Just came across this "e-article" (http://www.foxnews.com/health/2013/01/16/are-e-visits-as-good-as-office-appointments/). This was a new one for me, but I guess I shouldn't have been surprised. I suspect the insurance companies will embrace this concept...and maybe us healthcare consumers too. If describing my symptoms over the internetz saves me a trip to a germ-infested doctor's office just to see a PA anyway, then this might be a good thing...at least for life's minor ailments...
Dunno.
There tends to be a good thing about seeing someone face to face. Many diseases share some common signs. It takes a doctor to figure out the difference.
Doesn't sound too good.
If its good for the insurance companies it is gonna be good for you.
My wife is a PA who occasionally is on call during the weekends. There is only so much you can do to help a patient without physically seeing them. e-health care will amount to nothing more than the patient describing his condition and the healthcare provider proscribing some drug.
Pfft...if a dude in New Dehli can read a manual on how to solve all your computer problems, I'm sure they can read a facts sheet on medical issues and fix your right up too.
That guy from New Delhi wants to live in New York.
Quote from: Longdan on January 16, 2013, 07:12:00 PM
That guy from New Delhi wants to live in New York.
Not if we wants the freedoms he's heard exist in the United States.
Anything that will prevent me from having to get a rectal is the cat's meow, in my book.
Quote from: Jarhead0331 on January 16, 2013, 08:09:51 PM
Anything that will prevent me from having to get a rectal is the cat's meow, in my book.
Or be told about gun safety by your friendly neighborhood doc.
Quote from: Longdan on January 16, 2013, 06:52:50 PM
If its good for the insurance companies it is gonna be good for you.
Well, it ain't good for insurance companies.
If they are telling you it is a good idea it is good for them.
I'm sure it's cheaper in many ways for insurance companies.
What a coincidence!
Yeah. I'm sure that also makes it automatically evil.
Quote from: Longdan on January 16, 2013, 08:22:56 PM
If they are telling you it is a good idea it is good for them.
I'm not hearing that.
Actually, the way the system is designed, many employees will be dropped from their company-directed private insurance.
They'll be forced into the Obamacare public insurance program.
With fewer customers private insurance companies will be negatively impacted.
Lather, rinse, repeat.
Pretty soon there won't be much left of private insurance companies.
Then how will they pay their lobbyists?
Quote from: Longdan on January 16, 2013, 08:52:44 PM
Then how will they pay their lobbyists?
Bingo! Now you're getting it.
Obamacare creates greater unemployment.
Well they clearly weren't paying their lobbyists enough unless the figure they've
crippled this one enough already. Like a good neighbour Safeco is there.
Quote from: Longdan on January 16, 2013, 09:04:52 PM
Well they clearly weren't paying their lobbyists enough unless the figure they've
crippled this one enough already. Like a good neighbour Safeco is there.
You must have been snoozing through the vote. The Dems rammed Obamacare through with no regard for anyone's opinion. Popular, lobbyist, or other.
Just FYI...long before Obamacare was even a glint in anyone's eye (ie: Bush II years), e-visits were being tried by patients and doctors seeking new opportunities for continuity of care.
Over the past 10 years or so, there has been a "perfect storm" (if you will) of new and emerging technology trends that have made e-visits not only possible, but viable. A small list of technology enablers includes: high-speed internet access including fibre; social media; streaming video; interactive real-time two-way and mutli-path internet enabled communication in text, voice and video; browser-based application platforms; cloud-computing; secure communication including VPN, SSL and two-factor authentication; platform specific application (apps) for communication, personal health management, and provider-supported healthcare; standardizations in health data protocols and clinical coding (including HL-7, LOIN-C, SNOMED-CT, ICD-9 and ICD-10 and pharma-code standards); the maturation of data brokers (MS Biztalk and Healthvault being two such examples); internet-enabled PHR (personal health records, like GoogleHealth) tools; and certainly computing platform affordability and pervasiveness (iPads, etc)...just to name a few.
Perhaps even more important than ANY of these is the growth and distribution of electonic health medical record systems for both large-institution, multi-campus and small practice health care management. Figuring out patient diagnostic, procedure, and Rx history is measurably more effective in clinics that use an EMR, and multiple studies have shown that patient outcomes (and physician experience) is markedly improved where this technology is in place.
Couple these two gross factors with the simple fact that a student graduating med-school today grew up in a wholly digital world makes the same kind of assumption about high-speed internet access that middle age geezers like me make about the indoor plumbing (ie: "you DO have high-speed wireless, right?" and "you do have a flush toilet in the house, right?") and I think the only think that one should REALLY be surprised about is: "why the fook has it taken you idiots so long to figure out e-visits in healthcare?". Let's face it: you can book a trip around the world to five different countries, include hotel accomodation, car rentals, dinner and spa reservations, theme park passes, and downloaded "walking tours" on my itouch....but I have to march to my doctor's office, sit around in a crappy waiting room, sit around some more in the exam room and finally see my doctor for 5 minutes JUST so I can get a renew my Rx for warfarin?
FWIW and IIRC...one of the first remote surgical procedures was completed about 6 years ago in eastern Canada where a surgeon in one city remotely controlled a camera and robotic surgical tools to do an appendix procedure. And physician-to-physician consults via video-and-tele-conferencing are de riguer in most industrialized nations.
Nothing wrong with e-medicine per se.
The problem is that now it's being run by the government, rather than free market. Both are prone to error, but my money is on the free market producing a better mousetrap than centralized planning.
General rule of thumb: if the insurance companies want it it is good for the insurance companies.
Anything else is peripheral. But do not worry about them, they will pass any extra costs incurred
directly to the customer so everything will still be the way it is supposed to be.
Quote from: Longdan on January 24, 2013, 11:43:41 PM
General rule of thumb: if the insurance companies want it it is good for the insurance companies.
Anything else is peripheral. But do not worry about them, they will pass any extra costs incurred
directly to the customer so everything will still be the way it is supposed to be.
Of course, but insurance companies are in the business of getting customers. If they want something that's good for them, it's because they think it's good for their customers.
You don't make money by being mean to customers. You make money by providing them services they want.
Maybe they will spot that and lower your premiums.
Quote from: LongBlade on January 25, 2013, 07:47:57 AM
Of course, but insurance companies are in the business of getting customers. If they want something that's good for them, it's because they think it's good for their customers.
Sorry...but this is repeatedly been shown to be untrue with regards to health care services.
Take this very common example: Determining if someone is diabetic or pre-diabetic is typically done using something called the HbA1c blood test. In pretty much every industrialized nation in the world, if you have a A1c of 7% you are considered diabetic. In the US, a significant percentage of HIC raise that number to 8%. That's not because Americans are a heartier breed of person and can handle a greater amount of glycolized red-blood cells....it's because pushing the limit up by just 1% basically saves health insurance companies hundreds of millions of dollars, as they would otherwise be on the hook for providing glucose meters, testing strips, etc. Even worse, when a patient is finally diagnosed as diabetic with an A1c of 8%...they will be beset by a bunch of issues that could have been treated preventatively when their A1c was only 6%.
Many other examples exist. IIRC, 8 states plus DC allow health insurance companies to deny coverage (using pre-existing guidelines) to a patient who has suffered and been treated for domestic abuse or violence. So basically...you get beaten by your husband and you end up taking valium at part of the post-traumatic treatment and your next insurance company can dump you or deny you coverage.
I understand your bi-partisan dislike of all things Obama, and it's nice to think that he has come along and screwed up a perfectly good system...but healthcare
COSTS [edit] in the US has been a wreck for many years. And there is a ton of non-partisan evidence which shows hard statistical evidence like unnecessary pre-mature deaths per year (about 45,000); infant mortality; and percentages of bankruptcies where health-care costs are identified as primary cause (approximately 55%). Current per-family spending on health care has increased from about 5% ten years ago to almost 9%, now...and is predicted to rise even more (using non-obamacare stats).
This money suck largely occurs because health care is fragmented, disorganized and inconsistent. Low profit services (like mental health, geriatrics, primary health) are grossly neglected, while use of high-cost technology such (imaging, brand-name Rx) and elective procedures are rampant.
I wish untangling healthcare was simple. Obama is wrong; let the market figure it out, etc. Unfortunately, healthcare is one of the the most significant bugbears the US will have to face in the 21st century. I don't envy the process.
FWIW....MOST people don't "go shopping" for health insurance companies...they accept the deal that their employer gets them. And few employers are keen or motivated to grab cadillac health care plans if it means that either a) they might have to subsidize part of it or b) it would be unaffordable to their employees.
Like a good neighbour...Safeco is there. The HIC's are our friends, Jack.
I must be spoiled. Between my wife and I we've had maybe a half dozen or so. Never had a complaint. Well, we've had complaints, but nothing that made us so unhappy that we felt we were being screwed by the insurance company.
I agree - costs are crazy. It's why premiums go up.
I'm not saying the old system was perfect. I am saying that Obamacare is dismantling a good system and replacing it with a worse one.
My argument is he is taking a bad system and making it another kind of bad system.
The US health care whateveritis is in my opinion the reason why the US doesn't place
higher on those best places to live surveys. It certainly emphasises the inequities inherent
in the system. The underclass live poorer, unhealthier, shorter and generally crappier
lives than those who can afford coverage. They vote.
Our previous system was not bad. It may not have been great, but it was not bad.
Here is my question for proponents of the US health care nonsystem:
In Canada it was deemed inequitable that those with less money could not afford proper health care coverage.
The decision was made to basically hand basic health insurance over to the provinces under the regulation
of the Federal government. The insurance companies fought bitterly against it but they were ultimately
unsuccessful. In some provinces the same thing has been done with considerable success with auto insurance.
Anyway why do Americans find it preferable to pay enormous premiums to the Health Insurance companies
rather than a much smaller "head tax" to the government? I know the whole argument against big and
intrusive government but you already have Great Big Government and your health care is expensive and
for those without money just plain bad. Health Insurance company horror stories abound and you live at their
mercy. They operate for a (very large, just check) profit and no matter how they squeal they pass all costs
on to the user and still make money. Why is this better than from your taxes?
No Liberty freedom mumbo jumbo please, just why is it better? Because no freeloaders? Do people actually think about stuff?
Quote from: Longdan on January 29, 2013, 10:19:38 PM
In Canada it was deemed inequitable that those with less money could not afford proper health care coverage.
It's a myth that there are (were) people with no health care in the US.
It is also a myth that preventative care lowers costs.
Could the system have been improved? Yes.
Unfortunately we're still finding nasty easter eggs in this new health "care" law. That's the problem. It made things worse.
I do not know where those "myths" come from but they surely are widespread
and both are quite arguable. I do not know that the system in place here would
be a good fit in the USA but my question remains. Why the tyranny of the insurance
company (profit based) is preferable to the state being a nonprofit provider?
I know the state is not necessarily efficient but you will never know if your insurance
company is efficient. It may provide for your needs but at what cost?
One thing I do sense is health care reform should not be built on the tottering, jury rigged
non system that is there.
Quote from: LongBlade on January 30, 2013, 09:35:19 AM
It's a myth that there are (were) people with no health care in the US.
It is also a myth that preventative care lowers costs.
You need to back those statements up with evidence....
If by "no health care" do you mean "there were people who had / have no health care coverage" or do you man that "the health care system never turned any one away who truly needed help"?
And I'd need to see your source re: preventative care, because again, statistical information from basically every industrialized nation tends to disprove that that statement.
Respectfully,
Jack Nastyface
Quote from: Jack Nastyface on January 30, 2013, 04:38:31 PM
Quote from: LongBlade on January 30, 2013, 09:35:19 AM
It's a myth that there are (were) people with no health care in the US.
It is also a myth that preventative care lowers costs.
You need to back those statements up with evidence....
If by "no health care" do you mean "there were people who had / have no health care coverage" or do you man that "the health care system never turned any one away who truly needed help"?
And I'd need to see your source re: preventative care, because again, statistical information from basically every industrialized nation tends to disprove that that statement.
Respectfully,
Jack Nastyface
I mean that if you broke your arm you could go to an emergency room. Not the most elegant or cost effective way to manage things, but if you were ill, you could get help.
Here's a simple article, not a study. I apparently need to dig a bit further to get you the study I'm thinking of.
http://articles.cnn.com/2009-03-17/health/preventive.care.costs_1_preventive-medicine-preventive-care-health-care
The point of the study is that preventative care ends up generating false positives which send the patient and doctor down the path of needless extra screenings and test. Ergo, it costs more, not less.
That isn't to say that your quality of life is probably better catching diseases early. But it isn't cost effective.
Ah, here's another article:
Quote"Although different types of preventive care have different effects on spending, the evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall," Elmendorf wrote. "That result may seem counterintuitive.
"For example, many observers point to cases in which a simple medical test, if given early enough, can reveal a condition that is treatable at a fraction of the cost of treating that same illness after it has progressed. In such cases, an ounce of prevention improves health and reduces spending — for that individual," Elmendorf wrote. "But when analyzing the effects of preventive care on total spending for health care, it is important to recognize that doctors do not know beforehand which patients are going to develop costly illnesses. To avert one case of acute illness, it is usually necessary to provide preventive care to many patients, most of whom would not have suffered that illness anyway. ... Researchers who have examined the effects of preventive care generally find that the added costs of widespread use of preventive services tend to exceed the savings from averted illness."
http://abcnews.go.com/blogs/politics/2009/08/congressional-budget-expert-says-preventive-care-will-raise-not-cut-costs/
From the point of view of the insurance companies it is not cost effective. They do not necessarily need you alive.
Their best case solution is you never need health care, pay them thousands of dollars, buy extra insurance
and then drop dead. Preferably from a preexisting cause.
Thanks...definately an interesting find. I am admittedly going to have to give this a read over. FWIW...there is admittedly going to be some "more" truth to this statement in the current US healthcare system vis-a-vis the Canadian or European models, as certain types of preventative medicine have been so marginalized in US healthcare that providing them is more costly than simple addressing the outcome via well-supported infrastructure, later on.
@longdan....I'm trying to keep insurance companies out of the conversation. From my perspective, the thread began with a discussion of primary health care delivery methods (e-visits) and I'd therefore prefer to discuss healthcare outcomes rather than "who is going to pay for this". While the question of payment is important, the questions behind all this are really: Is healthcare a right or a priveledge? Can it be made worthwhile if made univesal...and is it affordable?
Interstingly, the US provides some absolutley stellar examples of making healthcare satisfy all these criteria. Kaiser Permante and the Mayo Clinic are two such examples...many other exists.
FWIW...the same kind of arguments we are hearing in the media against Obamacare were once made about universal public education (to name but one public issue) at the end of the 19th / early 20th century. There are always some fairly constant lines of argument / rhetoric within the public conversation, namely:
Most respectfully, your diatribe against insurance companies (right or wrong) does little to dispel any of these arguments. In the end, arguments for and against Obamacare need to vetted, cross-referenced and evaluated against a variety of outcomes and results. In the end, universal healthcare may NOT be viable (like democracy in China?) but we won't know if we don't ask and try...and it is a question worth asking and trying.
As I have said elsewhere in this thread, the exploration of universal healthcare in the US is going to be very tough ride indeed.
Quote from: Jack Nastyface on January 31, 2013, 01:06:15 AM
FWIW...the same kind of arguments we are hearing in the media against Obamacare were once made about universal public education (to name but one public issue) at the end of the 19th / early 20th century. There are always some fairly constant lines of argument / rhetoric within the public conversation, namely:
Unfortunately, since there has been a Cabinet level Department of Education, the quality of education in America has fallen.
I haven't spent any time looking into any studies which might provide (or dispell) a causal link, but there is.
There is nothing wrong with e-visits per se. It is hard to determine the difference
between cheaper and more cost effective. My only diatribe about insurance is the
refusal of some to understand that they are a money making business responsible
to turn a profit for their shareholders.