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Health Service Costs - 4/24/2009 3:31:08 PM

philosophy

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...from another thread, reposted here so we can avoid a total hijack....and because Orion brings up an interesting point.......

quote:

Based upon the US Governments past record for handling things, I think it would be an abysmal mess. My family used to have a Durable Medical Supply company, and Medicare sets the prices. The prices are set so that everyone makes a huge profit off the government. Think of a 400% mark up or more on many big dollar items such as hospital beds for the home, electric powered wheelchairs, etc.

They also have a scheme set up that is worse than insurance companies, for getting the paperwork through and actually getting paid. All Medicare bills were set to 90 to 180 terms, and that is the projection you used to manage your cash flow.

Invacare used to be one of the top wholesalers of medical supplies to stores such as my families, but they saw that being a large corp they could do online and phone retail sales and make and even larger profit. Do not even get me going about the "Scooter Store".

If the government touches anything, you might as well expect the cost to triple.

If you would like to start this part on it's own topic I can try and dig up some old price schedules and such for Medicare, and what the items were going for retail 5 years ago. This will give you a good idea of how Medicare sets the market price, so there is no price competition.

.....the UK health service has a sister organisation called NICE. National Institute for Clinical Excellence. Bit of a misnomer as it's basically a value for money watchdog. Legislation is set up so that the NHS can't buy stuff that NICE hasn't already tested for value for money. Actually causes a few problems....or at least moral dilemmas. For instance, imagine an experimental drug for cancer......very expensive but not yet shown to be effective. As NICE wont sanction it the NHS wont pay for it. Pisses some people off, but it does stop costs spiralling out of control. Sort of triage on a macro-financial scale.

Could not a US national health service have a similar thing controlling its costs.......

< Message edited by philosophy -- 4/24/2009 3:32:40 PM >

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RE: Health Service Costs - 4/24/2009 4:38:44 PM

Crush

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My question then is "Does such a system work against innovation and research, since there is no/low reward ?"

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RE: Health Service Costs - 4/24/2009 4:48:38 PM

OrionTheWolf

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Okay a quick expensive item that I can remember the costs and charges on pretty easily. Electric wheelchairs wholesale for about $899 to $1299 depending on sales a wholesale company is having. We had four different ones that we kept an eye on and bought them regularly at about $999. Now this is buying from the middle man, which is being eliminated quickly by wholesalers setting up a retail portion that they have. The chair includes a batter. The cushion has to be Medicare approved and you can get them for about $79 wholesale. The entire unit will bill out at about $4800 to $5200 depending on model and size.

That price is set by Medicare as the max amount they will pay, and since 95%+ of the sales were to Medicare, that sets the price. Medicare states they will only pay 80%, so the end price is actually marked up to compensate. If there is no secondary insurance, you send the patient a bill for a year, and then write it off at the end of the year. Writing off bad debt lowers a companies taxable income.

There is one of the examples I promised on the other topic.

Now to address yours. The best way to control cost of medical care is at the source or at the outlet. The example you give is controlling it at the outlet, meaning people will need to qualify to get expensive medical treatment. The formula they use is life expectancy, modifiers for the patients condition of health, and the cost of the procedure. This means Granny may not get that kidney she needs, because she is 65 (arbitrary age as I have no clue of the exact formulas).

Another question would be: Does the health care industry keep the elderly alive beyond a decent quality of life? Is this an unnecessary drain on medical costs?

Don't get me wrong, I have a 77 year old Mother and 81 year old Father that is in my household and we take care of. If not for us they would be cloistered away in a nursing home.

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RE: Health Service Costs - 4/24/2009 5:11:16 PM

Crush

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quote:

Another question would be: Does the health care industry keep the elderly alive beyond a decent quality of life? Is this an unnecessary drain on medical costs?

This starts that slippery slope, doesn't it?
I mean, if someone has MS, at a certain point is it an warranted drain on health care? Consider Stephen Hawking.
Addicted to drugs? You aren't worth treating.
We already make decisions that some people aren't worth treating to keep alive...the death penalty; killing in self defense; war.

What is the line we choose not to cross?

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RE: Health Service Costs - 4/24/2009 5:13:36 PM

Raechard

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quote:

ORIGINAL: philosophy
For instance, imagine an experimental drug for cancer......very expensive but not yet shown to be effective. As NICE wont sanction it the NHS wont pay for it.

NICE is almost a political organisation rather than a clinic of excellence. It doesn’t even matter how effective a drug has been proven to be. It’s more to do with how many people need such treatment and how much it costs; those are the only considerations and therefore it isn’t a good thing in its current form. Costs could easily be cut in other areas but never are.

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RE: Health Service Costs - 4/24/2009 6:22:03 PM

Crush

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And therein lies the problem of "Government Healthcare" It becomes political, rather than medical, in nature.

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RE: Health Service Costs - 4/24/2009 9:59:18 PM

Lorr47

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WILL WORK FOR HEALTH CARE

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RE: Health Service Costs - 4/24/2009 10:09:32 PM

couldbemage

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quote:

ORIGINAL: Crush And therein lies the problem of "Government Healthcare" It becomes political, rather than medical, in nature.

So it's medical now?

I thought it was all about profit, and only 'medical' when forced to be by politicians.

What the hell is 'medical' anyway? Deciding what is best for the patient?

Then paying for what is best... how, exactly? Private insurance makes the same cost/value judgements, but places far less weight on value.

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RE: Health Service Costs - 4/25/2009 12:18:25 AM

philosophy

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quote:

ORIGINAL: Crush

And therein lies the problem of "Government Healthcare" It becomes political, rather than medical, in nature.

...ok, let me table your point for the sake of argument. The US system is economic rather than medical in nature. It's not 'to each according to their needs', it's 'to each according to their means'.
How would one set up a health care system which is neither economically or politically driven? Rather one which treats those in need, when they need it.......you say government can't do it, i point to the US system and suggest that private industry has proven it can't do it either.

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RE: Health Service Costs - 4/25/2009 1:06:53 AM

ThatDamnedPanda

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I don't think it's possible to have a health care system that isn't economically driven. It's never "to each according to their needs;" ultimately it's always to each according to someone's means - if not the patient's, then the private insurance company, the government agency, whatever. I don't think there's a single health care system in the world that doesn't have some way of rationing health care. It's just not possible to spend whatever it takes to keep everyone alive as long as possible no matter how sick they are or how old they are. At some point, some administrator or actuary or accountant steps in and decides the money it would take to keep such and such patient alive for 6 more months would be better spent curing someone with a better chance of longterm survival, or someone younger, or whatever.

So, the only question is, what manner of economic rationing do we want, or are we willing to accept? In the US, we ration our health care based upon who can afford to pay. In other countries, it's rationed according to the likelihood of success, the age of the patient, the overall health of the patient aside from the condition being treated, or some combination of those and other factors. People in the United States who have insurance tend to think our system works better and is more fair than a system where rationing is based upon such factors as the age of the patient, whereas Americans who don't have insurance tend to think the system is the worst arrangement imaginable. And I'm sure an 80-year old woman in London who can't get treatment for breast cancer is convinced her system is the worst possible, and envious of 80-year old American women with good private insurance. We're never going to have a system that's totally fair to everyone, but it's clear by any criteria you can name that on the whole, the current American system is the worst system in the developed world, and is far less efficient (and therefore far more severe in its rationing) than almost any of the systems that so many Americans ridicule whenever this subject is debated.

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RE: Health Service Costs - 4/25/2009 7:24:08 AM

Raechard

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quote:

ORIGINAL: philosophy
The US system is economic rather than medical in nature. It's not 'to each according to their needs', it's 'to each according to their means'.

People in the UK can buy drugs not approved for use by NICE and have done so on the advice of their doctors numerous times. Therefore this divide still exists in terms of treatment according to their means regarding drugs therapy. In other areas such as surgical procedures there is more of an equal balance between rich and poor as these things are not driven by the demands of the drug companies. The NHS can't do anything about how much drug companies charge for their drugs but it can indoctrinate a medical practitioner in the ‘free at point of use’ ethos as it trains them up.

Most people rich and poor believe in that anyway but when it come to them it is a matter of survival.

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RE: Health Service Costs - 4/26/2009 7:06:01 PM

MrRodgers

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Well, what I am reading is as old as medicare and using private industry at all. Grandmother 'diagnosed' by 9 doctors, all of which spent about 10-15 minutes with her, claimed...'Yep, broken hip' and proceeded to bill medicare $250 EACH.

Mother sent to assisted-living center to recuperate from treatment and dehydartion caused a urinary track infection. Her Dr. is the Dr. of record at the center. He billed medicare for only $100 per visit, a nice guy hey ? Trouble is, he DIDN'T make those visits.

I love simple business math...say 10 patients, all getting the benefit of all those 'visits' could make $1,000/day while playing golf.

Any govt. 'insurance' system not RUN by the govt. will be defrauded of billions.

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RE: Health Service Costs - 4/27/2009 4:32:20 PM

SexDwarf

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medical care is free in NZ if its an emergency, and medication can be cheap sometimes. ! sexual health is free to people under 22 w00p!!

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