Process reflection 3

For my last Process reflection I’d like to say that as a whole the class has been very informative and interesting. The discussions have also gotten more involved in the last few weeks of the course which I thought made more information stick and generally made the course more interesting. I specifically liked the inclusion of the debate in the final Discussion, it forces us to take a more involved look into the many viewpoints on what we are being taught and cements that there are many possible solutions that all deserve to be heard. I think the class can be improved by making those debates more frequent in the coming semesters.

One issue that I’ve had with the course from the start and believe is still as much of an issue as ever however is this blog. It seems very disjointed from the rest of the class and although it is used by the discussion leader in class to bring up the points of individual students for examples, it just seems like an unnecessary addition that feels like busywork. The Analytical postings were interesting but never revisited after they were done for the most part. These process reflections would also be more useful to the instructors if done as a final assignment at the end of the semester rather than multiple peppered throughout, as one month is not very much time to take into account the opinions of more than one hundred kids and adjust the syllabus accordingly. Beyond that the blog is an unnecessarily complicated site to learn the use of for a single class and then most likely never use again

In all I’ve thoroughly enjoyed this class and it’s lectures  and would definitely recommend it to others on the pre-med track. I just hope that it stops over relying on the blog format and busywork that comes with that.

Pay Cuts for primary Care Doctors

Primary Care Doctors who saw reimbursement from the Government via treatment of medicare patients will lose that in the Coming year. This was a 10% bonus for caring for medicare patients. This will have a large impact on major practices, some of which have up to 90% of their patients paying via medicare. The loss of net profit could cause pay cuts and layoffs across such practices. Allowing this legislation to fall to the way-side now may “undervalue primary care providers’ ongoing role in coordinating patients’ care.”.

This undervaluing of a major and very important facet of healthcare, one which is already overlooked to the detriment of public health and healthcare costs, could further exacerbate the problem that America has with focusing on intervention care and ignoring general healthcare upkeep.

It is legislation that runs exactly opposite to the effective practices in some other countries, such and the UK, to pay primary Care doctors bonuses based on number of patients kept healthy. A program which is also run through the government, in the UK’s case the NHS.

The true short-sightedness of this however is how passing the buck on to intervention care by weakening the practices of primary care doctors will be more costly in the long run on the government due to an increased need for intervention down the line. This intervention is, especially in the US, wildly more expensive.

It will also weaken the health of the poorest members of society, as it now de-incentivizes them to be sought and taken on as patients of the clinic. This is illustrated by the finding that “while 93 percent take Medicare, a smaller percentage, 72 percent, accept new Medicare patients.” according to the Commonwealth Fund and the Kaiser Family Foundation.

http://www.npr.org/sections/health-shots/2015/11/28/457148697/end-of-medicare-bonuses-will-cut-pay-to-primary-care-doctors

Analytical Posting October

“New Maine website gives patients tools to compare hospital costs”

http://www.healthcareitnews.com/news/healthcare-headlines-across-web

The new website, covering hospitals in the state of Maine, is called comparemaine.org. It’s only goal being to show the differences on average in price between different Maine hospitals. One of the main issues with hospital care’s pricing is that it lacks any true transparency to the consumer, forcing the consumer out of any real power to decide between hospitals and allowing hospitals to charge differently depending on the situation. This website show’s shocking differences between costs of the exact same procedure at hospitals “…from a low of $5,402 at Rumford Hospital to $13,428 at Maine Medical Center.”.

I think that this website is not only genius but wholly necessary and should have analogues in other states. It allows for a system in which hospitals have unrestrained power of pricing to be severely limited. Of course emergencies will still necessitate that the nearest hospital be used without discrimination but surgeries that are planned weeks in advance or even births can to an extent be planned to a specific hospital. In all this is a huge jump forward for consumer-centric healthcare.

Process reflection 2

The class has changed a bit since our previous reflection and for the most part i’ve really enjoyed the change. I like that the newer sections seem to focus on changes at lower levels and how they can have a real large scale impact on Medical outcomes. Specifically how things like zoning laws and city planning can alter a persons projected lifespan via the options available in an immediate environment alone. This is in my opinion a welcome change from the previous section seemingly discussing only the very large scale implications of political and market processes that seem inextricable from one another and essentially unchangeable. I am also enjoying the discussion of stressors in everyday life and how they build upon other illnesses or lead to them in a way that compounds preexisting issues, such as how a high stress, low paying job leads to a less healthy lifestyle due to an inability to access resources that would allow for that.

Something that I have continued to enjoy immensely are the freedom of exploration in topics we cover in the discussion section. I think that the emphasis on bouncing ideas off of each other in class has given a lot of different viewpoints that may not otherwise be reached by the scope of the the lecture professor or Ms. Farber herself the chance to be aired and discussed openly.

Finally the most interesting thing I’ve come across yet in class is how entrenched racist sentiment is in healthcare outcomes. Particularly how African American, all other factors than race being identical, have worse healthcare outcomes and shorter lifespans, ostensibly from stress relating to racial prejudices. I was unaware that mental stressors such as these play such a large role in so  many medical issues and am interested in learning more as to how.

discussion question social conditions

in “Social Conditions as Fundamental Causes of Health Inequalities: Theory, Evidence, and Policy Implications”, Very little seemed to be directly discussed or put forth as causes. It seemed to dwell on what has been fixed rather than what remains wrong.  I’d like to know or discuss how diet changes in different socioeconomic classes, as well as exercise and high risk behaviors. I think this could be useful to help give an answer to the questions the article asks.

Process Reflection #1

So far in the semester I’ve found it interesting that we have gone so far in depth on very specific things while ignoring others entirely. I thought medical tourism for certain surgeries way very surprising but at the same time at like to know more about the briefly mentioned travel to America from other countries for the most advanced invasive surgeries by those who could afford it. We are incredibly cost prohibitive, but at the same time if we can provide some of the most cutting edge (and wallet draining) surgeries, why aren’t we discussing how that came to be in the same way. Essentially i’ve been a little disappointed by the complete focus on preventative medicine, which though important, will never completely end a need for intervention. Another thing I’ve thought was interesting was how we have heard surgeries and treatments would be driven down in price by a more centralized and government stabilized national healthcare service, but we haven’t discussed the additional tax burden that this would require very much. The tax burden must be there, as Vermont has essentially but their pursuit of a single-payer healthcare system on the back-burner due to the increase in taxation on individual’s incomes and small-business owners.

Something I’ve really enjoyed about this class and learned a lot from is how other countries have kept down the pricing of Healthcare while keeping the cost on individuals low. I’m a little disappointed however that we haven’t been able to discuss other countries systems in more detail. We seem to just keep centering on America and occasionally glancing over Britain’s NHS and Canada’s hardline negotiations over drug prices. In short I think what we have been discussing the most and cementing repeatedly are mostly things that are already accepted as problems and possible solutions to them. In all I think i’m learning a lot from this class and I hope that it continues much deeper into the issues it’s brought up as well as spending time on other countries systems.

Single Payer Vermont question

In the article “why single payer died in Vermont” they mention the inability to install a single payer system as a “public failure”.

Why is it that this is seen as a failure and not simply economic reality? It goes on to talk about the importance of this to Governor Schumlin but seems to frame everything about this basic economic issue as a failure of his and the end of his crusade to get single payer instituted.

Commercialism in healthcare question

In Alya Guseva’s Commercialism in healthcare, the sentence “The US health care system, however, ranks the highest on commercialism among Western industrialized democracies.” is spoken. My question is what metric is that measured on? They make examples of how we are more commercialist but never actually bring in a way to measure this more or less qualitative variable. Any thoughts?

“Why We Must Ration Health Care”

Healthcare, when payed for by the government is often looked at in terms of the individuals that require it alone, when by making it a government affair it concerns the country as a whole. This article looks at rationing and government funded healthcare’s implications on it.

The major concern of the article is treatment that can extend life but only that. A situation in which many people would opt to extend even at their own monetary peril, a judgement that a citizen paying for the treatment is completely fair to make. However when the government, and by extension everyone else in the country is footing the bill, it quickly becomes detrimental and wildly expensive to allow such meager gains for crushing prices. It’s a question of rationing and deciding how much is willing to be spent to extend life. This article seems to focus on the more concrete reasons to ration, specifically the dollar amount, but i think the human element also needs to be taken into account.

The main issue with judging based on cost alone is that it ignores the physical and emotional trauma on the patient, patient’s families might stop at nothing to convince a family member to continue uncomfortable and invasive treatments despite their low chance of effecting the disease if they are not paying the bill. However they might consider other options if the expenditure is controlled due to knowledge that it will only prolong the inevitable and cause discomfort.

The main issue with implementing any sort rationing however are American’s distaste for the idea. As a nation we tend to desire individual choice over a more standardized system which ends up running large debts or disallowing any treatment at all on account of difficulty getting steady coverage from a private insurer outside of job supplied coverage. The article ends pointing out Britain and Canada’s general satisfaction with a system that rations and allows extra coverage for a higher cost from private insurers. I agree with the article in its insistence that American’s will only accept rationing if given the ability to pay for additional private coverage, maintaining individual choice along with general protection.

http://www.nytimes.com/2009/07/19/magazine/19healthcare-t.html?pagewanted=all&_r=0