Quote:
Originally Posted by grizy
There are a few other things but these are the main ones that are studied the most. Insurance has also been IDed but empirical studies (there have been lots), even ones that lean left, show they account for relatively little of the difference between the ~6k/capita we'd be expected to pay as % and the ~10k/capita we actually pay. The biggest culprits are still end of life care and high drug prices.
Got a cite on the end of life care thing?
The culprits I understand are:
1) Higher prices across the board - meaning drugs cost more, doctors get paid more, procedures cost more. Some of this is difficult to address (it's not so easily to just pay doctors less in a country with high income inequality, you'll get less doctors) and some of it is because the government doesn't have the power to drive down costs that it does in other countries.
2) Administrative costs. For example,
How Large a Burden are Administrative Costs in Health Care?
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Estimates suggest that between 15-30 percent of overall health care spending, and one-quarter of the medical labor force, are involved in costs of billing, insurance management, hospital administration, and the like. “Administrative costs” refer to the “back-end” functions of the health care system, aside from direct patient care – including medical billing, scheduling patient appointments, hiring and managing staff, and investing in quality improvement efforts. There are no official data on their total size, but estimates extrapolated from micro-costing studies suggest that billing and insurance-related services alone comprise about 15 percent of health care spending, and total administrative costs may comprise about 30 percent.
A 2011
study found that 39% of the cost difference between Canadian and US hospitals were administrative. A 2014
study likewise found that hospitals in the US spent twice as much on administration as in countries like England. This is because of the complexity of the US system.
For example:
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Dr. John Cullen's four-physician family medicine practice in Valdez, Alaska, employs three full-time staffers who work on insurance and patient billing. A fourth full-timer focuses on obtaining prior authorizations from nine private and public insurers.
Even then, Cullen and his partners often must call and write letters to convince insurers to approve coverage or pay claims.
"It's an incredible bureaucratic mess to get anything done for patients," said Cullen, president-elect of the American Academy of Family Physicians.
In contrast, Dr. Trina Larsen Soles' 12-physician general practice in Golden, British Columbia, has one full-time staffer assigned each day to billing the province's public medical services plan, its public workers' compensation plan and its quasi-public auto insurance company. She and her colleagues don't get involved in billing or utilization-review issues.
"It's not a big hassle," said Larsen Soles, president of Doctors of BC, which represents British Columbia physicians in fee negotiations with the provincial health plan. "I can focus on patient issues, not administrative issues."
And the work done by staffers may be an underestimate, as many doctors shoulder this burden themselves.
For example:
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Health care professionals in America also reported a higher level of "administrative burden." A survey showed that a significant portion of doctors call the time they lose to issues surrounding insurance claims and reporting clinical data a major problem.