[tater]

Yeah, one huge problem is a disconnect between the customer, and cost, IMO.

Insurance companies have contracts with providers, but this is usually pegged to what medicare pays---more, but some multiple. It's known by all parties in negotiation that the providers lose money on government patients, so they must be paid more. But why do costs continuously increase instead of stabilizing?

Technologies change, for one thing, and then the government sets (arbitrarily) certain reimbursements low this year that were not low last year. Since the insurers are all pegged to some multiple, revenue drops across the board. You've got employees to pay, etc, so you start doing the "brand new" technique because it pays better.

In addition, patients DEMAND the new technique.

Look at laparoscopy. Everyone demands it now. The claim is made that you recover faster, etc. In my wife's experience this is often smoke and mirrors. In academic settings, docs will have you eat a bite of solid food the next day (and I do mean a single bite), then when they publish, they can claim the patient is eating solid food XX hours after surgery instead of clear liquids for a couple days. The reality is that it might not be all that different. In addition, the new techniques take longer. Wife has a partner who is trained (fellowship) in the latest, greatest stuff. He takes a couple hours to do a case with the scope that my wife can do in 20-30 minutes open. So the PATIENT might get out a day earlier, but in return they are under general longer, AND the docs far more valuable time is wasted. 2 hours of doc time at a few hundred bucks an hour in the OR vs 1/3 of an hour. Then there is the OR time---THAT is where the huge money is, not the doc fees. Doc makes several hundred bucks, OR fees for that can be HUGE. OR is like $40-50/minute. So the lap case is 5 grand, and the open case is under a grand for OR fees. But it's not just the money, it's the TIME. Do 4-6 open cases, or ONE scoped. Those other 3-5 people are waiting X days to have their surgery done because the doc only has so many hours per week in the OR to work with.

Since there is a shortage of docs, this makes for longer wait times, AND increased costs. Sometimes the latest isn't better, or is not cost-effective.

People nowadays also misuse the ER or urgent care. Our kids only go to urgent care if they are VERY sick. Otherwise, they make an appointment with their pediatrician. The patients that complain most about waiting in my wife's experience? Medicaid patients. They don't wait any longer, mind you, insurance status has zero connection to scheduling at her office---they are just more likely to: complain, not show up for an appointment, not follow care guidelines, and oh yeah, they are more likely to sue.

There's a chunk of cost, needless tests. Since the DOC is the one who will get sued, when in doubt, order another expensive scan, blood test, etc. Also, doc shortages increase tests... really. It's 3am. Doc gets called at home. He can go in right now, get zero sleep, then still have to see 30 patients tomorrow, OR he can order some scans, etc, knowing that the patient won't be back on the floor until 5am, then he can get up normally at 6am, and see the patient when he rounds at 7:00, or maybe go in a little early if it is urgent. Sure, someone, somewhere is writing large checks for the scan, but the doc got to sleep a couple desperately needed hours, so it was worth a few grand (you don't want to be the guy operated on that next day by a doc that needs sleep, do you?).