Can they have a different privacy policy compared to the other companies in the same field? My understanding is that anyone dealing with healthcare data has to be HIPAA compliant.
> Can they have a different privacy policy compared to the other companies in the same field? My understanding is that anyone dealing with healthcare data has to be HIPAA compliant.
HIPAA compliance probably means that while other care providers aren't allowed to sell your medical history to marketers, Amazon doesn't even have to do that, and can send you personalized offers based on your medical history all day long without violating HIPAA.
Furthermore, this may give them data they can use to correlate medical history with other behavior, and thus potentially infer medical events about other customers that aren't Amazon Care patients.
Keep in mind "provider" can mean someone with a 1.5 year online nurse practitioner degree that they got while working part time, with the majority of classes on "nursing theory."
First of all "board certification" is completely meaningless in the context of nurse practitioners. They are "board certified" by the nursing board, with standards that are completely paltry compared to the standards set for actual medical doctors. Secondly, even for medical doctors "board certification" is largely an extortion scheme.
Third - there are about 28 states where nurse practitioners can work independently of any supervising physician. Also, in many cases "supervision" is a joke, with the supervising physician hundreds of miles away and simply signing charts without reviewing them.
> It isn't like they can go to Bob's Online College and then it's a free-for-all after that.
It actually is, though. You would be very, very surprised.
> It actually is, though. You would be very, very surprised.
My Dad became a board-certified FNP when I was in high school. I've seen enough of the books, the reading, the studying, the records reviews, the toil, and the anxiety to know you're wrong about this.
Your dad was likely trained in a time before the explosion of nurse practitioner diploma mills.
Currently, certain nurse practitioner schools are better than others, but the fact remains that the minimum requirement for clinical training hours is 500. [1] That's literally 3 months working a 40-hr/week job. That's less than the number of hours Petsmart trains their dog groomers for (over 800). [2] Furthermore, many nurse practitioner schools are not even finding placements for their students, instead forcing them to beg others to take them on for what are mostly shadowing experiences.
Pretty much all empirical evidence so far shows no statistically significant difference between outcomes and quality of care between PAs, NPs, and traditional MDs.
"A meta-analysis of 38 studies, comparing a total of 33 patient outcomes of NPs with those of physicians, demonstrated that NP outcomes were equivalent to or greater than those of physicians. NP patients had higher levels of compliance with recommendations in studies where provider assignments were randomized and when other means to control patient risks were used. Patient satisfaction and the resolution of pathological conditions were greatest for NPs. NP and physician outcomes were equivalent on all other outcomes."
Compared with dermatologists, PAs performed more skin biopsies per case of skin cancer diagnosed and diagnosed fewer melanomas in situ, suggesting that the diagnostic accuracy of PAs may be lower than that of dermatologists. https://www.ncbi.nlm.nih.gov/pubmed/29710082
Nonphysician clinicians were more likely to prescribe antibiotics than practicing physicians in outpatient settings, and resident physicians were less likely to prescribe antibiotics. https://www.ncbi.nlm.nih.gov/pubmed/15922696
The quality of referrals to an academic medical center was higher for physicians than for NPs and PAs regarding the clarity of the referral question, understanding of pathophysiology, and adequate prereferral evaluation and documentation. https://www.mayoclinicproceedings.org/article/S0025-6196(13)...)
Further research is needed to understand the impact of differences in NP and PCP patient populations on provider prescribing, such as the higher number of prescriptions issued by NPs for beneficiaries in moderate and high comorbidity groups and the implications of the duration of prescriptions for clinical outcomes, patient-provider rapport, costs, and potential gaps in medication coverage. https://www.journalofnursingregulation.com/article/S2155-825...)
Antibiotics were more frequently prescribed during visits involving NP/PA visits compared with physician-only visits, including overall visits (17% vs 12%, P < .0001) and acute respiratory infection visits (61% vs 54%, P < .001). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5047413/
NPs, relative to physicians, have taken an increasing role in prescribing psychotropic medications for Medicaid-insured youths. The quality of NP prescribing practices deserves further attention. https://www.ncbi.nlm.nih.gov/m/pubmed/29641238/
(CRNA) We found an increased risk of adverse disposition in cases where the anesthesia provider was a nonanesthesiology professional. https://www.ncbi.nlm.nih.gov/pubmed/22305625
NPs/PAs practicing in states with independent prescription authority were > 20 times more likely to overprescribe opioids than NPs/PAs in prescription-restricted states. https://pubmed.ncbi.nlm.nih.gov/32333312/
Both 30-day mortality rate and mortality rate after complications (failure-to-rescue) were lower when anesthesiologists directed anesthesia care. <...
There's almost nothing in this wall of (mostly unrelated) citations that refutes any of the central claim: the health outcomes across NPs and PAs is comparable to, and sometimes better than traditional MDs, especially for the kind of care that Amazon Care is providing.
for some real life stories about PA/NP check /r/noctor. I realize that it's possible to find a bunch of sad anecdotes about MDs as well, but as your parent stated down the thread, those days PA/NP training is not what it used to be, and results of it are to follow in reality. (i was unfortunate to experience it myself)
Sorry marcod, our algorithms have detected that you tried to purchase a book that has been deemed harmful by our trust and safety council so we've canceled your upcoming kidney transplant.
On the one hand, I'm glad they're calling this Amazon Care so I know to stay a million miles away from it. On the other hand, why on earth did they attach the Amazon name to this? Does anyone actually want Amazon involved in their health?
Fair. In any case, I really wish we could drive an iron wedge between work and health. They're billing this as a workplace benefit, so it does nothing to get at one of the fundamental problems with American healthcare.
We need to drive a wedge between work and all benefits - people need to be allowed, without the state interfering, to choose exactly where they want to spend the money they got for their labor, from health insurance to retirement, to, gasp, paying for all the taxes levied on your paycheck.
For the same reason Alphabet named their division Google Health. The brand has baggage but people do trust it to be a world leader in AI and big data (which is what you want from health-tech, right?)
My prediction is that this is going to be generally good at the 95th percentile. Virtual-first care will drop costs significantly, improve outcomes (since you won't have to go in to a high-risk environment for many routine things), and be the forerunner of what will come: the breaking of the healthcare complex.
I honestly can’t stand Amazon, but isn’t health care the kind of thing you want commoditized and streamlined? Amazon is in the upper echelon of doing this kind of thing.
I would much rather be able to request services in the way Amazon allows you to buy products than continue to engage in the current opaque system.
If I’m having a heart attack, healthcare is distinguishable by “what’s the closest ER”. The ambulance crew is unlikely to even permit a choice in the matter.
I think you're misunderstanding the word "commodity". If healthcare were commoditized, then "what's the closest ER" would be the only thing that matters. You are actually advocating for commoditization.
Water, for example, is a commodity. It doesn't matter where you get it, because water from one tap is mostly indistinguishable to water from a different tap. When you need water, you simply just go to the closest tap and you can be happy that you're getting the same quality water as anywhere else. That's exactly what you want with healthcare, too.
Being a public utility or not has nothing to do with commoditization. You keep saying you're against commoditization but then make arguments in favor of it.
In fact, commoditization of healthcare is probably one of the best steps towards making it a public utility. So if that's what you want, then you probably do want healthcare to be commoditized.
Exactly, which is why you want it to be a commodity, so that there isn't even the need to do something like shop around. If healthcare was a commodity, you just go to the nearest hospital and can rest assured that you're getting the same care you would get anywhere else.
The trouble is there will always be a difference in quality. It’s a human business after all.
Different hospitals have different facilities as well. You’re better off having a type of procedure at one place than another for example. And even if you somehow made it so every hospital had the same high quality equipment you still wouldn’t have the same quality of specialists, surgeons, etc. This matters a lot.
There’s probably a baseline we could get to but the experience will never be a commodity overall.
There are definitely parts of healthcare that are unreasonable to expect to be commoditized. A heart transplant or brain surgery are probably things where centers specialized in those areas will be higher quality.
But for more common things like an annual wellness exam, or blood tests, mending a broken arm, treating the flu, or even doing surgery on a burst appendix, those are things that I think can reasonable be commoditized across any healthcare providers.
You're ignoring the vast vast majority of health care out there to focus on one extreme example - for which we have a separate answer already. (catastrophe insurance.) I just want a decent doctor to prescribe my meds and to purchase them at a reasonable price. I won't die without these things, and I'd prefer the costs be visible so there will be price competition. Most health care is like this.
Fun anecdote: after a weekend of skiing a few years ago, I had a sore throat, went to One Medical and got a rapid strep test, and was charged $140 for what was a negative result.
The next day I was on a flight from SFO to Singapore, and it was extremely apparent I had strep. Upon landing in Singapore, I went to a clinic where they diagnosed the strep, gave me antibiotics, decongestants, sudafed (the good kind), throat lozenges, and ibuprofen. Total cost? $20 USD.
The Singapore "3 M" model largely takes advantage of transparent pricing and savings-account driven healthcare spending to bring down costs, as well as price controls to introduce an upper-bound to prices. It's, in my opinion, the paragon of what "healthy regulation" of markets looks like; the price controls don't undermine the market forces, and are instead crafted to complement them.
Agreed. But maybe Amazon.com has more potential to "disrupt" the US healthcare industry than any kind of traditional legislation. And... maybe that disruption could benefit actual people? (I really don't know)
But I don't see the US government being able to do anything serious in the near term, with the forces of overpowered lobbying and general insanity working against it.
Nothing is freely available. Somebody is paying for it. In my case, I pay 800 euros per month, and then we can use it "freely". What you surely meant is universally available for all.
> Nothing is freely available. Somebody is paying for it. In my case, I pay 800 euros per month, and then we can use it "freely". What you surely meant is universally available for all.
In the US, most health plans include co-pays for various services, annual deductibles that delay the point that the insurance actually starts paying for things, and lifetime limits on the total amount the insurance can be required to pay. So people in the US usually have incentives to avoid using medical services unless they absolutely must. These incentives magically morph otherwise reasonable insurance plans into rather expensive versions of catastrophic insurance plans with a prescription benefit.
> I would much rather be able to request services in the way Amazon allows you to buy products than continue to engage in the current opaque system.
Is a system where n% of the care is provided by unqualified/unlicensed providers masquerading (indistinguishably) as other, qualified providers, where the reviews are invariably fake, and from which both customers and providers can be banned from the system with no recourse for arbitrary reasons really something we want?
Not to mention that people are different in their health needs, responses both physiological and psychological to treatment, and in their goals for healthcare.
I didn't think much could make the US's current health system less transparent or effective, but on reflection I think Amazon taking their current marketplace strategy and applying it to the health industry with a wide brush might just do the trick.
I think their thesis is aligned with Amazon: to decouple primary care from insurance as much as possible.
Another interesting care provider is Curai which (like Amazon) mostly focuses on tele-health: https://curaihealth.com/
Full disclosure: while I don't work for either of these companies, I do work on healthcare pricing and payments, and adjust claims; so I generally find news like this to be interesting and cool.
Jeff Bezos: "There are two kinds of companies, those that work to try to charge more and those that work to charge less. We will be the second."
If he can do that with healthcare, it could be a godsend for a great many people currently suffering under the opaque, private-equity-rigged healthcare system the US currently has. Such a system is ripe for disruption.
It seems to largely depend on what kind of healthcare quality and health outcomes Amazon can deliver while pushing prices down, as well as how Amazon can deal with the edge cases that currently account for the bulk of healthcare expenses in the current system.
One litmus test for where they're heading with this is whether they publish fixed costs for medical procedures or not. That seems to be one necessary-but-maybe-not-sufficient requirement for getting this mess under control.
The value and effectiveness of Amazon's approach will take some time to be proven or disproven.
But I'm open to any approach to bring insane US health care costs into line. Americans spent nearly 18% of the US GDP on health care in 2020. Healthcare spend increased 4.6% in 2019 alone[0]. It's out of control.
Commoditizing healthcare will only make its quality plummet, seen it in countless cases all around the world
The point is that it's not a commodity, because it's often the product of the skills of a single physician, whether manual or mental.
I want to pay more to choose a better physician if he's going to cut my -something- open, not choose the lowest price based on bogus "Amazon recommends" reviews.
I think a better model would be something where insurance is included..or covered by the source of healthcare.
Example: Hospitals are generally the source / hub of medicine in an area. So you subscribe to a hospital and pay them 5% of your income.
Hospital then negotiates rates with other hospitals or all hospitals maybe set common-rates for things. Whether you're in an injury locally or across the globe they cover the cost.
Hospital gets recurring income monthly to budget by. PCP's and specialists might get a cut of that as well maybe they get shares of the income based on office visits/year?
I'd love this for when my kids get sick off hours (which is every time they get sick). When my first key was very little I was a super anxious new parent. Now that I have two, and they're older, I know they're not immediately going to die when they get sick.
I'm in the US and have a loved one with a chronic disease, and honestly just the logistics of health care couldn't get much worse. Coordinating between different specialists, different labs, and different pharmacies is always a nightmare. Calls, manual entry, etc.
Just last week I had to deal with offices _faxing_ each other back and forth with one insisting they sent it and the other insisting they never received it. I constantly have to be the one making an active effort to keep on top of things or suddenly I find it's going to take me a week to get a medicine that I have only 5 days left on
If amazon does nothing else but makes making an appointment as easy as ordering a tube of toothpaste, I'll celebrate.
72 comments
[ 1.5 ms ] story [ 163 ms ] threadI stand corrected
Unless you don't plan to read it as an individual but as part of an effort, like EFF does, to point out it's shortcomings.
HIPAA compliance probably means that while other care providers aren't allowed to sell your medical history to marketers, Amazon doesn't even have to do that, and can send you personalized offers based on your medical history all day long without violating HIPAA.
Furthermore, this may give them data they can use to correlate medical history with other behavior, and thus potentially infer medical events about other customers that aren't Amazon Care patients.
(after dealing with "normal" health insurance I can only think "well, it can't be any worse, can it?")
American healthcare is truly a mess.
It isn't like they can go to Bob's Online College and then it's a free-for-all after that.
Third - there are about 28 states where nurse practitioners can work independently of any supervising physician. Also, in many cases "supervision" is a joke, with the supervising physician hundreds of miles away and simply signing charts without reviewing them.
> It isn't like they can go to Bob's Online College and then it's a free-for-all after that.
It actually is, though. You would be very, very surprised.
My Dad became a board-certified FNP when I was in high school. I've seen enough of the books, the reading, the studying, the records reviews, the toil, and the anxiety to know you're wrong about this.
Currently, certain nurse practitioner schools are better than others, but the fact remains that the minimum requirement for clinical training hours is 500. [1] That's literally 3 months working a 40-hr/week job. That's less than the number of hours Petsmart trains their dog groomers for (over 800). [2] Furthermore, many nurse practitioner schools are not even finding placements for their students, instead forcing them to beg others to take them on for what are mostly shadowing experiences.
----
[1] https://www.nccwebsite.org/content/documents/cms/2020323_fin...
[2] https://services.petsmart.com/grooming
"A meta-analysis of 38 studies, comparing a total of 33 patient outcomes of NPs with those of physicians, demonstrated that NP outcomes were equivalent to or greater than those of physicians. NP patients had higher levels of compliance with recommendations in studies where provider assignments were randomized and when other means to control patient risks were used. Patient satisfaction and the resolution of pathological conditions were greatest for NPs. NP and physician outcomes were equivalent on all other outcomes."
https://www.aanp.org/advocacy/advocacy-resource/position-sta...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5594520/
https://pubmed.ncbi.nlm.nih.gov/28234756/
Compared with dermatologists, PAs performed more skin biopsies per case of skin cancer diagnosed and diagnosed fewer melanomas in situ, suggesting that the diagnostic accuracy of PAs may be lower than that of dermatologists. https://www.ncbi.nlm.nih.gov/pubmed/29710082
Advanced practice clinicians are associated with more imaging services than PCPs for similar patients during E&M office visits. https://jamanetwork.com/journals/jamainternalmedicine/fullar...
Nonphysician clinicians were more likely to prescribe antibiotics than practicing physicians in outpatient settings, and resident physicians were less likely to prescribe antibiotics. https://www.ncbi.nlm.nih.gov/pubmed/15922696
The quality of referrals to an academic medical center was higher for physicians than for NPs and PAs regarding the clarity of the referral question, understanding of pathophysiology, and adequate prereferral evaluation and documentation. https://www.mayoclinicproceedings.org/article/S0025-6196(13)...)
Further research is needed to understand the impact of differences in NP and PCP patient populations on provider prescribing, such as the higher number of prescriptions issued by NPs for beneficiaries in moderate and high comorbidity groups and the implications of the duration of prescriptions for clinical outcomes, patient-provider rapport, costs, and potential gaps in medication coverage. https://www.journalofnursingregulation.com/article/S2155-825...)
Antibiotics were more frequently prescribed during visits involving NP/PA visits compared with physician-only visits, including overall visits (17% vs 12%, P < .0001) and acute respiratory infection visits (61% vs 54%, P < .001). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5047413/
NPs, relative to physicians, have taken an increasing role in prescribing psychotropic medications for Medicaid-insured youths. The quality of NP prescribing practices deserves further attention. https://www.ncbi.nlm.nih.gov/m/pubmed/29641238/
(CRNA) We found an increased risk of adverse disposition in cases where the anesthesia provider was a nonanesthesiology professional. https://www.ncbi.nlm.nih.gov/pubmed/22305625
NPs/PAs practicing in states with independent prescription authority were > 20 times more likely to overprescribe opioids than NPs/PAs in prescription-restricted states. https://pubmed.ncbi.nlm.nih.gov/32333312/
Both 30-day mortality rate and mortality rate after complications (failure-to-rescue) were lower when anesthesiologists directed anesthesia care. <...
I work in healthcare and have determined that there's no difference in care outcomes between NPs and Others in our organization.
I and my teams have wasted tons of man hours trying to convince MDs of this fact instead of working to help our patients.
When I ask my insurance company to pay for some health care, they might pay.
I would much rather be able to request services in the way Amazon allows you to buy products than continue to engage in the current opaque system.
No? I want it separated from employment and universally and freely available like the rest of the developed world.
(At half our costs, and similar outcomes!)
Sorry, I’m not following.
So under that definition what you’re describing isn’t relevant to whether it’s a commodity or not.
Also, health care isn’t a commodity right now but I’d argue it should be (a high quality one).
Amazon Care does not provide emergency surgery at the moment.
Health care is far more than just emergency services.
Water, for example, is a commodity. It doesn't matter where you get it, because water from one tap is mostly indistinguishable to water from a different tap. When you need water, you simply just go to the closest tap and you can be happy that you're getting the same quality water as anywhere else. That's exactly what you want with healthcare, too.
In fact, commoditization of healthcare is probably one of the best steps towards making it a public utility. So if that's what you want, then you probably do want healthcare to be commoditized.
Different hospitals have different facilities as well. You’re better off having a type of procedure at one place than another for example. And even if you somehow made it so every hospital had the same high quality equipment you still wouldn’t have the same quality of specialists, surgeons, etc. This matters a lot.
There’s probably a baseline we could get to but the experience will never be a commodity overall.
But for more common things like an annual wellness exam, or blood tests, mending a broken arm, treating the flu, or even doing surgery on a burst appendix, those are things that I think can reasonable be commoditized across any healthcare providers.
The next day I was on a flight from SFO to Singapore, and it was extremely apparent I had strep. Upon landing in Singapore, I went to a clinic where they diagnosed the strep, gave me antibiotics, decongestants, sudafed (the good kind), throat lozenges, and ibuprofen. Total cost? $20 USD.
But I don't see the US government being able to do anything serious in the near term, with the forces of overpowered lobbying and general insanity working against it.
We’ve picked the worst of each approach in the US and combined them.
In the US, most health plans include co-pays for various services, annual deductibles that delay the point that the insurance actually starts paying for things, and lifetime limits on the total amount the insurance can be required to pay. So people in the US usually have incentives to avoid using medical services unless they absolutely must. These incentives magically morph otherwise reasonable insurance plans into rather expensive versions of catastrophic insurance plans with a prescription benefit.
Is a system where n% of the care is provided by unqualified/unlicensed providers masquerading (indistinguishably) as other, qualified providers, where the reviews are invariably fake, and from which both customers and providers can be banned from the system with no recourse for arbitrary reasons really something we want?
Not to mention that people are different in their health needs, responses both physiological and psychological to treatment, and in their goals for healthcare.
I didn't think much could make the US's current health system less transparent or effective, but on reflection I think Amazon taking their current marketplace strategy and applying it to the health industry with a wide brush might just do the trick.
I think their thesis is aligned with Amazon: to decouple primary care from insurance as much as possible.
Another interesting care provider is Curai which (like Amazon) mostly focuses on tele-health: https://curaihealth.com/
Full disclosure: while I don't work for either of these companies, I do work on healthcare pricing and payments, and adjust claims; so I generally find news like this to be interesting and cool.
If he can do that with healthcare, it could be a godsend for a great many people currently suffering under the opaque, private-equity-rigged healthcare system the US currently has. Such a system is ripe for disruption.
It seems to largely depend on what kind of healthcare quality and health outcomes Amazon can deliver while pushing prices down, as well as how Amazon can deal with the edge cases that currently account for the bulk of healthcare expenses in the current system.
One litmus test for where they're heading with this is whether they publish fixed costs for medical procedures or not. That seems to be one necessary-but-maybe-not-sufficient requirement for getting this mess under control.
But I'm open to any approach to bring insane US health care costs into line. Americans spent nearly 18% of the US GDP on health care in 2020. Healthcare spend increased 4.6% in 2019 alone[0]. It's out of control.
[0] https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta...
The point is that it's not a commodity, because it's often the product of the skills of a single physician, whether manual or mental.
I want to pay more to choose a better physician if he's going to cut my -something- open, not choose the lowest price based on bogus "Amazon recommends" reviews.
That said, it's frustrating that consumers need to go through their employers to get their healthcare.
Example: Hospitals are generally the source / hub of medicine in an area. So you subscribe to a hospital and pay them 5% of your income.
Hospital then negotiates rates with other hospitals or all hospitals maybe set common-rates for things. Whether you're in an injury locally or across the globe they cover the cost.
Hospital gets recurring income monthly to budget by. PCP's and specialists might get a cut of that as well maybe they get shares of the income based on office visits/year?
https://amazon.care/for-employers.html
Just last week I had to deal with offices _faxing_ each other back and forth with one insisting they sent it and the other insisting they never received it. I constantly have to be the one making an active effort to keep on top of things or suddenly I find it's going to take me a week to get a medicine that I have only 5 days left on
If amazon does nothing else but makes making an appointment as easy as ordering a tube of toothpaste, I'll celebrate.