tag:blogger.com,1999:blog-2584705757436511038.comments2023-03-14T05:31:00.746-07:00Gen Y HealthcareAndy Juanghttp://www.blogger.com/profile/02921959709575775344noreply@blogger.comBlogger35125tag:blogger.com,1999:blog-2584705757436511038.post-16229079596701431702010-03-22T12:23:41.452-07:002010-03-22T12:23:41.452-07:00I think you mean "2010" for "The fi...I think you mean "2010" for "The finals steps began with Obama’s healthcare summit on February 25th, 2009." Obama's healhcare summit did feel like a year long marathon though. My favorite part was the back and forth between McCain and Obama.<br /><br />When will we get your thoughts on yesterday/today's historic occassion?Anonymoushttps://www.blogger.com/profile/17266664420676891097noreply@blogger.comtag:blogger.com,1999:blog-2584705757436511038.post-17733072436308705632010-03-19T13:02:34.393-07:002010-03-19T13:02:34.393-07:00Great summary of the events, Andy. I think it'...Great summary of the events, Andy. I think it's hilarious that Republicans are already mobilizing to repeal the law even though it hasn't been passed yet. To me, this indicates that Republicans have accepted the likelihood of bill passage and have already mobilized the next steps in the game.<br /><br />http://voices.washingtonpost.com/44/2010/03/health-care-bill-not-yet-a-law.html<br /><br />Anyway, Sunday is when it all (purportedly) goes down! We certainly do live in exciting times.Tonyhttps://www.blogger.com/profile/03537151023022803697noreply@blogger.comtag:blogger.com,1999:blog-2584705757436511038.post-64247323883687516562010-03-11T23:09:51.600-08:002010-03-11T23:09:51.600-08:00Just a comment I'd like to add;
When I was int...Just a comment I'd like to add;<br />When I was interning at a small-mid sized pharma company doing research, the company prided itself on investing at least 25% of its profits on R&D. 25% may seem like a reasonable amount for R&D but it actually is on the higher spectrum of companies reinvesting in R&D. It's surprising how much little money gets spent in developing new drugs compared to advertising and the business aspect of pharma, especially in an industry that is driven by innovation.Unknownhttps://www.blogger.com/profile/16639153113109316442noreply@blogger.comtag:blogger.com,1999:blog-2584705757436511038.post-58808703297227551312010-02-22T08:34:52.970-08:002010-02-22T08:34:52.970-08:00I tend to think it is a lack of transparency and e...I tend to think it is a lack of transparency and effective regulation that causes the net result of US paying more for branded drugs than other nations. I'm sure I'm oversimplifying the issue, but I think if there was full disclosure of how much drug companies make off of each product in each nation and how much they charge respectively, the problem would be half way solved. Drug companies try to keep the pricing and profits vague in order to keep everyone guessing at what the true profit is. Then they cry about how development costs are skyrocketing when in reality, these added costs just gets pushed through the system. All the middlemen (distributors, insurance, etc) must make a profit too, so their "services" further adds to the overall spend that ultimately the consumer pays. <br /><br />Very interesting blog and points. Look forward to reading more :)dirtycelebsecretshttps://www.blogger.com/profile/14676812670001591867noreply@blogger.comtag:blogger.com,1999:blog-2584705757436511038.post-63578715791399573102010-02-15T19:04:56.391-08:002010-02-15T19:04:56.391-08:00Hi Lydia,
I hate to use the word 'blame' ...Hi Lydia,<br /><br />I hate to use the word 'blame' for the higher prices since I think innovation is a positive thing for society, but 'blame' has a negative connotation to it. In any case, some thoughts on the points you bring up...<br /><br />1. I think the ultimate payer is the American consumer. The conduit would be the US insurance companies. So I suppose - why do you or I willingly agree to pay a higher price for [Nexium or whatever drug] vs. the Canadian government? Well - we don't really have a choice. The choice is pretty much either to buy the drug or forgo it. I suppose the reason the individual consumer doesn't think of it that way is that the insurance companies spread the cost of usage among both the sick and healthy patients. So you're right in both cases - they don't know the real price of the drug and they don't really have a way to pay less. <br /><br />2. To sell drugs in the US at all, it must pass FDA approval. Since this will be a market that drug makers will want to access, this approval process is the key to bringing any large-scale drug to market. My original intended point was that we have been purposely paying more for drugs in order to encourage medical/drug innovation. Frankly, it's worked - there are hundreds of new drugs that I believe never would have existed otherwise. <br /><br />The US does import generics as soon as legally possible. You'd be quite amazed how quickly the changeover happens - the market share of a branded drug literally drops from 100% to around 40-50% overnight. To do it any sooner would require changing US law (which isn't something I'm trying to advocate here).<br /><br />There's a whole cottage legal industry dedicated to challenging (or extending) drug patents. Foreign generic manufacturers constantly file lawsuits to contend that their drug is actually a different drug from the existing branded drug - thereby getting around the original patent by creating a new one and increasing competition in the market.Andy Juanghttps://www.blogger.com/profile/02921959709575775344noreply@blogger.comtag:blogger.com,1999:blog-2584705757436511038.post-42968113950106904532010-02-12T08:42:10.798-08:002010-02-12T08:42:10.798-08:00You suggest in the passage that patent laws in the...You suggest in the passage that patent laws in the US are to blame for manufacturers charging a premium when selling into the US market versus selling into other markets. I thought I’d ask some questions to understand the issue better.<br />1. Who do you consider the payer in this transaction? Why would the payer willingly agree to pay high prices to drug manufacturer knowing that foreign payers are paying less for the same drug? Is it because they don’t know how much higher the prices actually are or because they have no choice but to pay the premium? <br />2. What are the patent laws in other countries that pay less for branded drugs? If patent laws are significantly less strict in foreign countries, then US payers should be trying to find some way around it or try to import foreign generics earlier. Why does that not happen?dirtycelebsecretshttps://www.blogger.com/profile/14676812670001591867noreply@blogger.comtag:blogger.com,1999:blog-2584705757436511038.post-53672088310403510132010-01-18T11:40:59.107-08:002010-01-18T11:40:59.107-08:00I prefer the chilean or singaporean system. basic...I prefer the chilean or singaporean system. basic care provided through a tax based system with additional more expensive system for those who have a higher willingness to pay for better care.Unknownhttps://www.blogger.com/profile/04735863864094901909noreply@blogger.comtag:blogger.com,1999:blog-2584705757436511038.post-50944763523674717522009-12-30T09:14:43.632-08:002009-12-30T09:14:43.632-08:00What exactly does for-profit in health care mean? ...What exactly does for-profit in health care mean? Does it mean that the hospital system has public investors and its shares can be publicly traded on the market?Unknownhttps://www.blogger.com/profile/16639153113109316442noreply@blogger.comtag:blogger.com,1999:blog-2584705757436511038.post-35705977171244689042009-12-23T19:21:17.185-08:002009-12-23T19:21:17.185-08:00Another thing I've started to realize about wh...Another thing I've started to realize about why our system is the way it is has to do with how we view healthcare in the States. In other countries, health care is seen as a cost to society - similar to sanitation, defense, education, etc. Profit, money, and whatnot can be made in this field, but the driving force behind the healthcare system is to keep society healthy and functional. Our country views health care as subject to the free market, and unlike many other health care systems, profit is what currently drives our health care system. The many inefficiencies, obscure costs, and pains to keep inequality in the system has led to what we have right now. Unless this mindset changes, it's going to be difficult to improve our health care system.Unknownhttps://www.blogger.com/profile/16639153113109316442noreply@blogger.comtag:blogger.com,1999:blog-2584705757436511038.post-35792191710162912402009-12-20T13:06:06.087-08:002009-12-20T13:06:06.087-08:00@KF
Vertical integration is much more than just le...@KF<br />Vertical integration is much more than just leveraging the fixed costs in the system (although that is certainly an aspect of it). It's changing the incentives of the players involved. I mentioned the non-profit status because these systems (and doctors) can actually make more money if they focused on the revenue of the per-service rather than delivering integrated care. I'm certainly no enemy of the for-profit incentive system, but that's not how the system is setup today.Andy Juanghttps://www.blogger.com/profile/02921959709575775344noreply@blogger.comtag:blogger.com,1999:blog-2584705757436511038.post-4693424325256639832009-12-15T15:06:05.182-08:002009-12-15T15:06:05.182-08:00great post as usual andy. keep'em coming!great post as usual andy. keep'em coming!taigahttps://www.blogger.com/profile/14267111624431942357noreply@blogger.comtag:blogger.com,1999:blog-2584705757436511038.post-10226336849602543502009-12-06T15:55:52.325-08:002009-12-06T15:55:52.325-08:00From an outsider's perspective, this sounds li...From an outsider's perspective, this sounds like vertical integration and "industry consolidation" is the clear way to go to leverage fixed costs in the system... but is the reason we're not moving that direction due to the different incentive structures between physicians and hospitals? I.e. independent practitioners don't want to give up the per-service potential and cap their salary? Why do the hospitals have to be non-profit? Sounds like it would be in everyone's interest to have a for-profit hospital system in which doctors would have equity in the LT performance of the 'system'?kfhttps://www.blogger.com/profile/16956384759650724389noreply@blogger.comtag:blogger.com,1999:blog-2584705757436511038.post-66464397715910099782009-12-01T20:24:00.292-08:002009-12-01T20:24:00.292-08:00The reason why the donut hole has been controversi...The reason why the donut hole has been controversial is because of the assumption that the donut hole will force seniors to be smarter spenders. Seniors that don't fall into the donut hole have conditions that can be treated/managed with generics affordably. For instance, a senior that needs metformin or glyburide for his type 2 diabetes only needs to pay $4 a month for it. They can also take Januvia, a newer drug, that costs more money, as is just as effective for non-refractory patients. Doesn't matter what he picks, Medicare Part D will take care of the tab. Or, if a patient has depression, they can choose to take a generic SSRI for $4/month, or they can choose the new fancy but expensive SSRI/SNRI that will have the same efficacy but has a brand name going for it. Since medicare part D pays for it, the patient is going to be inclined to take the more expensive drug. On the flip side, a patient with crippling rheumatoid arthritis can enjoy a good quality of life if they take a biologic called infliximab. For $1650 every two-three months, you can live a life not hindered by painful arthritis. Or, a patient who has CML (a leukemia) can have a prolonged life expectancy if they go on Gleevec. All is great...if they can afford to pay $88 a day for it. Unfortunately, this means the patients will have to go into the donut hole; for many, this means they will have to stop taking the drugs after a few months. <br /><br />The crux of what I'm saying is that when a patient has a condition that requires medication, it's not the same choice as if I want to buy a new laptop or not. In the latter, if I can't afford the newest laptop, I will have to make do without one or with a lesser model, but it won't affect my life that much. I can always shop around for cheaper alternatives. For the former, it's either you take the meds, or you either die or live a very poor quality life. That medication may cost you thousands a year. I might be ok if I have a well-paying job, but if I'm retired, I'm in a bind. This is why the donut hole has received criticism; patients that need Medicare Part D the most are the ones that get shafted. Pharm companies have received billions because taxpayer money is used to pay for pricier brand name medications for easily manageable conditions though a generic can do just fine. When a patient truly needs a newer drug that becomes expensive, Medicare Part D fails because the whole point of it was to help patients with costlier bills make their ends meet. The only thing I like about Medicare Part D so far is that it does encourage generic drug usage. Otherwise, it needs to be redone. <br /><br />Last, on further research, I found out that the writer of the bill quit after it passed to become the head of the PhRMA, a pharma lobbying group. His salary is somewhere in the millions. In addition, 14 congressional aides quit their jobs to work in the pharm and medical lobbying industry afterwards.Unknownhttps://www.blogger.com/profile/16639153113109316442noreply@blogger.comtag:blogger.com,1999:blog-2584705757436511038.post-31848076237206208012009-12-01T19:48:48.162-08:002009-12-01T19:48:48.162-08:00The two issues with "concierge medicine"...The two issues with "concierge medicine" comes from two different aspects. The first one is economic; how the principle works is that it's a fee-for-service model that requires the patient to pay for visits + an annual fee. This model came into being because physicians were sick of tired of dealing with insurance and cuts in Medicare/Medicaid. The economic issue is that it forces patients to pay extra to physicians who do concierge medicine to basically get the same standard of care they got before. Patients getting the right care at the right time with this is misleading; obviously they will be getting the standard of care when needed, but in order to be a licensed physician in the US, you are REQUIRED to provide the standard of care if you want to keep your license. The extra $1,500 a year forked up may let patients sit in plush nice chairs, enjoy coffee and TV while they wait, and have more physician contact, but the care is basically the same. If patients don't pay, they get shunted off to other physicians who will be even more burdened with higher patient loads, or will have to see nurse practitioners or physician assistants for cases that need to be managed by physicians. What is even more ironic about this is that wealthier patients tend to require less expensive treatment than poorer patients because end-stage disease pathology and prevalence tend to be more concentrated in patients of lower socioeconomic status (many cancers and systemic diseases tend to run in such patients; retrospective case studies have proven this to be true). In my opinion if this practice grows, it will create a vicious cycle that'll result in two ways: patients will basically have to fork out even more money to get the same standard of care, resulting in higher costs overall; or they will have to resort to seeing a even more burdened primary care provider, a NP or PA, or may even have to forgo seeing their physician because of the costs. If this issue is limited to the wealthy, fine. It's their money, let them spend it on their care as they wish if they want the doctor's office to be a country club. If this becomes more widespread, this will for sure result in even more limited care for middle-class patients. <br /><br />The other aspect is an ethical/moral aspect. The physician-patient relationship is a very respected and sacred one. One of the foundations of it is that if a patient is sick, it is a physician's obligation to see and treat the patient, regardless of ability to pay or not. Though the purity of the principle is impractical, the main point of payment not being an issue of good patient care is tantamount to physicians doing the best for the patients. How would you feel if your physician based how they approached, treated, and managed you based on your economic status? All patients want to be treated respectfully and ethically by their physicians, regardless of who they are. Concierge medicine gets in the way of that completely. If it remains in its current state, I'd be concerned but not too alarmed. If it becomes more widespread, I would then be alarmed, because future physicians like me would be tempted to pre-select patients who tend to be healthier and wealthier, where our care could be more useful treating those who need it. This might sound crass for me to say it, but this is basically health care rationing for the wealthy. When I started my clinical rotations, I started to see how economic status played such a part in how patient care is handled. If I as a physician submit to this philosophy even more, I am breaking an oath physicians have held for centuries.Unknownhttps://www.blogger.com/profile/16639153113109316442noreply@blogger.comtag:blogger.com,1999:blog-2584705757436511038.post-46139573447134178832009-11-25T13:19:07.147-08:002009-11-25T13:19:07.147-08:00@ Albert
Concierge medicine! Interesting concept....@ Albert<br />Concierge medicine! Interesting concept. I've heard of some physicians that don't take insurance etc. as well. As far as I understand though, it's primarily reduced to very rich clientele. If you know more about it though, I'd love to hear about it. The most interesting healthcare delivery model I've heard of is located in South Florida (yes, the home of Medicare Fraud). They're called Leon Medical Centers - basically the approach to healthcare is thought of as a Ritz-Carlton like service atmosphere. Big open lobby when you step in, cappucinos in the waiting room, free bus rides from the home to the Leon Medical Center, etc. By making sure the patients get the right care at the right time, they can actually keep costs lower while providing very high quality care and service.<br /><br />@ Charo<br />Thanks for the links to the post-article information. That's stuff I actually hadn't seen yet, so they were helpful. I found the political carve outs pretty interesting (and quite sad as well). <br /><br />I know of two companies on the for-profit side that deal with McAllen. 1) Universal Health Services is a hospital that existed before the Doctors Hospital at Renaissance (the same hospital that Atul refers to). These guys are definitely pretty bitter about Renaissance - accusing them of opening up/expanding surgery centers that take away the most profitable parts of the hospital business while leaving the unprofitable parts for others. 2) A company called HealthSpring recently acquired a Medicare Advantage HMO that was losing money. They've been trying to turn it around, but they'll tell you first hand that the costs there are very difficult to control. Incidentally, HealthSpring also owns the Leon Medical Centers that I pointed out above. So managed care is coming to McAllen - just not on the commercial side (as far as I am aware). It'll be interesting to see how it all unfolds.Andy Juanghttps://www.blogger.com/profile/02921959709575775344noreply@blogger.comtag:blogger.com,1999:blog-2584705757436511038.post-23331404652612819982009-11-25T12:53:09.895-08:002009-11-25T12:53:09.895-08:00@ Albert
I completely agree with you on the fundam...@ Albert<br />I completely agree with you on the fundamental issue of the trigger. Ironically, I think every liberal's fear about the trigger is that it won't ever trigger (ie. like Part D) and every conservative's fear is that it will trigger too easily. Square 1 right? On the surface it sounds like a great compromise, but then arguing about what the trigger itself will be puts everyone back at square 1.<br /><br />(For readers that don't know, Part D is the drug benefit for Seniors passed in 2003 and implemented in 2006. The actual benefit is a little bit odd. There is a small deductible up front, 75% coverage for the next ~$2,500, 0% coverage for the next $3,600 [called the donut hole], and 95% coverage thereafter.) The trigger that was written into the 2003 legislation was that if there weren't more than 2 plans in each of the 34 regions of the US, then the government could implement a public Part D plan. There were legitimate concerns that plans would avoid rural areas, but this turned out to be quite the opposite. There is thriving competition in the program, and the program is one of very few that has cost the government LESS money than expected and it has covered more people than expected. I think it is less about 'gaming' the wording vs. just genuinely being unsure if competition would exist. I think rural Senators wanted a little reassurance that the program would be available in their areas vs. Congress wanting a public plan to run the program.<br /><br />On the topic of Part D though, I do not think it has been criticized that much - it really is one of the few successful programs I can point to: lower costs for the government, drug benefit for seniors (when it wasn't available before), and a popular program/high satisfaction rate for seniors. The criticism has been about the donut hole itself, which I find focuses too much on the minority. The donut hole is doing its job - it is forcing seniors to become price-aware consumers of their drug spending habits. That encourages more focus on using generics, purchasing cheaper branded alternatives, etc. Sidebar: I'm actually quite incensed that the Pharma industry's "contribution" to healthcare reform is cheaper branded drugs in the donut hole where they are losing volume to generics already. If we want to lower costs, we should be encouraging generics - not branded drugs. Even if they didn't get anything back through more volume, $80bn/10 years is a complete joke for the industry - any pharma analyst will tell you that. To be sure though, there are definitely seniors out there that hitting the donut hole causes them a significant burden. Hopefully these people are part of the low-income subsidy program or are dually eligible for the Medicaid program, but if not, then these are the ones that fall through the cracks. They are not, by any means, the majority though. I do think eliminating the donut hole altogether is throwing the baby out with the bathwater. I personally don't view it as a bad thing.<br /><br />By the way, if anyone knows any actuaries that look at Part D and/or Medicare Advantage, then please let me know! I would love to talk to them.Andy Juanghttps://www.blogger.com/profile/02921959709575775344noreply@blogger.comtag:blogger.com,1999:blog-2584705757436511038.post-40533761076937986692009-11-24T00:48:49.949-08:002009-11-24T00:48:49.949-08:00Texas Monthly: Wealth Care
Is a loophole in our h...Texas Monthly: Wealth Care<br />Is a loophole in our health insurance system costing the state millions in unnecessary spending or saving people’s lives in the Rio Grande Valley?<br />http://www.texasmonthly.com/2009-12-01/hart.php<br /><br />Texas Monthly: Mismanaged Care<br />A unique confluence of medicine, money, and politics is driving health care costs in the Rio Grande Valley. At the center of it all is a Democrat from Palmview, who is already under indictment for unreported income.<br />http://www.texasmonthly.com/2009-08-01/webextra11.php<br /><br />Washington Post: An Interview With Atul Gawande<br />(rebutting McAllen Doctors)<br />http://voices.washingtonpost.com/ezra-klein/2009/06/an_interview_with_atul_gawande.html?hpid=news-col-blog<br /><br />The New Yorker: Atul Gawande: The Cost Conundrum Redux<br />(rebutting McAllen Doctors)<br />http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-the-cost-conundrum-redux.html<br /><br />The Cost Conundrum<br />(The original New Yorker article that started it all)<br />http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawandeUnknownhttps://www.blogger.com/profile/01824899424598637208noreply@blogger.comtag:blogger.com,1999:blog-2584705757436511038.post-75706196862042898152009-11-24T00:46:20.971-08:002009-11-24T00:46:20.971-08:00"McAllen, TX costs twice as much as its NEARB..."McAllen, TX costs twice as much as its NEARBY neighbor El Paso, TX"<br /><br />Not so nearby. <br />Google Maps shows it's 790 miles from McAllen to El Paso.Unknownhttps://www.blogger.com/profile/01824899424598637208noreply@blogger.comtag:blogger.com,1999:blog-2584705757436511038.post-88524652922268160592009-11-23T21:48:25.291-08:002009-11-23T21:48:25.291-08:00If you think this is expensive, wait till fee-for-...If you think this is expensive, wait till fee-for-service and concierge medicine becomes mainstream. A lot of docs, some I know, are going the no-insurance fee-based service because of the headache and paperwork for reimbursements and claims. Though I don't agree with the principle I don't blame them either, because all the work required to deal with insurance is too much.Unknownhttps://www.blogger.com/profile/16639153113109316442noreply@blogger.comtag:blogger.com,1999:blog-2584705757436511038.post-17134417546604378432009-11-23T21:45:40.243-08:002009-11-23T21:45:40.243-08:00Doing some looking into on the trigger option, the...Doing some looking into on the trigger option, the left seems more happy with an opt-out plan rather than a trigger plan because though the trigger plan sounds like a great compromise, the true issue is the condition(s) for the trigger to happen. The conditions for the public option to take into effect can be so vague and strict that it can be written in a way so that it would be nearly impossible to "pull the trigger". In essence, a trigger option may mean no public option at all.<br /><br />Best example of the above is Medicare Part D. It was supposed to work on the same trigger principle, with the closure of the donut hole and reinstating some rules that would seem like no-brainers, like allowing gov't to negotiate with drug companies. The way it was written, the trigger never got pulled because the legislators gamed the wording so that it would be nearly impossible to reach the conditions. This is why Medicare Part D has been criticized so much; drug companies have basically been given taxpayer money by the billions due to this program, and when seniors truly need Medicare Part D, they almost always run into the donut hole.Unknownhttps://www.blogger.com/profile/16639153113109316442noreply@blogger.comtag:blogger.com,1999:blog-2584705757436511038.post-13297828020024388572009-11-22T17:19:06.351-08:002009-11-22T17:19:06.351-08:00He's lying; this is Sammy JHe's lying; this is Sammy JSamhttps://www.blogger.com/profile/05243521631496638965noreply@blogger.comtag:blogger.com,1999:blog-2584705757436511038.post-80591853600526227472009-11-22T17:18:33.627-08:002009-11-22T17:18:33.627-08:00Bold. Heart.
-Sam L.Bold. Heart.<br /><br />-Sam L.Samhttps://www.blogger.com/profile/05243521631496638965noreply@blogger.comtag:blogger.com,1999:blog-2584705757436511038.post-59153459932580706172009-11-22T17:17:42.689-08:002009-11-22T17:17:42.689-08:00I now see there is another Sam floating around the...I now see there is another Sam floating around the blog. I can only assume he is trying to steal my identity. To be clear, this is Sam L.Samhttps://www.blogger.com/profile/05243521631496638965noreply@blogger.comtag:blogger.com,1999:blog-2584705757436511038.post-84892957533313970422009-11-22T17:12:04.008-08:002009-11-22T17:12:04.008-08:00Interesting summary and views!
-SamInteresting summary and views!<br />-SamSamhttps://www.blogger.com/profile/05243521631496638965noreply@blogger.comtag:blogger.com,1999:blog-2584705757436511038.post-27970095216688283112009-10-20T18:38:23.262-07:002009-10-20T18:38:23.262-07:00Good article, very insightful about the access to ...Good article, very insightful about the access to health care issue. If you're interested in a source for info for your next article, try this site: www.commonwealthfund.org. I used the recent results of that study for my opinion article in my medical school.Unknownhttps://www.blogger.com/profile/16639153113109316442noreply@blogger.com