Understanding US Healthcare Systems

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thf214

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I am applying this cycle, and want to understand more about the healthcare system in the US for interviews and for my own benefit in preparation for being a physician. I have collected some reading material, but I was wondering if anyone had any good articles that would explain how our system works, what is wrong with it, how to fix it, etc and especially how it impacts physicians specifically.

Thanks in advance!
 
+1 and yes, I also used google. I'm hoping specifically for something detailed and comprehensive that is easily understandable, or that other people found particularly useful. I've read a lot of things but I'm still unclear on things like overall impact for doctors, how exactly it is going to be implemented, etc.
 
I have found these to be somewhat helpful. Putting these links in here so that the thread will get more attention and maybe someone will be able to put these articles into context with overall health care reform. It is such a big topic I don't want to think I'm getting the big picture when I'm really only looking at one vantage point of the issue at the loss of other perspectives.

http://www.physiciansfoundation.org...the_Decline_of_Physician_Private_Practice.pdf

http://www.amsa.org/AMSA/Libraries/Committee_Docs/HealthCareSystemOverview.sflb.ashx

http://www.amsa.org/AMSA/Libraries/Initiative_Docs/SinglePayer101.sflb.ashx
 
I actually appreciate this thread because I have little understanding on how healthcare actually works. Every time my parents explain it I tune out
 
I actually appreciate this thread because I have little understanding on how healthcare actually works. Every time my parents explain it I tune out
How do you know you want to practice medicine if you don't understand the healthcare system in which you will practice? Genuinely curious.
 
I don't care about the financial aspect I care about the patient and doctor relationship.
The more you understand the financial aspect, the better you might be able to treat your patient. The financial aspect doesn't just include your take home. Besides, are you telling me that after busting your butt during your pre-med years, pouring over applications, taking on significant loans, med school and then residency that you don't care about the "financial aspect"? How would you feel after all that getting paid maybe $25 an hour?

I hope you follow some of the links and find ways to get interested in the system you are about to commit a good chunk of your life to "indirectly". The decisions made by the government, insurance companies, hospitals, lawyers, etc will all have an impact on your relationship with your patient. Once you understand the general infrastructure things start to get more intriguing.
 
The more you understand the financial aspect, the better you might be able to treat your patient. The financial aspect doesn't just include your take home. Besides, are you telling me that after busting your butt during your pre-med years, pouring over applications, taking on significant loans, med school and then residency that you don't care about the "financial aspect"? How would you feel after all that getting paid maybe $25 an hour?

I hope you follow some of the links and find ways to get interested in the system you are about to commit a good chunk of your life to "indirectly". The decisions made by the government, insurance companies, hospitals, lawyers, etc will all have an impact on your relationship with your patient. Once you understand the general infrastructure things start to get more intriguing.

I'm actually going to have almost no debt so no worries there. I have a lot of shadowing hours so I feel I have a good grasp of the job. Plus I like to work hard. I don't do it to be rewarded I do it because I like it. If I didn't like it then I wouldn't do it.

I honestly don't care how everything works. I just care that I'm able to get my patients the medicine or procedures they need. Learning about the finicial aspects makes me mad. I talked to some doctors about it and some of the things drug companies/insurance companies do to hurt the patients is so sad. They seem to be heartless monsters. I have no interest at this time learning with that.
 
I'm actually going to have almost no debt so no worries there. I have a lot of shadowing hours so I feel I have a good grasp of the job.

I honestly don't care how everything works. I just rate that I'm able to get my patients the medicine or procedures they need. Learning about the finicial aspects makes me mad. I talked to some doctors about it and some of the things drug companies/insurance companies do to hurt the patients is so sad. They seem to be heartless monsters. I have no interest at this time dealing with that.

Well that's really one-sided. Personally, working for a drug company I'm really excited about our drug and the lives that will be saved. We have never hurt any of our patients and while I know the CEO and CSO have financial stakes in the production of this drug they are not horrible people. I can't defend insurance companies but seeing that you will get a paycheck from them as reimbursement they aren't something you really can't have any interest in.

Also, just because you don't like something isn't an excuse to avoid learning about it. Regardless, thinking "Big Pharma" and the horrible insurance companies are all heartless monsters you still have to play on the same field as them. I repeat, the more you understand about the field and players on that field the better you will play the game.
 
Well that's really one-sided. Personally, working for a drug company I'm really excited about our drug and the lives that will be saved. We have never hurt any of our patients and while I know the CEO and CSO have financial stakes in the production of this drug they are not horrible people. I can't defend insurance companies but seeing that you will get a paycheck from them as reimbursement they aren't something you really can't have any interest in.

Also, just because you don't like something isn't an excuse to avoid learning about it. Regardless, thinking "Big Pharma" and the horrible insurance companies are all heartless monsters you still have to play on the same field as them. I repeat, the more you understand about the field and players on that field the better you will play the game.

I'm not interested in playing the game. That's not what I want my life to be about.

I'm not saying drug companies can't do good. But the bottom line is they are companies and they are looking to make money. They aren't looking to do anyone any favors. I have just saw stuff like a drug company buying up generics to jack up prices and stuff like that. Or just plain insane prices on drugs with patents that are too long. Not saying they don't help in some areas but some of the stuff they do makes me sick to my stomach.
 
I'm not interested in playing the game. That's not what I want my life to be about.

I'm not saying drug companies can't do good. But the bottom line is they are companies and they are looking to make money. They aren't looking to do anyone any favors. I have just saw stuff like a drug company buying up generics to jack up prices and stuff like that. Or just plain insane prices on drugs with patents that are too long. Not saying they don't help in some areas but some of the stuff they do makes me sick to my stomach.
Am I way off base assuming you haven't worked in the real world?

I haven't sold my soul to the devil because I choose when to fight my battles. The relationship I established with my patients and their caregivers as a nurse is how I found particular battle I want to fight for them is exactly why I want to go to medical school. So I'm not saying give up your bleeding heart for medicine...you are going to have to develop a stronger stomach though otherwise you will just get trampled on.
 
Am I way off base assuming you haven't worked in the real world?

I haven't sold my soul to the devil because I choose when to fight my battles. The relationship I established with my patients and their caregivers as a nurse is how I found particular battle I want to fight for them is exactly why I want to go to medical school. So I'm not saying give up your bleeding heart for medicine...you are going to have to develop a stronger stomach though otherwise you will just get trampled on.

I couldn't agree more! Part of being a good doctor is practicing within the realm of reality. In order to care for your patients you have to be able to navigate the system (whether you agree or disagree with it).

Interestingly, the idea of medical insurance was originally started in US by doctors and hospitals as a method of advocating for their patients (look into the history of the Blue Cross and Blue Shield). Although I am not defending the current state of medical insurance in our country, everything isn't always black and white.

If you have some time, I recommend reading "Opposing viewpoints on health care." It's a very short book about 100 pages and it presents the various sides of the argument on multiple issues.
 
Am I way off base assuming you haven't worked in the real world?

I haven't sold my soul to the devil because I choose when to fight my battles. The relationship I established with my patients and their caregivers as a nurse is how I found particular battle I want to fight for them is exactly why I want to go to medical school. So I'm not saying give up your bleeding heart for medicine...you are going to have to develop a stronger stomach though otherwise you will just get trampled on.

You're joking right? Life saving new drugs in fields like HEP C and HIV are so prohibitively expensive that insurance won't cover the new version of them.

I understand you're trying to make that poster think, but to absolve drug companies of any responsibility is hilarious. They're for profit companies with stocks and shareholders, their primary responsibility is to their shareholders, not to the patients. You need to take a primer on the brand of capitalism that America preaches if you're really as naive as your words make you out to be.

As for the poster you're responding to, I do agree with you that understanding the system and being an advocate for reform is one way that providers can make a difference. If they want to be private practice and only accept insurance that pays them well, then thats a different issue altogether.
 
You can't be a successful physician if you "refuse to play the game." Also, the primary goal of a hospital is to make profit, not improve patient care. Sometimes those two can go hand-in-hand, sometimes they won't. You'll be screwed if you go against your hospital's policy just because "it makes you sick" or it won't improve the care you provide to patients. Bottom line is, you can't be an excellent physician if you're gonna be that g**d*** stubborn. The reality of medicine is full of BS that we all have to deal with, whether we like it or not.
 
You can't be a successful physician if you "refuse to play the game." Also, the primary goal of a hospital is to make profit, not improve patient care. Sometimes those two can go hand-in-hand, sometimes they won't. You'll be screwed if you go against your hospital's policy just because "it makes you sick" or it won't improve the care you provide to patients. Bottom line is, you can't be an excellent physician if you're gonna be that g**d*** stubborn. The reality of medicine is full of BS that we all have to deal with, whether we like it or not.

Correct me if I am wrong: But aren't the majority of hospitals non-profit? They are definitely concerned with maximizing their revenue, but since they don't have shareholders they aren't pressed as much as drug companies to make a "profit." However, as we all know the "non-profit" world is very complex. Although all of a non-profit's profit is suppose to go back to the organization, those hospital administrators definitely do get their cut. The CEO of the hospital I work at is making $1.4 million/yr as his base salary. He is probably making a lot more than if you factor in his bonuses and benefits. Compare that to the average salary of a doctor! Funny thing is there is also a lady under him with the title of "President". I don't really understand why these positions aren't the same thing, but I am sure she is also getting a nice cut!
 
Correct me if I am wrong: But aren't the majority of hospitals non-profit? They are definitely concerned with maximizing their revenue, but since they don't have shareholders they aren't pressed as much as drug companies to make a "profit." However, as we all know the "non-profit" world is very complex. Although all of a non-profit's profit is suppose to go back to the organization, those hospital administrators definitely do get their cut. The CEO of the hospital I work at is making $1.4 million/yr as his base salary. He is probably making a lot more than if you factor in his bonuses and benefits. Compare that to the average salary of a doctor! Funny thing is there is also a lady under him with the title of "President". I don't really understand why these positions aren't the same thing, but I am sure she is also getting a nice cut!
I just read somewhere that the goal of most hospitals is to maximize revenue. I'm not sure what the reality is. My main point was that you have to play by the hospital's rules no matter if you agree with them or not because they are the ones paying you (assuming you work in a hospital instead of private practice or concierge).
 
Read the wiki page on the US Healthcare system. Don't worry too much about the details.

Most of your questions regarding the healthcare system will be what you think the biggest problem is + your solution. In other words the best way to prepare would be to watch some videos from different sides on what/how they would fix. It's not like they're going to test you on the actual bureaucracy or the difference between various PPOs.
 
You're joking right? Life saving new drugs in fields like HEP C and HIV are so prohibitively expensive that insurance won't cover the new version of them.

I understand you're trying to make that poster think, but to absolve drug companies of any responsibility is hilarious. They're for profit companies with stocks and shareholders, their primary responsibility is to their shareholders, not to the patients. You need to take a primer on the brand of capitalism that America preaches if you're really as naive as your words make you out to be.

As for the poster you're responding to, I do agree with you that understanding the system and being an advocate for reform is one way that providers can make a difference. If they want to be private practice and only accept insurance that pays them well, then thats a different issue altogether.
Actually I am serious. The drug is revolutionary and not cost prohibitive which is why I sought to work for the company. I very much understand what I'm talking about but can't share specifics due to losing anonimity. My point wasn't to say that pharmaceutical companies don't have primarily financial stakes in their product. My point was that they aren't all these horrendous companies who value the dollar far above harming patients. That we shouldn't take such one-sided views on an entire industry just because there are some companies with no moral compass.
 
You're joking right? Life saving new drugs in fields like HEP C and HIV are so prohibitively expensive that insurance won't cover the new version of them.

I understand you're trying to make that poster think, but to absolve drug companies of any responsibility is hilarious. They're for profit companies with stocks and shareholders, their primary responsibility is to their shareholders, not to the patients. You need to take a primer on the brand of capitalism that America preaches if you're really as naive as your words make you out to be.

As for the poster you're responding to, I do agree with you that understanding the system and being an advocate for reform is one way that providers can make a difference. If they want to be private practice and only accept insurance that pays them well, then thats a different issue altogether.

Agreed 100% andd when I actually practice I'm going to learn the system
 
I am applying this cycle, and want to understand more about the healthcare system in the US for interviews and for my own benefit in preparation for being a physician. I have collected some reading material, but I was wondering if anyone had any good articles that would explain how our system works, what is wrong with it, how to fix it, etc and especially how it impacts physicians specifically.

Thanks in advance!

For those more wonky: http://theincidentaleconomist.com/wordpress/

Actually I am serious. The drug is revolutionary and not cost prohibitive which is why I sought to work for the company. I very much understand what I'm talking about but can't share specifics due to losing anonimity. My point wasn't to say that pharmaceutical companies don't have primarily financial stakes in their product. My point was that they aren't all these horrendous companies who value the dollar far above harming patients. That we shouldn't take such one-sided views on an entire industry just because there are some companies with no moral compass.

http://theincidentaleconomist.com/wordpress/treating-hepatitis-c-sofosbuvir/

cost doesn't seem to increase that much per "cure"
 
@jsquared91 cool link! Thanks for that. I used to be much more familiar with that stuff at my last job!
I think Trinurse doesn't work for gilead and is saying that her company is releasing a drug that isn't prohibitive. She hasn't said what it is or what it treats to remain anonymous.

Actually I am serious. The drug is revolutionary and not cost prohibitive which is why I sought to work for the company. I very much understand what I'm talking about but can't share specifics due to losing anonimity. My point wasn't to say that pharmaceutical companies don't have primarily financial stakes in their product. My point was that they aren't all these horrendous companies who value the dollar far above harming patients. That we shouldn't take such one-sided views on an entire industry just because there are some companies with no moral compass.

It's not a one sided view. The purpose of a company with shares is to make money for shareholders. They do what they must to make that happen, which usually happens with expensive one-off drugs. The fact that most big companies do trials in poor countries with more limited resources, which is ethically eh to begin with.

This is not saying that drug companies are evil. It is saying that they do what they do because it makes money. The 'greater good' approach is moot. They're just like banks and the number of players in the field is also shrinking the same way.
 
@jsquared91 thank you for the link! Reducing the cost of treating HCV over a 20 year period by 75% is quite impressive. I'll have to add that blog to my rss feed. I've gained a lot of interest in clinical research through my current position and have been opened up to a completely new way of understanding drug development. @ridethecliche you are correct in saying that I meant the drug my company is trialing isn't cost prohibitive. I'm not sure how familiar you are with "re-purposing" drugs but that's what we are doing with our drug currently. So the drug has already been approved by the FDA for a few specific uses and approved for compassionate off-label use. We are working to prove efficacy for a different therapeutic use.
http://www.ncats.nih.gov/research/r...urpose/therapeutic-uses/therapeutic-uses.html gives an overview of the idea.


I understand and agree with your point about companies with shareholders. Our company is relatively small and not publicly traded. This particular trial is funded through a grant. That being said, I know the end point is making money. There are, however, hundreds and thousands of ways to make money though. Some ways happen to help people in some fashion while other ways don't.

As for trials in poorer countries, I'm against. Clean clinical data is hard enough to obtain in more economically developed countries. I can't imagine trying to conduct a trial in underdeveloped countries for logistical reasons in addition to the ethical dilemma.[/user]
 
Yup. There's certainly a need for drug companies. Some do it better than others. Glad yours is on the better side!

Cheers!
 
@jsquared91 thank you for the link! Reducing the cost of treating HCV over a 20 year period by 75% is quite impressive. I'll have to add that blog to my rss feed. I've gained a lot of interest in clinical research through my current position and have been opened up to a completely new way of understanding drug development. @ridethecliche you are correct in saying that I meant the drug my company is trialing isn't cost prohibitive. I'm not sure how familiar you are with "re-purposing" drugs but that's what we are doing with our drug currently. So the drug has already been approved by the FDA for a few specific uses and approved for compassionate off-label use. We are working to prove efficacy for a different therapeutic use.
http://www.ncats.nih.gov/research/r...urpose/therapeutic-uses/therapeutic-uses.html gives an overview of the idea.



I understand and agree with your point about companies with shareholders. Our company is relatively small and not publicly traded. This particular trial is funded through a grant. That being said, I know the end point is making money. There are, however, hundreds and thousands of ways to make money though. Some ways happen to help people in some fashion while other ways don't.

As for trials in poorer countries, I'm against. Clean clinical data is hard enough to obtain in more economically developed countries. I can't imagine trying to conduct a trial in underdeveloped countries for logistical reasons in addition to the ethical dilemma.[/user]
Someone else that uses RSS still? Aren't many of us left.
 
I read this book for a class of mine called: The US Healthcare System.

Can't be more straightforward than that.

http://www.amazon.com/Your-Money-Life-Medicine-Americas/dp/0195181328

The author (David Cutler) served on the clinton administration and obama's health administration. It gives a pretty solid overview of the healthcare system (not specifically Obamacare) but if you know little to nothing about healthcare this will definitely educate you. One my favorite books in the area and it's a pretty short read.
 
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