Healthcare commentary

[unixronin]

From an OOB discussion with johnkzin:  Prevention may be better than cure, but treatment is WAY more profitable than prevention.

Discuss.

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(Crossposted to neph_politics)

Comments

[dafydd.livejournal.com]

Kaiser Permanente (http://www.kp.org).

[unixronin.livejournal.com]

Wondered if it was. My parents are with Goup Health, up in Spokane, which is also not-for-profit and also has very good prevention programs.

[bratling.livejournal.com]

even for-profit HMOs will want to prevent illness. if they can reduce the need for treatment in their population, they make more money.

thus, we cannot blame HMOs for the high cost of healthcare. look elsewhere...

[johnkzin.livejournal.com]

The original commentary wasn't really about HMO's, it was about the industry which does the research and manufacturing. And it was also more about cure vs treatment, than prevention vs treatment.

I had seen it recently stated (not sure of the quality of the source, but it made me think) that the main reason we haven't found a cure for diabetes is that it's more profitable, for the drug manufacturers, etc. to treat it than to cure it.

[bratling.livejournal.com]

the original comment that spawned this thread was "My HMO is not-for-profit, making the statement irrelevant.". i can't see how the profit status of an HMO affects the industry that supplies the products and services -- both non-profit and for-profit want to minimize cost. (i happen to think that for-profits are more likely to do so at cost to the patient's well-being, though.)

I had seen it recently stated (not sure of the quality of the source, but it made me think) that the main reason we haven't found a cure for diabetes is that it's more profitable, for the drug manufacturers, etc. to treat it than to cure it.

hmm. that seems like a vast oversimplification -- we're far from being able to fix malfunctions in body chemistry in general -- but it is an interesting thought. i suspect (but have not done the research to prove or disprove) that much more research is done on diabetes in academia ("pure" research) than in industry ("commerical" research).

(in fact, i had to fight my impulse to write off the comment as typical looney left ... a loud and obnoxious element that hurts the intelligent left by unfortunate association... much as neoconservatives hurt intelligent conservatives.)

hurm.

[unixronin.livejournal.com]

i can't see how the profit status of an HMO affects the industry that supplies the products and services -- both non-profit and for-profit want to minimize cost.

No, this doesn't follow.

Non-profit and not-for-profit want to minimize cost. A for-profit organization wants to maximize profit, which isn't necessarily the same thing. Given a procedure with a cost of $40,000 on which they can make a profit of $20,000, or a procedure with a cost of $75,000 on which then can make $60,000, many for-profit operators will opt for the $75,000 procedure, even if it's no better for the patient. This is especially true of "sexy" procedures.

A good example of this is multiple-bypass surgery, which is "sexy", expensive, and highly profitable -- but recent studies have found that the long-term prognosis for multiple-bypass patients is actually no better than for patients with similar conditions who did not have bypass surgery. (I don't remember where I read this, or I'd give a cite. It might have been New Scientist.)

Another related (and possibly more controversial) example is chelation therapy. Many US medical practitioners say it doesn't work, and will not perform it. In other nations, it's widely used and considered highly effective. (There are reports even of patients with complete kidney failure who have recovered enough kidney function after chelation therapy to come off dialysis.) I have heard it alleged that the reason US medical practitioners don't like it is because it's inexpensive and "not sexy", and there's little money to be made from it.

[bratling.livejournal.com]

No, this doesn't follow.

Non-profit and not-for-profit want to minimize cost. A for-profit organization wants to maximize profit, which isn't necessarily the same thing. Given a procedure with a cost of $40,000 on which they can make a profit of $20,000, or a procedure with a cost of $75,000 on which then can make $60,000, many for-profit operators will opt for the $75,000 procedure, even if it's no better for the patient.

okay, let's check our definition of terms. we may not be talking about the same thing.

an HMO is a Healthcare Management Organization. They are basically a healthcare insurer, except they also often are providers as well. As a provider that is paying themselves for the service, where do they make money?

Now, in the case of me, where i used to have Blue Cross/Blue Shield, but used an HMO as my provider because it was close to home, fast and competent (and referrals involved walking down the hall, not driving across the city and taking another day off of work), yes, in such a situation that HMO would be motivated to run a more expensive procedure, because they aren't paying for it. but this is a very atypical scenario for HMOs -- i had an unmanaged healthcare plan where i could choose my own provider, and used an HMO. that's not an HMO's bread and butter.

i'm pretty sure that you're describing a non-insuring provider (such as a hospital, doctor or clinic), not an insurer or a self-paying insurer-provider (which ultimately foot the $90,000 bill).

[unixronin.livejournal.com]

Oh, I'm sorry. I think I inadvertently over-generalized your statement.

[bratling.livejournal.com]

i thought so.

i've actually been spending a lot of time lately wondering where the money goes. everybody talks about the high cost of healthcare, but why is it so high?

Nurse Practitioners are very well paid -- starting salaries around here are $70,000 -- but that still breaks down to not very much per patient visit. Surgeons assistants are paid almost criminally low wages for the painstaking work they do. Doctors are well paid, but have over a decade's education to pay back -- i don't think most are overpaid, especially not the GPs that most people see most of the time. i'm convinced that not much of the money goes to the individuals providing the services.

i should probably just scape together some money, buy some Phizer stock and call it a night...

[unixronin.livejournal.com]

I know one thing I have heard of is that in many areas, particularly rural areas, general practitioners are opting out of the insurance system altogether. They won't take any insurance, but they save enough by not having to jump through all the paperwork hoops that they can afford to charge office-visit fees close to the copayments required by many insurance plans for the same office visit.

[bratling.livejournal.com]

wish i could find one of those...