re: Out of the Box Healthcare Ideas

well you're miserable so that's understandable.

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End of life care represents 10-20% of total medical spending.

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That is true in any modern system. We die in hospitals, hospice, or assisted living which is tallied aa medical as well. Those costs will always be there. But it is not only a geriatric issue.

A 25y/o trauma victim may previously have spent little or nothing on healthcare. When he dies after multiple surgeries and an extended ICU stay, virtually 100% of his lifetime care costs will have occurred during that single stay.

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Not as familiar with SNF risk adjustments, are they demographic/ICD based?

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Yes. They target typical issues in NHs like falls, pain control, wounds.

You could use HAIs, etc.

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A 25y/o trauma victim may previously have spent little or nothing on healthcare. When he dies after multiple surgeries and an extended ICU stay, virtually 100% of his lifetime care costs will have occurred during that single stay.

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This is the outlier. Gramma on her 4th trip to the ER with COPD and dyspnea isnt.

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That is true in any modern system. We die in hospitals, hospice, or assisted living which is tallied aa medical as well. Those costs will always be there. But it is not only a geriatric issue.

A 25y/o trauma victim may previously have spent little or nothing on healthcare. When he dies after multiple surgeries and an extended ICU stay, virtually 100% of his lifetime care costs will have occurred during that single stay.

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And what percentage of end of life costs do you think are attributed to patients with a single discrete high cost event?

And how do you explain findings like:

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Over half a million Americans die each year from cancer. While progress has been made over the last two decades in addressing patient preferences near the end of life, much more needs to be done. Most patients with cancer who are approaching the end of their lives prefer supportive care that minimizes symptoms and their days in the hospital. Unfortunately, the care patients receive does not always reflect their own preferences, but the prevailing styles of treatment in the regions and health care systems where they happen to receive cancer treatment.

In analyses of Medicare data that control for patient age, sex, race, tumor type, and non-cancer chronic conditions, the chances that a patient with advanced cancer died in the hospital in 2010 varied from one in eight (13%) to one in two (50%) depending on the medical center providing their care, even among National Cancer Institute-designated Cancer Centers. Similarly, the number of days patients spent in intensive care units (ICUs) in the last month of life varied more than fivefold across these centers. The chances of a patient receiving hospice care differed by a factor of five.

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Or studies that find that the regional supply of health care resources is a driver of the intensity of care, irrespective of the patient’s particular condition or illness.

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The federal government spent $980 billion in tax revenue on direct healthcare distribution systems in 2015

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Give it to the states via the 10th...

1T saved

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quote: Over half a million Americans die each year from cancer. While progress has been made over the last two decades in addressing patient preferences near the end of life, much more needs to be done. Most patients with cancer who are approaching the end of their lives prefer supportive care that minimizes symptoms and their days in the hospital. Unfortunately, the care patients receive does not always reflect their own preferences, but the prevailing styles of treatment in the regions and health care systems where they happen to receive cancer treatment. In analyses of Medicare data that control for patient age, sex, race, tumor type, and non-cancer chronic conditions, the chances that a patient with advanced cancer died in the hospital in 2010 varied from one in eight (13%) to one in two (50%) depending on the medical center providing their care, even among National Cancer Institute-designated Cancer Centers. Similarly, the number of days patients spent in intensive care units (ICUs) in the last month of life varied more than fivefold across these centers. The chances of a patient receiving hospice care differed by a factor of five.

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Fascinating and unsurprising.

I'm starting to get to the point where I want business and money out of the way of healthcare....

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The problem is that in our system, all care is very expensive. There is limited market pressure to drive costs down. There is extensive societal and legal pressure driving costs up. We disempower decision-makers and expertise in favor of regulation and bureaucracy.

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Bingeaux.

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Is there a better answer out there?

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Something I've tossed about for a while now but would really like constructive feedback on: barring insurance companies from dealing with medical personnel/facilities.

Around 25% of medical costs come from the brigade of employees a doctor needs to keep around just to handle dealing with the various insurance companies and each one's particular way of doing things.

Removing this avenue does two things:

-it lowers costs by allowing the medical professional/establishment to cut staff

-eventually market forces would push insurance companies to streamline their services