their insurance cover the cost. However, the insurance companies could also refuse to pay for them and assume that most women will still take them anyway (i.e. they will buy them on their own). If women are taking BCPs, regardless of who is paying for them, then there won't be an increase in pregnancies (or at least not a large enough increase to offset money saved by refusing to cover the cost of BCPs). I assume this is their reasoning. The insurance companies are well aware that most women (who are currently on birth control) will pay 20$ a month to avoid the risk of getting pregnant.
     
  20. Starlight Estel

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    Actually, insurance companies are required by law in most (if not all) states to offer maternity coverage. Before these laws were passed, it was routine to have exclusions for pregnancy expenses, or to charge extra for a pregnancy rider on the insurance policy.
     
  21. QofQuimica

    QofQuimica Seriously, dude, I think you're overreacting....
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    Ok, so that makes sense. But I still don't understand why they wouldn't want to pay to prevent me from getting pregnant in the first place.
     
  22. bananaface

    bananaface Pharmacy Supernerd
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    There are fewer medical expenses associated with being on OCPs than pregnancy and delivery. It doesn't make good financial sense for them to be an outright formulary exclusion. My guess would be that the plan in question is a non-prevention oriented plan, which excludes all preventative services in exchange for a lower premium. Or, maybe it's just antiquated and more people need to call and ask for a formulary addition.
     
  23. QofQuimica

    QofQuimica Seriously, dude, I think you're overreacting....
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    We just need you to be our pharmacist, banana. :love: When are you going to be done with school???
     
  24. bananaface

    bananaface Pharmacy Supernerd
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    June 2007. :)
     
  25. Shredder

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    doesnt make economic sense. if theres demand for lower quality and cheaper treatments and products, it follows that suppliers should step in to serve that need unless legislation prevents it. and thats a big unless. its equivalent to wondering if the only TVs we have one day will be super 3D virtual reality TVs that cost a million dollars, leaving everyone else with nothing. witness the computer industry and draw an analogy to medicine. in medicine today it seems that everyone wants the medical version of a 3 Ghz thin screen laptop with DVD writer. nevermind the fact that its not within their means and they should be settling for the 1 Ghz desktop. as for the availability of that 1 Ghz option in medicine...? and as for reasons why it may not be available...?
     
  26. Shredder

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    moose youve really been on the mark lately :thumbup:
    public eugenics outcry. serious
     
  27. QofQuimica

    QofQuimica Seriously, dude, I think you're overreacting....
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    That would only make sense if they were forcing me to take them, or tricking me into doing it. But if I am voluntarily and knowledgeably doing so, who's going to cry out???
     
  28. Shredder

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    its one thing to kill babies, but its another to get paid for it. i dont have strong views on it, but many staunch pro lifers out there do. also humans arent chess pieces to be moved by making policies. they respond to incentives. the unintended consequence of giving money for abortions will lead to intentional pregnancies for money. most indigent folk wouldnt mind the moral repercussions of trading babies' lives for cash. as it is, govt subsidized abortions is a heated topic that puts politicians on the spot. thats nothing compared to going above and beyond abortions by giving payment. how to prevent ppl from making careers out of baby production?

    there are a lot of things that people can do voluntarily and knowledgeably but face outcry and bans. suicide, drugs, driving without a seat belt, biking without a helmet, seeing a doctor without a license. such is the "protection" of the citizens too foolish to decide right from wrong on their own.
     
  29. QofQuimica

    QofQuimica Seriously, dude, I think you're overreacting....
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    They already WOULD pay for me to have abortions. That's why I think their refusal to pay for BCPs is so pointless.
     
  30. bananaface

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    Government subsidized abortions does not mean the woman gets paid to abort. (Where did this ramdom idea come from? :confused: ) It means that the procedure is available to the patient at reduced or no cost. It's cost effective to the state to pay for abortions with welfare money, because raising a kid on the state's tab costs them more than the procedure.
     
  31. MoosePilot

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    Makes sense and yet is morally reprehensible. It would be cost effective to hire someone to shoot welfare recipients for the small bounty of one month's welfare check, too, but nobody would suggest that.
     
  32. Shredder

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    i was just thinking of saying: by that logic it would be cost effective to set up gas chambers and put up wanted dead or alive posters. a real financial boon. just in case, this is called sarcasm.
     
  33. bananaface

    bananaface Pharmacy Supernerd
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    Certainly, some people find abortion morally reprehensible. I don't. I think people should choose when to bear children. Fetuses are parasitic in nature, even if one accepts them as a human being with rights and all that. Forcing a woman to carry one is like forcing her to donate a part of her body to someone else so that they can live. We don't do that in any other circumstances, because most of us find it morally reprehensible. As well we should.
     
  34. Gut Shot

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    Wow, it's nice to see that wanton hyperbole is alive and well.
     
  35. MoosePilot

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    I do too. Failing to choose doesn't mean you get to kill the result of your voluntary action.
     
  36. bananaface

    bananaface Pharmacy Supernerd
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    Consenting to sex is not equivalent to consenting to pregnancy. (And, not everyone consents to sex.)
     
  37. MoosePilot

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    Not everyone consents to sex, but if you want, we can assume abortion being ok in that instance, just to make it simpler.

    Consent has to be to someone. Choosing to have sex is as close to consenting to pregnancy (or the risk of it) as is possible.
     
  38. MollyMalone

    MollyMalone I'm a Score Quadruplet
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    The greatest advance of the last 50 years is that this is no longer true.

    When I get in my car, even if I drive as safely as possible, there is a chance that I may get into an accident. This does not mean that I am *consenting* to being blindsided by a dump truck.

    When I have sex, even if I correctly use birth control, there is still a chance that I may become pregnant. This does not mean that I am *consenting* to conception.
     
  39. bananaface

    bananaface Pharmacy Supernerd
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    If birth control methods are attempted, consent to pregnancy isn't reasonably in place.
     
  40. Scrub MD

    Scrub MD Senior Member
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    Are you freaking crazy?



    Bullets are way cheaper!!! (Sarcasm added for humoral effect) j/k
     
  41. MoosePilot

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    I'm sorry, did you two not get the insert that mentioned that no form of birth control is 100% effective? Did you not understand it?

    You know that you're taking a risk. You choose to take that risk. At this point we're debating the definiton of consent and usually in internet arguments that's the point to stop.
     
  42. MollyMalone

    MollyMalone I'm a Score Quadruplet
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    Since I said in my post that there is a chance of becoming pregnant even when correctly using birth control, I think it's blindingly obvious that I understand that there is a risk.

    I agree that the discussion at this point does revolve around the definition of consent. Since this is a tangent to the main point of the thread, I think it's reasonable to let it lie here.
     
  43. Shredder

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    messy and doesnt scale up well. but i wont pursue that line of potentially offensive analogy anymore
    as are many members of society
     
  44. Gij

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    I want to say that, I agree to a great extent with what you are saying about no incentive being out there for developing CHEAP technology. Free market to me is somewhat like natural selction. When there is food (in market = $) to go around you'll see life in the form of dinosaurs with plenty of appetite. Current technologies are designed that way, and there is no reason to change it. I believe as a byproduct of moving towards a government-run (maybe the term makes it sound bad but you see this in many industrial countries) healthcare system, a more evenly distribution of resources stops (or reduces) development of expensive technologies. Imagine if your only customers were those living in the developing world, then you had to focus not only on effective but also on cheap technology. I should say that at the academic level there is a move towards making inexpensive medical technology, but industry is far behind.

    I agree that from the point of patient care focus on prevention is ALWAYS better than treatment. However when it comes to cost, prevention is not always cost-effective. Example: Getting everybody to have EBCT (electron beam CT) for CHD is not cost-effective. I believe treatment of hyperlipidimia for patients (without CHD) with statin drugs is also not cost-effective. There are many technologies and drugs that are out there and might have some preventive benefits, but when you multiply the individual costs by the number of people, they don't benefit the public enough (by measurable parameters such as mortality rate) to justify the huge cost.
     
  45. Larch

    Larch Hero of my own life.
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    I would just like to point out one very simple peice of logic that I have seen ignored time and again...

    Consenting to sex (even consenting to completely unprotected sex for one reason or another) may imply an acceptance of the risk of pregnancy. HOWEVER, such consent does not indicate how such a pregnancy would be treated. A woman may very well think, "I understand that I could get pregnant, and if that should happen I will have an abortion." Whether or not people think that this is moral or intelligent doesn't matter. The fact is that it is legal.

    All the arguments that say "consent to sex is consent to full term gestation and delivery" are assuming that abortion is already illegal or restricted only to cases of nonconsentual sex, risk to the mother's health, or fetal abnormality. Since this isn't the case, those of you opposed to theraputic abortion should frame this particular argument more like, "I think that consent to sex SHOULD imply consent to continuing any subsequent pregnancy." Then, you should talk about what changes to abortion law would be required in order to make this the case.

    Then think about how rational such revisions would be and whether or not they could actually be implemented logistically or without infringing on privacy rights.
     
  46. sdn1977

    sdn1977 Senior Member
    10+ Year Member

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    I disagree...a few years back - about 8 perhaps, insurance companies made the choice to disallow OCP under the same umbrella logic of disallowing drugs for erectile dysfunction. The companies did not want to allow payment for the erectile dysfunction drugs claiming they were "lifestyle" medications and not required for a "disease". Groups sued the insurance companies claiming discrimination since they covered OCP, so all of them got swept out of coverage - even though their arguments were not medically sound. However, this is state by state.....here in CA, we have insurance plans which do and don't cover medications for erectile dysfunction, but all of them cover contraceptives of all types in addition to Plan B. Medicaid (or what used to be medicaid...covered all contraceptives & Plan B, but not erectile dysfunction). So...that is how the conservative political influence of some states has influenced insurance coverage.....lots of funny stories like that!
     
  47. bananaface

    bananaface Pharmacy Supernerd
    Pharmacist Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

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    I'm confused as to what part(s) of my post you disagree with. The content doesn't seem mutually exclusive. :confused:
     

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