Healthcare Thread #4411

[para transit fellow]

Originally Posted by Cowperson

They spend astronomically more on healthcare administration than more efficient government run systems.

Cowperson

I agree.

a little known factoid is that almost every physician in the USA has to have a billing clerk to deal with the challenges from the insurance companies trying to defer paying for procedures and tests.

Dr Grumpy once pointed out:

http://drgrumpyinthehouse.blogspot.c...ay-reruns.html

[Maritime Q-Scout]

two challenges to consider for your modelling:

The first challenge to your model is that most doctors /specialists are paid PER Procedure instead of by the hour.

Second challenge is how does private procedures change wait times when there is a fixed number of doctors in the system?

My observation from having a surgeon in the family - there is only on so many hours in a week. So if half of his efforts were focused on privately funded care, then he only has the remaining half to focus on public care.... In his specialty, he cannot increase his overall weekly output, so by taking on privately funded patients, he has changed his funding base but has not changed any overall impact on wait time.

So it's per procedure and not per hour? That seems weird (not that I'm saying you must be wrong, I have no idea hence the disclaimer).

It just seems odd to me that if you're doing a heart bypass for example and one patient goes smoothly (let's say an hour, again I don't know how long it would actually take) you get paid the same as if there are complications and you have to take twice as long for the same procedure? I just assumed they'd bill their time accordingly.

Hmmm, this is the info I want for my thought experiment. Thanks

[para transit fellow]

Originally Posted by Maritime Q-Scout

So it's per procedure and not per hour? That seems weird (not that I'm saying you must be wrong, I have no idea hence the disclaimer).

It just seems odd to me that if you're doing a heart bypass for example and one patient goes smoothly (let's say an hour, again I don't know how long it would actually take) you get paid the same as if there are complications and you have to take twice as long for the same procedure? I just assumed they'd bill their time accordingly.

Hmmm, this is the info I want for my thought experiment. Thanks

There are some cases where the physician is hourly, but even ER docs are on the piecemeal schedule.

Dad was in orthopedics. so I can't speak to your example of cardiac surgery. I can tell you that an artificial hip replacement takes pretty much most of the morning - most orthopods can only manage 2 procedures in a day (although three is possible if everything is tightly organized)

You can see the procedure list for Alberta here:

http://www.health.alberta.ca/professionals/SOMB.html


(eye-opening suggestion: go look up what a family physician gets for an examination)

[Azure]

So I'm going to go ahead and assume that surgeons/specialists of any kind are pretty much busy doing what they do all the time. Which means if you want to push through more surgeries, per day, you need more doctors/resources/machines, etc, etc.

Which either costs more, i.e. more funding, so more taxes, or we find ways to cut spending from areas like administration, and move it over to areas like surgery.

I'm also going to go ahead and assume that nobody on CP, including done in the top 1% are using 'private' health services like Copeman and can't chime in as to what exactly they offer in term of care?

Would be interesting, as they are technically a private provider. And Canada has no private health care.

[para transit fellow]

Originally Posted by Azure

So I'm going to go ahead and assume that surgeons/specialists of any kind are pretty much busy doing what they do all the time. Which means if you want to push through more surgeries, per day, you need more doctors/resources/machines, etc, etc.

Which either costs more, i.e. more funding, so more taxes, or we find ways to cut spending from areas like administration, and move it over to areas like surgery.

I'm also going to go ahead and assume that nobody on CP, including done in the top 1% are using 'private' health services like Copeman and can't chime in as to what exactly they offer in term of care?

Would be interesting, as they are technically a private provider. And Canada has no private health care.

With a billions and billions of budget, I recall that AHS was claiming that overhead (i.e. over paid executives as well as averagepaid nobodies) was in the realm of 4% of the entire health budget.

Does anyone have a confirming/ countering number for AHS overhead costs?

If this 4% figure is true, then there is not a lot of fat to cut from admin and put to general health care.

heck 10% admin still won't give a lot to front line healthcare

[SebC]

Originally Posted by Cowperson

They spend astronomically more on healthcare administration than more efficient government run systems.

All those murders will put a dent into life expectancy too.

[Cowperson]

Originally Posted by SebC

All those murders will put a dent into life expectancy too.

About 2.4 million Americans die every year of which, I think, about 16,000 are murdered. Not that significant.

http://www.itsmywill.com/itsmylife/stats.html

Cowperson

[SebC]

Originally Posted by Cowperson

About 2.4 million Americans die every year of which, I think, about 16,000 are murdered. Not that significant.

http://www.itsmywill.com/itsmylife/stats.html

Cowperson

But those who are murdered are often young compared to the overall life expectancy (32.7 vs 78.2 - data from 2008/2010). That means homicides drag down the life expectancy by 3.6 months. In Canada we have 1/3rd the US homicide rate, so the US homicide rate accounts for roughly 2.4 months of the life expectancy difference compared to Canada. There's a 2 year 7 month gap, so it's not the largest factor, but it's not negligible either.

[jayswin]

Originally Posted by SebC

But those who are murdered are often young compared to the overall life expectancy (32.7 vs 78.2 - data from 2008/2010). That means homicides drag down the life expectancy by 3.6 months. In Canada we have 1/3rd the US homicide rate, so the US homicide rate accounts for roughly 2.4 months of the life expectancy difference compared to Canada. There's a 2 year 7 month gap, so it's not the largest factor, but it's not negligible either.

Only 1/3rd? I thought it was even worse than that in the States.

[Sylvanfan]

Originally Posted by Azure

So I'm going to go ahead and assume that surgeons/specialists of any kind are pretty much busy doing what they do all the time. Which means if you want to push through more surgeries, per day, you need more doctors/resources/machines, etc, etc.

Which either costs more, i.e. more funding, so more taxes, or we find ways to cut spending from areas like administration, and move it over to areas like surgery.

I'm also going to go ahead and assume that nobody on CP, including done in the top 1% are using 'private' health services like Copeman and can't chime in as to what exactly they offer in term of care?

Would be interesting, as they are technically a private provider. And Canada has no private health care.

My wife has a foot issue. AHS will only pay forthis proceedure if done by an Orthopedic Surgeon. In the Capital region, none of the Orthopedic Surgeons are currently taking referrals for this procedure. There is one in Calgary, and when you can see this surgeon...it's than another 12 months until you can get the surgery. In the meantime a podiatrist can do it next month....but it will cost us 5 grand out of pocket. So why am I flatbroke...well bitchy wife for three years, or exhaust another credit line and hope this qualms this issue that she cries about every day?

It is not a major surgery, and can be done by podiatrists....why waste ER time, and the resource that is orthopedic surgeons when others are capable? I bet with the ER time and the like it's much more costly for an orthopedic surgeon to do the proceedure. Even if AHS would give you a 50% coverage option, I suspect a lot of people would go this route.

[para transit fellow]

https://secure.cihi.ca/estore/produc...=en&pf=PFC1000

The Cost of Hospital Stays: Why Costs Vary provides information about how certain factors can affect average costs of hospital stays for typical patients (excludes patients who transfer between acute care facilities, die in hospital, sign out of hospital before completing recommended course of care and stay in hospital longer than those who have a similar condition and/or procedure).

https://secure.cihi.ca/free_products...s_report_e.pdf

[Northendzone]

Originally Posted by Sylvanfan

My wife has a foot issue. AHS will only pay forthis proceedure if done by an Orthopedic Surgeon. In the Capital region, none of the Orthopedic Surgeons are currently taking referrals for this procedure. There is one in Calgary, and when you can see this surgeon...it's than another 12 months until you can get the surgery. In the meantime a podiatrist can do it next month....but it will cost us 5 grand out of pocket. So why am I flatbroke...well bitchy wife for three years, or exhaust another credit line and hope this qualms this issue that she cries about every day?

It is not a major surgery, and can be done by podiatrists....why waste ER time, and the resource that is orthopedic surgeons when others are capable? I bet with the ER time and the like it's much more costly for an orthopedic surgeon to do the proceedure. Even if AHS would give you a 50% coverage option, I suspect a lot of people would go this route.

it is unfortunate that you are not a AHC executive, if so then you'd be off the an all expense paid trip to somewhere in the US at your employers urging/expense to have this issue taken care off. and while you are there, don't forget to have a nice meal and stay in an above average hotel - it is all an eligible expense

[LChoy]

Just want to say that this is a great thread to talk about Health Care. I have a working background in Canadian Health Policy and working in a Health Data organization right now.
I'll post a much longer post when I have a chance, but in the mean time, here are a few points:

- Canada's health care system is built on Private delivery, but paid for by the Public. This means that physicians are not employed by the government or region per say, but operate as private business. However, instead of charging the patient directly, they bill the Province/Region

- The fee structure for physicians are negotiated every 5 years between the Doctor's association and the province and what they charge for and how much is codified into the Schedule of Medical Benefits (SOMB).

- Therefore, most physicians operate on a per procedure fee system. There are alternative compensation models including capacity (a rate determined by the patient population), salary system, locum (Substitute doctor), and academic compensation models, but they are not very popular in Canada compared to other countries

- At the clinic level and doctor's office level, the nurses, the admin staff, and the non-physician staff are likely to be paid by Salary out of the physician's pocket. In the acute and hospital world, the Health Regions are the main employer of the non-physician medical professionals and also tend to be paid by salary and wages (shift work).

- Naturally, a pure private health care (ie the US) would mean the physician bills the patient directly, unless the patient has private health insurance. The best way to think about this model is that that your physician works similar to a dentist or a vet.

- The best Health Care systems in the world have a measure of both public and private fee structure (ie, the 2 Tier system). Those that do however, have different measures and balances that theoretically keep the 2 tiers at an acceptable level of care. Measures include a larger proportion of physicians on compensation structures outside of fee for service, mandatory public service hours/days for private physicians, proportion of money from private practice is given back towards the public health care service...etc

- The Canada Health Act is the law that governs the Universal health care system, and it is the law that would need to be changed if we were to allow direct private payer system of health care.

- The best place to get information on health carefor international comparisons is at the OECD website and CIHI.

http://www.oecd.org/els/health-syste...CANADA2012.pdf (Canada's OECD report)
http://www.cihi.ca/CIHI-ext-portal/i...cts/cihi000005 (CIHI reports)

Wish to write more later

LChoy