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What makes the US healthcare system so expensive? Why is the US so expensive compared to Canada?
There are a long list of reasons but here's a start.1. Americans won't permit or accept healthcare rationing. America spends much more for care in the last 6 months of life than any other country. By a lot.Walk through any ICU and you'll routinely see some people in vegetative conditions with virtually no chance of getting better. Yet they are receiving a full court press with anything and everything that can be done from the standpoint of medical technology.Some of the push for this care comes from families who are adamant against witholding or withdrawing care. But doctors are also guilty of over treatment. We all know some crazy doctors who believe that miracles can happen daily in the ICU regardless of how hopeless the situation may be.The expense is enormous and American families are divorced from it. If the patient is uninsured, the costs are absorbed by the treating hospital and the doctors. If the patient is insured, the deductible has been met and the rest is paid for by insurance or via the taxpayers (Medicaid/Medicare). 28% of Medicare costs involve the last 6 months of life. That is a ton of money.You won't see this in any other country with a national health service. Elderly patients don't get started on dialysis in the NHS in England. They die of kidney failure. You won't see 75 or 80 year olds getting quadruple bypass surgery either. Cancer patients in Canada and England routinely don't get $10,000 a month drugs for cancer treatment that prolongs life by several months (on average). The drugs either aren't available at all like in Canada where some cancer drugs never get approved, or they are made virtually unavailable through a lottery in England.Americans are often overtreated. NHS patients are often under-treated.End-Of-Life Care: A Challenge In Terms Of Costs And QualityCancer drug lottery still rife I'm proof that a new wonder drug beats skin cancer. So how can the NHS let thousands like me die?Wait Time For Cancer Drugs In Canada Exceeds U.S., Europe2. Americans pay much more for pharmaceuticals than anyone else in the world. The American government under pressure from the Big Pharma lobby refuses to negotiate discount rates for Medicare. So Americans pay 30% to 300% more than Canadians for the identical drug made in New Jersey or California.U.S. Consumers Foot the Bill for Cheap Drugs in Europe and Canada3. There is gigantic waste and fraud in Medicaid and Medicare programs. Billing is electronic and payment is automatic. Auditing is very expensive and apparently very rarely occurs. It's so lucrative and easy to skim hundreds of millions of dollars per scheme that organized crime is now involved.  There are reasonable estimates that the fraud is $120-180 billion a year. This are astronomic numbers.Comments are frequently made about how efficient Medicare/Medicaid are because they have such low administrative costs compared to insurance companies. (It's pretty difficult to scam insurance companies for large amounts of money.) But the administration of Medicare/Medicaid includes the Department of HHS and also various law enforcement arms of the federal government. That's not cheap. And it's apparently not very effective either.And while every state struggles with Medicaid fraud, the Office of the Inspector General says the five topping the list are California, Texas, New York, Ohio and Kentucky. The good news is that states recovered $1.7 billion in fraudulent payments in 2022. The bad news is the government had to spend $208 million to do it.Medicare And Medicaid Fraud Is Costing Taxpayers Billions4. Americans demand immediate access to technology. We want the ability to get an MRI or PET scan tomorrow or that latest diagnostic test and treatment reported on CNN. That kind of access is incredibly expensive both in overhead to build the facilities and purchase the machines let alone the costs of the procedures.  In no other country does this happen. Many small American cities have more MRI scans and PET scans than exist in entire provinces of Canada. In Canada and England there is a waiting list for these kinds of tests and they are often not approved because the yearly budget runs out of funds.We Americans want these tests sometimes even when they are considered not necessary for good health. We ask our doctors to rule out the 1 in 10,000 event. It's human nature to want the latest and greatest of everything. But its never free and this kind of medical care costs a tremendous amount of money.More than half of lower-back MRIs ordered at two Canadian hospitals were inappropriate or of questionable value for patients—and family doctors were more apt than other specialists to order these unnecessary tests, according to newly published medical research from Alberta and Ontario teams.The findings are important because in some parts of the country, MRI tests for the lower back account for about one-third of all MRI requests. Across the country, wait times for MRIs are long and patient access is limited.Requests for lower-back MRIs often unnecessary: studyOur friends in Canada and England accept rationing of healthcare sevices. Americans give no indication that they are willing to. Look at the uproar over the IPAB (called by some death panels) in the ACA law.5. The wasteful practice of defensive medicine. In American there are enormous numbers of unnecessary tests and scans that are performed by a doctor to cover his/her ass just in case of a lawsuit. It's impossible to practice in America without facing the threat of litigation. I and every doctor answering honestly will admit to ordering defensive tests.I've seen estimates of $600+ billion a year in unneeded tests and procedures done primarily to avoid litigation. That's a lot of money that could otherwise go to insuring the uninsured. Opponents to tort reform quote very small numbers because they only use the cost of defending lawsuits in their equation. But that's a drop in the bucket compared to what doctors in America waste so that no one will accuse them of "missing something".Defensive Medicine: A Cure Worse Than The Disease
How much paperwork do doctors, patients, and administrators need to fill out in countries with universal healthcare before treatment can occur?
If the treatment is simple counselling in my office, all I have to do is type my note, then I bill automatically through my electronic health record. So all codes for diagnosis and type of exam are preprogrammed into the system. Treatment has occurred. No trees were injured.If the treatment requires a prescription, then I can write the prescription in my Electronic health Record (EHR) and efax to pharmacy. Or I print it out, sign it. The patient takes it to a pharmacy where his or her insurance is checked, information is added to her computerized record and the medication is dispensed. If I made an error or pharmacist has a question, then they contact me and we fix it. Sometimes a medication is covered only under specific circumstances, so I may have to fill out an online form that gets efaxed to government requesting approval. (Examples might be a cholinesterase inhibitor for dementia, or a specific expensive treatment for Attention Deficit Disorder…). Minimal paperwork for treatment.It’s more complicated if I refer to a specialist. Depending on the specialty, there are a variety of ways to refer. Some go to a centralized booking Center, some are given to the patient who then has to call and make appointment, sometimes it goes to a team that has a specific referral form (pain clinic, head trauma….). In some cases I phone a specialist to find out how to get a patient in for rapid diagnosis in cancer care. Sometimes they’ll see the patient the next day. Only paperwork was a printed out referral with a copy of the X-ray.I have very little paperwork in general for treatment to occur (which is what you asked in your question).When I do have paperwork, it’s usually for insurance companies for short or long term disability, life insurance, workman’s compensation, road insurance for someone injured in a vehicle accident, fitness to drive forms….,The other administrative stuff I have to do involves looking up the patient results for all the tests I do. I try to minimize the testing I do, for example I do not send every cough for a chest x Ray or every case of dizziness for a brain scan. But even so, most of my patients come in with an illness that does require testing and I have to look through the results, file them or act upon them. That takes at least an hour a day.That has nothing to do with whether healthcare is privatized or universal.Hope this answered your question.
Will I need to fill out the ETIAS (new European Union visa regulation) every time I travel to a EU country? Are can I just fill it out ones and it's valid for life time?
The answer is somewhere inbetween.Each ETIAS will be valid for 3 years from the date of issue (or until the expiry date of the travel document).Full details can be found at: ETIAS - European Travel Information and Authorisation System
How do you work around healthcare regulations to start a healthcare company?
Depends what you mean by "work around" ... If you meant not having to follow them but still want to be successful, then the answer no, you can't work around them, nor should you: the very purpose of regulations from the HHS or FDA are meant to protect civilians, and they should be followed.If instead you meant: how do you still adhere to regulations but do so in a cost-effective way that allows you to get off the ground as a startup ... the short answer is you rely on companies who prproducts or services that abstract away the regulations as a concern for you.Let me give you an example, to which in full disclosure is the very purpose of the company I work for:HIPAA compliance is an important set of regulations to protect people's protected health information (PHI). It's sadly also extremely complicated, but it doesn't have to be.As a digital health startup trying to build a product in healthcare, you have to worry about HIPAA because inevitably you will handle PHI as data. So what does that mean? What do you have to worry about? Is it expensive? HIPAA is an example of a regulatory hurdle that could stop you from getting off the ground because of how complicated it can be.Thus, a company like mine which builds HIPAA compliant hosting and integration tools lets you build and host your software application in a way where you never even have to worry about HIPAA. In effect, you have "worked around" that regulation while still adhering to it.(If you want to learn more about HIPAA and your obligations, check out our free guide: https://catalyze.io/hipaa-compli...)This is a literal example of HIPAA impacting digital health startups, but other regulatory bodies like the FDA can impact other types of startups. Thus, regardless of what type of startup you have, I encourage you not to think of "work around" as in ways to hack not having to do it period, but rather "work around" as in finding the right partners who will relieve the burden of compliance off your shoulders.
How does one get invited to the Quora Partner Program? What criteria do they use, or is it completely random?
I live in Germany. I got an invite to the Quora partner program the day I landed in USA for a business trip. So from what I understand, irrespective of the number of views on your answers, there is some additional eligibility criteria for you to even get an email invite.If you read the terms of service, point 1 states:Eligibility. You must be located in the United States to participate in this Program. If you are a Quora employee, you are eligible to participate and earn up to a maximum of $200 USD a month. You also agree to be bound by the Platform Terms (https://www.quora.com/about/tos) as a condition of participation.Again, if you check the FAQ section:How can other people I know .participate?The program is invite-only at this time, but we intend to open it up to more people as time goes on.So my guess is that Quora is currently targeting people based out of USA, who are active on Quora, may or may not be answering questions frequently ( I have not answered questions frequently in the past year or so) and have a certain number of consistent answer views.Edit 1: Thanks to @Anita Scotch, I got to know that the Quora partner program is now available for other countries too. Copying Anuta’s comment here:If you reside in one of the Countries, The Quora Partner Program is active in, you are eligible to participate in the program.” ( I read more will be added, at some point, but here are the countries, currently eligible at this writing,) U.S., Japan, Germany, Spain, France, United Kingdom, Italy and Australia.11/14/2018Edit 2 : Here is the latest list of countries with 3 new additions eligible for the Quora Partner program:U.S., Japan, Germany, Spain, France, United Kingdom, Italy, Canada, Australia, Indonesia, India and Brazil.Thanks to Monoswita Rez for informing me about this update.
How can I get more people to fill out my survey?
Make it compellingQuickly and clearly make these points:Who you are and why you are doing thisHow long it takesWhats in it for me -- why should someone help you by completing the surveyExample: "Please spend 3 minutes helping me make it easier to learn Mathematics. Answer 8 short questions for my eternal gratitude and (optional) credit on my research findings. Thank you SO MUCH for helping."Make it convenientKeep it shortShow up at the right place and time -- when people have the time and inclination to help. For example, when students are planning their schedules. Reward participationOffer gift cards, eBooks, study tips, or some other incentive for helping.Test and refineTest out different offers and even different question wording and ordering to learn which has the best response rate, then send more invitations to the offer with the highest response rate.Reward referralsIf offering a reward, increase it for referrals. Include a custom invite link that tracks referrals.
My startup processes payments in healthcare and should not be regulated as a medical entity. What is the best way to figure out how to avoid unnecessary and unjust regulation?
If the only thing you do is take a file with payment information and process it, without getting into any of the claims or adjustments, and thus making your startup suitable for any kind of payment processing (medical and non-medical alike), then you can just tweak your purpose and your filings to arrive at the needed cession of liability.If your systems are designed only for medical field, and you regularly interact with billers/coders and payment recipients, and your purpose for existence is to "Process healthcare payments", then there's no way to avoid the voluminous and costly regulations.
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