Understanding American Healthcare

geomark said:
One interesting twist I should mention is that some public hospitals have "private" after hours clinics which charge almost private hospital rates and deliver private hospital quality. I did that myself recently because the doctor I wanted to see keeps hours at a public hospital. It's a very interesting effect - as soon as the hospital switches over from public to private at 5:00 p.m. the service and quality jump. There you have a side-by-side comparison of private versus public.
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That's interesting. Why is the quality so different? It's the same hospital and staff, right? Is it just the difference in compensation? They aren't able to, or won't, provide the same level of service? Would the service rise to the same level if the level of compensation were increased?

Are there strings attached to the government funded service that aren't present with private care? Could it be a cultural prejudice thing, i.e., the doctors/staff treat the poor worse?

Regardless of that, people still have a choice to use the better private care if they can afford it, no? Would it be better if they did not have that choice, and if they could not afford it, might get no health care at all?

What's more, that is Thailand. Is that a good example of government-run health care? Wouldn't it be more useful, as a point of comparison to US health care, to look at public health care in more advanced economies, as in Europe, Australia, Canada, Japan?
 


geomark said:
A number of reasons for that. One reason is that if you sue for malpractice here you are awarded costs for remedial care but not enormous "pain and suffering" monies.
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You're not suggesting the government should put an end to enormous pain and suffering malpractice suits are you? That would be evil government intervention, and the free market is jesus.
 
Pseudo Nym said:
Wouldn't it be more useful, as a point of comparison to US health care, to look at public health care in more advanced economies, as in Europe, Australia, Canada, Japan?
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The European universal public healthcare systems shouldn't be a role model to any country.

The healthcare systems of Portugal, Spain, Uk, etc all have gargantuan unsustainable deficits each year. Even the French "best healthcare system in the world" had a 12 billion euro deficit last year...
 
I didn't listen but I am in this arena, my other Doctors are suffering along with patients who have to pay more and more for less and less.

Simply put, when the HMO's entered the picture, well they and Big Pharma became the winners, and the Dr's and the patients the losers. I have a variety of Dr. friends, cardiologists, neurologists, they have a decent lifestyle, but it is very demanding, difficult work with long hours, the constant threat of an audit or lawsuit, HMO's that don't want to pay but are glad to cash the check from the consumer, and consumers who come to the front office to be told they have a $40 co-pay for $135 of services, $7 which gets paid to the Dr. after the $40 co-pay. Then the $40 check bounces as the consumer is broke, and you are in the red. Oh yea that happened a couple of weeks ago.

My cardioogist buddy who I went to undergrad with tells me a HMO is paying them $300 ish for a heart catheter, that means opening up a patient, putting in the cath, closing up the patient. How the hell is he going to spread that around to his nurses and staff and pay the rent at the hospital?

So you have this downward grind from the Doctors point of veiw, a racheting down of your livelihood and lifesyle, you have to work harder and you are getting older...

The HMO's and Drug Companies-Big winners
The Patients and the Doctors -big losers
 
Pseudo Nym said:
That's interesting. Why is the quality so different? It's the same hospital and staff, right? Is it just the difference in compensation? They aren't able to, or won't, provide the same level of service? Would the service rise to the same level if the level of compensation were increased?

Are there strings attached to the government funded service that aren't present with private care? Could it be a cultural prejudice thing, i.e., the doctors/staff treat the poor worse?

Regardless of that, people still have a choice to use the better private care if they can afford it, no? Would it be better if they did not have that choice, and if they could not afford it, might get no health care at all?

What's more, that is Thailand. Is that a good example of government-run health care? Wouldn't it be more useful, as a point of comparison to US health care, to look at public health care in more advanced economies, as in Europe, Australia, Canada, Japan?
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Those are good questions and I don't know the answers to most of them. I do see that it is mostly the same staff and facilities. I see that the private clinic hours are fairly busy but the nearly free regular hours are much busier. There may be limitations imposed on the government funded services, I don't know, or they just may be oversubscribed as you would expect from the price distortion of making a valuable service free.

One thing that is obvious is that the private hours are subject to market forces - patients are paying the costs directly, service providers either meet expected level of care or consumers go elsewhere as there are competing options. The regular hours are virtually free to the patients so there are no market forces at work - any dissatisfaction or negative feedback can only be processed through a noisy and inefficient government channel instead of the immediate and efficient pricing mechanism of the market.

It's interesting that the public hospitals with private clinic hours occupy a unique niche because they charge less than fully private hospitals for equivalent quality of care but in a much less luxurious environment. If you have visited hospitals like Bumrungrad or Samitivej in Bangkok you know how luxurious they are. A public hospital like Siriraj, although it has all the modern equipment, is housed in old and worn buildings with no fancy lobbies with Starbucks etc, it is very public hospital-like in atmosphere. But it's clear that the hospital administrators found a market niche and are exploiting it effectively.
 
johnmatrix said:
You're not suggesting the government should put an end to enormous pain and suffering malpractice suits are you? That would be evil government intervention, and the free market is jesus.
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Didn't the government enable that in the first place? How about we take away that part of the government, and a lot more of it while we are at it.
 
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