My impression is a lot of US health care problems are caused in part by a sort of unholy combination of restricted competition and access, together with profit driven market participants. So you end up with this marketplace constricted by overregulation — some well-meaning but often basically occurring because of protectionist moats and regulatory capture — increasingly controlled by profiteers trying to extract as much money as possible, with patients at the bottom, providers in the middle, and executives at the top. I think the problems with monopolies in the US are broad in scope but it hits healthcare especially hard because of how grotesquely distorted it is.
I'm not surprised by this finding, although I find in economics and healthcare forums the results tend to be misused (at least in my opinion), because it gets used to argue against any deregulation or cost cutting, instead of cost cutting of the type that tends to happen for the benefit of investors and shareholders, rather than cost cutting of the type that increases healthcare options and access.
There are a significant number of people in this country that will view this as the market enforcing rational healthcare (at least until it affects a loved one). I’m not sure we have the will to improve our care.
i'd be curious about other metrics in addition to death rate...
- health adjusted quality of life metrics and the way they are impacted by various diagnoses
- healthspan metrics
- patient satisfaction
- employee satisfaction
Ultimately, capitalism is not necessarily at odds with providing efficient high qualty healthcare. But we have to decide what matters. If death rate were the only relevant metric, medicine would be practiced much differently.
is the change in death rate because the health services got worse or because the type of patients going to that hospital have shifted?
if they slash staffing and make it hard to schedule in a reasonable amount of time, patients with low-risk issues will just skip going altogether. Or, if they have the means, go to a nicer hospital.
History will be hard pressed to find a success story after private equity takes anything over. Here I was thinking I had coined a term for them, only to find out it already exists... "HYENA CAPITALISM".
>These “high-markup hospitals” (HMH), which comprised about 10% of the total the researchers examined, charged up to 17 times the true cost of care. By contrast, markups at other hospitals were an average of three times the cost of care.
>They also have significantly worse patient outcomes compared with lower-cost hospitals, new UCLA research finds.
>After instrumenting for the patient-nursing home match, we recover a local average treatment effect on mortality of 11%. Declines in measures of patient well-being, nurse staffing, and compliance with care standards help to explain the mortality effect.
The market really is the greatest mechanism for laundering morally reprehensible processes, isn't it? I find that many people struggle to find the vocabulary or concepts to denounce this kind of outcome because it occurs through market forces.
Maybe the next Democratic president will use the newly confirmed limitless executive power to reshape our healthcare system. Remove limits on creating new hospitals, eliminate the AMA, add in a public option for insurance, drop the age limit for Medicare to 0, etc. There are plenty of opportunities to use the power for something good.
One popular approach to saving money is to replace physicians with nurse practitioners and physician assistants, who have less education and training. The article does not discuss this element, and I'd be interested to see if that is a factor in patient outcomes. There's less data on this than you might expect.
ETA: From my post lower down, adding for visibility:
[The training gap is] quite a lot more than a year - in primary care, it's more like four additional years of training for physicians, and 15000 supervised clinical hours for physicians (vs 500 to 1500 hours for NPs). The gap can be wider in other physician specialties, because many have longer residencies than the primary care programs. For example, child psychiatry training is four to five years (depending on the route you take), making it longer than the three years of family practice residency.
This certainly reflects my experience with private equity in general. It seems private equity by definition does not care if you die in any form direct or indirect. IMO its one of the greatest evils going on that literally nothing is being done about.
Last year I went to an interview where they flat out admitted to me that the private equity that bought them fired the entire previous team because they "believed" it could be done with far less people (4 vs 25). I asked them who has been maintaining things since that happened and they told me they have been hiring contractors to get through the period but "they haven't really been doing the job". I guess at least they were honest with me so I could nope out of there ASAP.
People assume staff shortages, but I've been to a cheap non-profit hospital and everyone was very green and TERRIBLE at their jobs due to lack of training.
Privatize the profits and socialize the losses, is this too difficult to understand of being the core motto of a private equity firm. A PE firm will not have patients at the top of their priority, unless legislation enforces and regulates that.
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[ 1.7 ms ] story [ 60.6 ms ] threadI'm not surprised by this finding, although I find in economics and healthcare forums the results tend to be misused (at least in my opinion), because it gets used to argue against any deregulation or cost cutting, instead of cost cutting of the type that tends to happen for the benefit of investors and shareholders, rather than cost cutting of the type that increases healthcare options and access.
This seems extremely high.. Ireland with free public healthcare for example is ~6%.. I think the largest in Europe, by a lot, is Germany? ~13%.
- health adjusted quality of life metrics and the way they are impacted by various diagnoses
- healthspan metrics
- patient satisfaction
- employee satisfaction
Ultimately, capitalism is not necessarily at odds with providing efficient high qualty healthcare. But we have to decide what matters. If death rate were the only relevant metric, medicine would be practiced much differently.
if they slash staffing and make it hard to schedule in a reasonable amount of time, patients with low-risk issues will just skip going altogether. Or, if they have the means, go to a nicer hospital.
The rich don’t care about anyone but their financial advisor.
>These “high-markup hospitals” (HMH), which comprised about 10% of the total the researchers examined, charged up to 17 times the true cost of care. By contrast, markups at other hospitals were an average of three times the cost of care.
>They also have significantly worse patient outcomes compared with lower-cost hospitals, new UCLA research finds.
NURSING HOMES: Owner Incentives and Performance in Healthcare: Private Equity in Nursing Homes ( https://www.nber.org/papers/w28474
>After instrumenting for the patient-nursing home match, we recover a local average treatment effect on mortality of 11%. Declines in measures of patient well-being, nurse staffing, and compliance with care standards help to explain the mortality effect.
Public healthcare is the only way to go. This has been proven multiple times in so many countries.
One popular approach to saving money is to replace physicians with nurse practitioners and physician assistants, who have less education and training. The article does not discuss this element, and I'd be interested to see if that is a factor in patient outcomes. There's less data on this than you might expect.
ETA: From my post lower down, adding for visibility:
[The training gap is] quite a lot more than a year - in primary care, it's more like four additional years of training for physicians, and 15000 supervised clinical hours for physicians (vs 500 to 1500 hours for NPs). The gap can be wider in other physician specialties, because many have longer residencies than the primary care programs. For example, child psychiatry training is four to five years (depending on the route you take), making it longer than the three years of family practice residency.
Here's a chart looking at training for MDs vs NPs in primary care. It is from a physician organization. https://www.tafp.org/media/advocacy/scope-education.pdf
Last year I went to an interview where they flat out admitted to me that the private equity that bought them fired the entire previous team because they "believed" it could be done with far less people (4 vs 25). I asked them who has been maintaining things since that happened and they told me they have been hiring contractors to get through the period but "they haven't really been doing the job". I guess at least they were honest with me so I could nope out of there ASAP.