Health care - administrative incompetence

[PhantomWolf]

Politics. UHC means simply coverage for all. There are many ways to achieve this and most use a mix of public and private funding. The countries with Single-Public-Payer systems are looking to privatize more and more. More private=more free market.

Except that the majority of those systems came into place because the free market systems they replaced weren't working.

I don't know enough about NZ healthcare to really discuss this. Educate me.

I'd have to educate you in NZ politics since 1970, which judging from your actions in this thread would be rather hard.

Long story short, during the 1980's and 90's NZ had a number of right-wing governments with the mantras of "Government shouldn't be in Business" and "User Pays" and proceeded to sell of the assets and ramp up the fees. This pushed over into healthcare with "unprofitable" hospitals being closed and finally in a move towards the US HMO model, with the remaining Hospitals becoming CHEs (Crown Health Enterprises), basically commerically run profit oriented businesses. It failed, majorly. By 2000 they were all tens if not hundreds of millions in debt and the health system was on the verge of collapse, with politicians, the media, and the public all screaming for change and fast. The new Labour Government had to revamp the entire system, reintroducing DHBs (District Health Boards) and placing hospitals under their control, getting rid of a lot of the fees and administration that had overloaded the hospitals, and paying out huge amounts of money to pay off the debts of the CHEs.

The whole experiement of trying to open up the health system to being commerical user pays was a failure that even now we are trying to recover from in some areas.

 

[Ducky]

That's the "British Pound" or "Pounds Sterling", used in what we call "the United Kingdom". There is, you will find, no such thing as "the English Pound" any more than there is a "Queen of England".

There is, of course, a Scottish NHS.

[/derail]

No Queen of England? What's Elton John's title?

 

[xjx388]

Such as?

Such as patient specific recommendations based on claims and prescription data. Sometimes they recommend a cheaper drug and provide evidence that it's just as effective. Sometimes they point out that patient X is diabetic and hasn't had a visit in awhile. All kinds of stuff.

Hand waving noted.

If you want to debate supplements and the like, you are free to start a new thread. I see no need to derail this one.

Sure you can! I have no way of knowing how good my doctor is short of my personal experience and look at public records. Beyond that, it's a crap shoot.

Certain doctors have a good reputation and others don't. Every decision we make is a crapshoot, really. Do you really think it's different in the UK?

So, you admit then that you overutilized by testing for strep in every case of sore throat?

No. Our doctor follows the guidelines set by the AAFP.

How would I know? I mean, other than really obvious stuff like plastic surgeons, who really knows how good anybody is? How can I find out how good you are?

How does anyone know how good a plastic surgeon is? Reputation, maybe? Same thing for any other doctor.

It's actually quite germane. That clinic where you live seems mostly focused on making a profit. Once again, how do you feel about doctors rebranding supplements and opening a gym/dance studio as part of their practice? As for my opinions about how to treat obesity, this clinic violates the standards that you personally put forth regarding obesity. Based on the one client I actually found, it looks like they went straight to a drug that is banned in some countries rather than waiting to see what kind of results the person got otherwise.

Are you from South Texas? If not, I highly doubt you found a client of a weight-loss clinic down here. In any case treatment of obesity is not the subject of debate here. Why can't you stay on topic? If you want to debate supplements, dance studios, gyms and "banned" drugs, you are free to start threads on those subjects.

This ties into the profit motive. You see, it can take a lot of effort to lose weight. What better way to get people to stick with a $150/month program than to give them an appetite suppressant? You get quick results, which keeps them coming back. Then you get some quick referrals. That's not patient-centered - that's profit centered.

If a clinic develops a protocol using a perfectly legal drug that results in significant weight-loss for it's clients, then bully for them! Such a clinic can make a profit because it's focusing on providing results to its clients. If it wasn't, then there would be no clients.

Again, how do you feel about a doctor's office rebranding supplements and selling them? It's bad enough we have this crap in the supermarket, but do you really think doctor's should be selling the stuff?

I don't have a problem with doctors selling supplements.

Funny. You call it patient centered focus, but you spend most of your time yapping about insurance companies and how you limit Medicare patients. Did you learn about how to deal with insurance companies when you were in med school? Was that part of your curriculum?

I didn't go to Med school. Our clinic is fully patient-centered. We don't yap about insurance or Medicare to our patients. I yap about that here because, well, that's the subject of the thread.

 

[kellyb]

Certain doctors have a good reputation and others don't. Every decision we make is a crapshoot, really. Do you really think it's different in the UK?

Could be rephrased:

"Certain homeopaths have a good reputation and others don't. Every decision we make is a crapshoot, really. Do you really think it's different in the UK?"

No, it's not different in the UK, other than the fact that our government is less inclined to pretend that homeopathy is real and endorse it.

2 points for the US.

Quacks still have huge profits and followings over here, though, in spite of the fact that their reputations "should" drive them out of business.

sCAM was wildly popular and the predominant form of "medicine" before agencies like the FDA arose to "impair" the "free market".

 

[kellyb]

I didn't go to Med school.

That depends on which "I" is posting at the moment, doesn't it?

 

[Uncayimmy]

Certain doctors have a good reputation and others don't. Every decision we make is a crapshoot, really. Do you really think it's different in the UK?

Reputation with whom?

I think it's vastly different in the UK. Show me where I can find anything comparable to this in the USA (randomly selected GP in London).
http://www.nhs.uk/ServiceDirectories/Pages/GP.aspx?pid=E47E451C-8A75-48C2-9EE4-CE0681CB12B0
Check out the How We Perform page and the patient comments page. There's nothing like that in the USA. At best there are some independent sites that hope for a few patient reviews, but that's it.

No. Our doctor follows the guidelines set by the AAFP.

Are you okay with guidelines or not????

How does anyone know how good a plastic surgeon is? Reputation, maybe? Same thing for any other doctor.

Nope. You can look at a facelift and see if it was any good. I have no idea if someone's hypertension is being treated properly. That's a huge difference.

Are you from South Texas? If not, I highly doubt you found a client of a weight-loss clinic down here.

Doubt all you want. I find a blog written by a woman who described her treatment.

In any case treatment of obesity is not the subject of debate here. Why can't you stay on topic? If you want to debate supplements, dance studios, gyms and "banned" drugs, you are free to start threads on those subjects.

If you have a problem with the subject matter, report it to the moderators. We are discussing universal versus for-profit health care. I am discussing the activities of a for-profit health clinic run by a doctor.

If a clinic develops a protocol using a perfectly legal drug that results in significant weight-loss for it's clients, then bully for them! Such a clinic can make a profit because it's focusing on providing results to its clients. If it wasn't, then there would be no clients.

Hand waving noted. If you put sawdust in a malfunctioning transmission, it will smooth things out...for a while. If you give appetite suppressants to an obese patient as a first line of treatment, you get fast "results." This keeps them coming back for a couple of months (the longest recommended time for taking the med in question). When you take them off, what happens then? Maybe they stick around another month or two (paying $150/month), then they stop. The clinic takes in about $1,000. The patient, excited by the early progress, maybe makes a referral or two. A year later, they are right back where they started.

Seriously, how can you teach behavior modification techniques to someone on an appetite suppressant? How can they learn to deal with their cravings if you are artificially suppressing them? Problem is, if you start off with behavior modification, and the person struggles, they quit within a couple of months without any results. They just reach the same point a few months sooner than the person treated with drugs.

Profit versus Evidence Based Medicine.

I don't have a problem with doctors selling supplements.

I do. Doctors should stick to medicine. There's a conflict of interest when the doctor makes a profit off of unproven (supplements are typically unproven) treatments. It's one thing to answer a question by a patient saying, "It looks like maybe [whatever] might help." It's quite another to be selling the stuff in the doctor's office. That's an endorsement, and it's not evidence based.

I didn't go to Med school.

How did you learn about all this?

 

[xjx388]

Could be rephrased:

Why would you rephrase it that way?

No, it's not different in the UK, other than the fact that our government is less inclined to pretend that homeopathy is real and endorse it.

2 points for the US.

Ok.

Quacks still have huge profits and followings over here, though, in spite of the fact that their reputations "should" drive them out of business.

Well, some people believe in that stuff and you can't shake them of their belief.

sCAM was wildly popular and the predominant form of "medicine" before agencies like the FDA arose to "impair" the "free market".

That was a long time ago. But there is a demand for CAM and businesses arise to fill the demand. It's a fact here, in the UK and everywhere else in the world. Short of outright banning it, there isn't much we can do.

Can you clarify how any of that is relevant to the direction we should take Healthcare in the US?

 

[Uncayimmy]

Can you clarify how any of that is relevant to the direction we should take Healthcare in the US?

Sigh...

You claim that your practice succeeds because of how well it does treating patients. Homeopathy, by definition, does nothing for its "patients," yet it succeeds wildly. All a medical practice really has to do to succeed in the free market is be nice to patients, reduce insurance hassles and not kill them outright. There's no way of knowing how well a doctor's office is doing.

 

[kellyb]

There's nothing like that in the USA. At best there are some independent sites that hope for a few patient reviews, but that's it.

Heh. I saw the worst doctor (obgyn) EVER a few years ago. Long story, but she tried to convince me I was in "active labor" around Thanksgiving (at 37, almost 38 weeks gestation), when my water hadn't broken, I wasn't having contractions, etc.

I got a second opinion and was told I might have another month left before labor started.


This, after she (my primary obgyn) told me at around 30 weeks "So, I have holiday plans around the time you're due, so I'm going to induce you at 38 weeks, ok?" and I was like "Um, NO, I don't want to be induced without medical reason." and she was like "We'll see, then."

So, after she proclaimed me in "active labor" at 38 weeks and a second opinion told me I wasn't in labor at all, I canceled the next week's appointment, and saw her 2 weeks later, and she said I was some kind of medical miracle, and have been in pain free active labor for 2 WEEKS now!
I was like "I DO NOT WANT TO BE INDUCED WITHOUT MEDICAL REASON" and her response was "It wouldn't be "induction" because you're already in labor, it would be "labor augmentation."

And then she basically threatened me with going AMA if I didn't go to the hospital to be induced that moment.

So, I went home and cried but was able to find a new doc (an FP, interestingly enough) to take me in so late in gestation. (I was very lucky. I had gotten my medical records and was prepared to be an ER walk-in. Which was terrifying.)

Anyway...back to the topic at hand...

I went and reviewed that horrible OB at every website I could find. (I gave all the good docs I've dealt with good reviews at the same time). I was and remain pissed. But my bad reviews keep getting deleted and replaced by a single "Doctor G is the best! I love her!" review.

I don't think her (one of the least ethical docs in the US) "reputation" even exists. A vast majority of the patients she screws over with early induction for her own convenience probably don't know what's happening to them.

 

[kellyb]

Why would you rephrase it that way?

Because you're saying you wouldn't be in business if your medicine wasn't effective.
This is clearly false, as can be demonstrated by sCAM.

 

[xjx388]

Reputation with whom?

Uh, let's see . . . their patients who recommend a clinic to their friends and family and so on.

I think it's vastly different in the UK. Show me where I can find anything comparable to this in the USA (randomly selected GP in London).
http://www.nhs.uk/ServiceDirectories/Pages/GP.aspx?pid=E47E451C-8A75-48C2-9EE4-CE0681CB12B0
Check out the How We Perform page and the patient comments page. There's nothing like that in the USA. At best there are some independent sites that hope for a few patient reviews, but that's it.

I don't think that such information is particularly helpful to patients. BCBS of Texas rates doctors based on adherence to EBM measures. Other insurance companies do the same. It's cool, but not particularly helpful.

Are you okay with guidelines or not????

Guidelines are fine when they are developed by specialty groups and not mandated by the government. They should be guidelines, not programs.

Nope. You can look at a facelift and see if it was any good. I have no idea if someone's hypertension is being treated properly. That's a huge difference.

It's not like there's a registry of facelifts anywhere. You'd have to know someone.

Doubt all you want. I find a blog written by a woman who described her treatment.

Wonderful.

If you have a problem with the subject matter, report it to the moderators. We are discussing universal versus for-profit health care. I am discussing the activities of a for-profit health clinic run by a doctor.

I don't have a problem with the subject matter. I have a problem with derailing the thread. But I will say this: If a doctor's outcomes are good then there is no problem with whatever they want to do as far as gyms, dance studios, etc. Those things can be drains on profit, but if they've found a way to do it and help their patients, then more power to them. If patients are not satisfied and not seeing results, then such a clinic will not profit. Weight-loss clinics come and go; the ones that work become profitable.

Hand waving noted. If you put sawdust in a malfunctioning transmission, it will smooth things out...for a while. If you give appetite suppressants to an obese patient as a first line of treatment, you get fast "results." This keeps them coming back for a couple of months (the longest recommended time for taking the med in question). When you take them off, what happens then? Maybe they stick around another month or two (paying $150/month), then they stop. The clinic takes in about $1,000. The patient, excited by the early progress, maybe makes a referral or two. A year later, they are right back where they started.

You seriously misunderstand the Medical treatment of obesity. This is not the place to correct you.

Seriously, how can you teach behavior modification techniques to someone on an appetite suppressant? How can they learn to deal with their cravings if you are artificially suppressing them? Problem is, if you start off with behavior modification, and the person struggles, they quit within a couple of months without any results. They just reach the same point a few months sooner than the person treated with drugs.

Profit versus Evidence Based Medicine.

You have no clue what you are talking about here. This is purely your own speculation.

I do. Doctors should stick to medicine. There's a conflict of interest when the doctor makes a profit off of unproven (supplements are typically unproven) treatments. It's one thing to answer a question by a patient saying, "It looks like maybe [whatever] might help." It's quite another to be selling the stuff in the doctor's office. That's an endorsement, and it's not evidence based.

Plenty of supplements can be medically beneficial. Fish oil, Vitamin D, calcium, etc. Doctors recommend these things every day. Some sell them. Pharmacies sell them too. Big deal.

How did you learn about all this?

My learning has nothing to do with this. Address my arguments.

 

[kellyb]

My learning has nothing to do with this. Address my arguments.

I don't think you understand how difficult this is when you're talking to two different people, with two different education levels, posting under the same account.

I think the dialogue would be a hell of a lot easier for all involved if the two of you had separate accounts.

Just sayin'.

 

[xjx388]

Sigh...

You claim that your practice succeeds because of how well it does treating patients. Homeopathy, by definition, does nothing for its "patients," yet it succeeds wildly. All a medical practice really has to do to succeed in the free market is be nice to patients, reduce insurance hassles and not kill them outright. There's no way of knowing how well a doctor's office is doing.

Well, how do we know how any business/service does? Not even in the UK can patients get real, useful data on outcomes, just bar-graphs that don't really give much info. All we have to go on is recommendations from family and friends, public databases, etc.

 

[Uncayimmy]

Uh, let's see . . . their patients who recommend a clinic to their friends and family and so on.

That's not really what I call a reputation, but whatever.

I don't think that such information is particularly helpful to patients.

LOL! Didn't see that coming.

BCBS of Texas rates doctors based on adherence to EBM measures. Other insurance companies do the same. It's cool, but not particularly helpful.

It's not cool. It's not helpful. Doctors can opt out.

Guidelines are fine when they are developed by specialty groups and not mandated by the government. They should be guidelines, not programs.

What is that supposed to mean? Never mind, we've been through this before. You ignored it then, and you'll ignore it again.

It's not like there's a registry of facelifts anywhere. You'd have to know someone.

Oh, what nonsense. Go to any plastic surgeon's website, and you'll see tons of before and after photos. There's nothing remotely comparable for any other practice.

I don't have a problem with the subject matter. I have a problem with derailing the thread.

Then report it and stop responding to it.

But I will say this: If a doctor's outcomes are good then there is no problem with whatever they want to do as far as gyms, dance studios, etc. Those things can be drains on profit, but if they've found a way to do it and help their patients, then more power to them. If patients are not satisfied and not seeing results, then such a clinic will not profit. Weight-loss clinics come and go; the ones that work become profitable.

We have no idea if the outcomes are good because there is no reporting whatsoever. Your claim about staying in business based on patient satisfaction assumes that it's a factor, but as with homeopathy, it's pretty clear that good outcomes don't mean squat. Another great example is treatment for depression. We discussed this in another thread, but the gist of it is that only in cases of severe depression do the studies show even a modest clinically significant improvement. The results for mild to moderate depression are barely statistically significant, yet anti-depressants are huge business.

So, please, don't feed me this nonsense about the market ensuring positive outcomes.

You seriously misunderstand the Medical treatment of obesity. This is not the place to correct you.

Why do you sometimes capitalize words like Medical and Physician but other times not? It's strange . . .

You have no clue what you are talking about here. This is purely your own speculation.

It's not speculation to say that you can't teach people to resist their urges while those urges are being artificially suppressed.

Plenty of supplements can be medically beneficial. Fish oil, Vitamin D, calcium, etc. Doctors recommend these things every day. Some sell them. Pharmacies sell them too. Big deal.

I would hardly call vitamin D and calcium supplements. There's some evidence for fish oil. The vast majority have very little clinical evidence. I find it a conflict of interest when doctors sell products of dubious value, especially when they measure the "success" by profit.

My learning has nothing to do with this. Address my arguments.

You are citing yourself as an expert in dealing with insurance companies. You tell us about things you see "first hand" that we cannot verify independently. Therefore, your credentials in that regard are open to scrutiny.

 

[xjx388]

I don't think you understand how difficult this is when you're talking to two different people, with two different education levels, posting under the same account.

I think the dialogue would be a hell of a lot easier for all involved if the two of you had separate accounts.

Just sayin'.

Really, you're gonna pull that one? This is an old issue that was already handled by the mods. If you think more than one person is using this account, you are free to report it to the mods. Otherwise, drop it.

It's obvious that you and UY can't argue the issues so you try to personalize things. Typical . . .

 

[Uncayimmy]

Well, how do we know how any business/service does? Not even in the UK can patients get real, useful data on outcomes, just bar-graphs that don't really give much info. All we have to go on is recommendations from family and friends, public databases, etc.

The NHS guidelines are available to everyone, and they are evidence based. Patients are empowered. The bar graphs compare the facility to the local area and NHS as a whole. They also include far more patient reviews.

It's funny how you cite "reputation" as being one-off accounts from friends and poo-poo surveys and monitoring by NHS.

 

[kellyb]

Really, you're gonna pull that one? This is an old issue that was already handled by the mods. If you think more than one person is using this account, you are free to report it to the mods. Otherwise, drop it.

It's obvious that you and UY can't argue the issues so you try to personalize things. Typical . . .

No, really, it is REALLY obvious that there are two people posting under the xjx account. I doubt that me and UY are the only two to have noticed it.

I'd just like to be able to talk to the two of you separately, is all.

 

[kellyb]

Really, you're gonna pull that one? This is an old issue that was already handled by the mods. If you think more than one person is using this account, you are free to report it to the mods. Otherwise, drop it.

It's obvious that you and UY can't argue the issues so you try to personalize things. Typical . . .

Oh, and hey, welcome back, DUDE.

 

[jimbob]

I wonder what accounts for the huge price difference. It's really hard to think of an explanation for that much of a difference.

Well, if your governmental healthcare provider will pay what the manufacturers ask, without negotiating, and both sides know that, it isn't very surprising.

 

[xjx388]

That's not really what I call a reputation, but whatever.

Ok.

LOL! Didn't see that coming.

How is a bar graph helpful? Look at this practice. They have horrible reviews but their bar graphs show "good" outcomes. What do the percentages even mean. There is no real data here. Even when you look for more detailed information there isn't any outcome information, just "indicators" like "The percentage of patients with asthma between the ages of 14 and 19 in whom there is a record of smoking status in the previous 15 months." How is that helpful in making a decision about the level of care provided?

It's not cool. It's not helpful. Doctors can opt out.

About as helpful as the UKs info.

What is that supposed to mean? Never mind, we've been through this before. You ignored it then, and you'll ignore it again.

It means that the government should not be the arbiter of acceptable medical care. The medical societies like the AAFP, AAP, etc should be responsible for developing guidelines. The government can only create mandates.

Oh, what nonsense. Go to any plastic surgeon's website, and you'll see tons of before and after photos. There's nothing remotely comparable for any other practice.

Not every plastic surgeon. And those pictures are usually their best work. There's no guarantee that you will get their best work or that most of their work is as good.

Then report it and stop responding to it.

I don't care enough.

We have no idea if the outcomes are good because there is no reporting whatsoever. Your claim about staying in business based on patient satisfaction assumes that it's a factor, but as with homeopathy, it's pretty clear that good outcomes don't mean squat. Another great example is treatment for depression. We discussed this in another thread, but the gist of it is that only in cases of severe depression do the studies show even a modest clinically significant improvement. The results for mild to moderate depression are barely statistically significant, yet anti-depressants are huge business.

So, please, don't feed me this nonsense about the market ensuring positive outcomes.

If you say so.

Why do you sometimes capitalize words like Medical and Physician but other times not? It's strange . . .

To entertain you. I know how much you like to analyze writing, being an amateur graphologist and all.

It's not speculation to say that you can't teach people to resist their urges while those urges are being artificially suppressed.

Yes it is.

I would hardly call vitamin D and calcium supplements.

Oh really?

There's some evidence for fish oil. The vast majority have very little clinical evidence. I find it a conflict of interest when doctors sell products of dubious value, especially when they measure the "success" by profit.

We measure success by outcomes, which we do track.

You are citing yourself as an expert in dealing with insurance companies. You tell us about things you see "first hand" that we cannot verify independently. Therefore, your credentials in that regard are open to scrutiny.

I've "cited" myself as no such thing. I do deal with insurance companies everyday and see many things first hand, but I don't think I'm an expert. If you feel my position is missing evidence somewhere, you are free to point it out. But you also make a lot of unsupported statements, like the ones above about behavior modification and depression, so your credentials are likewise in question.