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[Neonivek]

Actually it seems more like, to me at least, that the American system for some reason encourages lower quality work for greater pay.

Yeah, because it's totally the doctor's fault 

Damn doctors and their ability to transform into concepts like systems!

Though by all means why leave the doctors out of it? Why are they immune to this discussion?

[ChairmanPoo]

You mentioned specifically lower quality work. Which kind of sounds like you mean  doctors and maybe nurses. Hence: Why do you think the work of US healthcare professionals (which, by the way, I am not) are of lower quality than whichever other professionals?

Though by all means why leave the doctors out of it? Why are they immune to this discussion?

Well, I can only talk about myself, but I think I've been pretty open in my position about healthcare systems.   I believe national healthcare systems are fairer, more efficient, and result in better care for everyone, not just poorer people, as bigger, more specialized centers are more affordable. This is not to say that a private clinic cannot be good, but as a general rule they tend to have less resources for the most part.

[Neonivek]

Ok I will correct myself. The reason you don't blame the doctors is... Lets say 100% it IS that doctors are low quality and scum...

You know like how American Lawyers suffer immensely from a quality and corruption problem.

It would be far better to talk about the schooling process, government oversight, societal expectations or things that are causing them to become this way.

Why do you think the work of US healthcare professionals (which, by the way, I am not) are of lower quality than whichever other professionals?

Other doctors in other countries and honestly I have no idea.

[ChairmanPoo]

The thing is that while there are likely worse doctors and better doctors -like everywhere else- I find it dubious to blame them altogether as a group... just like I would seriously hesitate about talking globally about american lawyers as a group. Particularily if we're working from hearsay.

[Neonivek]

The thing is that while there are likely worse doctors and better doctors -like everywhere else- I find it dubious to blame them altogether as a group... just like I would seriously hesitate about talking globally about american lawyers as a group. Particularily if we're working from hearsay.

I am not exactly sure we are on the same page.

[scriver]

You're both on page four on 25 ppp.

[Sheb]

I'm not sure about lower quality, but the way incentive are structured in the US is that doctor have an interest in prescribing as many procedures as possible.

[ChairmanPoo]

I'm betting most doctors in the US aren't self employed.

That being said, for what I've seen about private clinics over here, they do that with some frequency, and since the US lacks a proper public healthcare, it wouldn't surprise me.

[Jimmy]

I'd like to believe doctors are mostly genuinely invested in providing quality healthcare over pure financial considerations.

Yes, at the end of the day a doctor needs to turn a profit just like anyone else in order to survive. That doesn't mean they're going to compromise their standards doing so. After all, there's clear penalties for malpractice, and whilst they're not used liberally except in the most obvious of cases, the amount of time and effort invested to earn a medical degree simply doesn't stack up against whatever small sideline profit you can make abusing that qualification.

Plus the workload tends to push away anyone not genuinely invested in providing healthcare for more than simple monetary compensation. If you wanted big money, go into business instead. Less years of your life invested into study, less debt, and less dealing with broken messy biological functions.

[BorkBorkGoesTheCode]

I'd like to believe doctors are mostly genuinely invested in providing quality healthcare over pure financial considerations.

Yes, at the end of the day a doctor needs to turn a profit just like anyone else in order to survive. That doesn't mean they're going to compromise their standards doing so. After all, there's clear penalties for malpractice, and whilst they're not used liberally except in the most obvious of cases, the amount of time and effort invested to earn a medical degree simply doesn't stack up against whatever small sideline profit you can make abusing that qualification.

Plus the workload tends to push away anyone not genuinely invested in providing healthcare for more than simple monetary compensation. If you wanted big money, go into business instead. Less years of your life invested into study, less debt, and less dealing with broken messy biological functions.

That is a generalization.

[ChairmanPoo]

I don't think that depends as much on doctors as on the hospital's board. Likely they are not making money directly. I know that people in private clinics over here are not.  Freedom of prescription is all well and good, but if the board insists on doing something else and takes reprisals against uncompliant physicians.... you might have trouble, particularily in the US, because of it's lax labor laws.

[Starver]

Probably something like "we make profit on every time the CT scanner is used and charged for, we insistthat you find a reason to conduct a CT scan as much as you can find a good reason for..."

While over here "it costs £FOO at public expense to conduct a CT scan, are you sure we will get a better value-for-money outcome² if you send the patient to be scanned?"


(Hypothetical example, indicating the limits of the exercise. The former doesn't count the costs of any non-chargable/non-recoupable scans, or the possibility that such vital scans are elbowed out by scans that are little more than sheer vanity. The latter doesn't take into account the idle-running (and staffing) costs that happen regardless of use, if such a machine is sitting there waiting. In the UK there was, within the last year or two, a call to make scanners such as this a 24-hour resource (give or take maintenance downtime) so that out-of-hours emergencies didn't need to go through hoops to get potentially life-saving scans immediately (where not already done) and if they could get in-patient cases dealt with all around the clock (betwixt the aforementioned priorty emergencies) there might be more useful and more timely medical information for all.  Same with X-ray/etc resources.  But Jeremy 'the C-word' Hunt and the doctors' unions had pretty much opposing views on how to set about changing the existing seven-day NHS into a seven-day NHS...)




¹ Or by a bonus scheme, of some arbitrarily opaque nature, we shall reward you well for performing your part in the  process of extracting as much money from insurance schemes (public and/or private) as possible.

² Not necessarily the same as a better outcome, entirely health-and-wellbeingwise

[ChairmanPoo]

While over here "it costs £FOO at public expense to conduct a CT scan, are you sure we will get a better value-for-money outcome2 if you send the patient to be scanned?"

More like "We are close to the end of the year; are you sure you have to conduct that CT scan?"
My experience is that the administration becomes more miserly as the time to make the yearly accounts draws to a close.

[PTTG??]

No, no, you don't understand. The free market will work perfectly.

You see, there is a fair price for all medical care. Say you have a heart attack. Like all rational consumers, you will do a quick price comparison of all the hospitals in the nation, balance that against the treatment outcomes for people with similar conditions, and then call that hospital.

Hospitals that overcharge or provide bad services, such as those in poor neighborhoods, will go out of business. Hospitals which take only a reasonable profit and provide good services will succeed and attract investors who will encourage the hospitals to expand.

The best part is, if all hospitals overcharge, then consumers will make the rational choice to not seek treatment at all, and instead die, for their own convenience. This untapped market will encourage hospitals to develop ways to charge less.

[Jimmy]

Thus supporting Darwinian selection and weeding out the obese, smokers and genetically faulty specimens of humanity.

Brilliant!