(Full-time co-founder of a healthcare startup here): W/r/t the US specifically: it seems there is no shortage of inefficiencies and obvious solutions to the inefficiencies in the US healthcare system. To me, the real problem seems to be a system that has almost diabolically evolved to create competing interests that deadlock all sides into a sub-optimal solution. Specifically-- patients, payers, physicians, pharma, facilities and insurers almost all have indirect but competing interests much like the Dining Philosopher's problem we're familiar with in Computer Science.
I'm not sure what the solution is short of a total swamp draining, but our startup went overseas to develop/trial our product in a country with a single payer system. Not perfect, but much more amenable to finding efficiencies.
In the united states we can't successfully implement negotiation on drug prices for MediCare. They literally can't negotiate with their suppliers. By law.
Anybody thinking software is going to solve that is way in a bubble.
I bet making structural changes so that cost of care is more visible to patients would help a lot in the US. Of course this means disincentivizing health care as a benefit rather than incentivizing it, so it will never happen. It is kind of happening with things like HSAs, but not really.
We should also work on removing arbitrary barriers to entering the supply side of the market. Not just for individuals that want to be a doctor or other sort of provider, but certificates of need and such too. Currently, lots of states dictate who can operate a CT scanner.
Don't forget farm subsidies dumping cheap corn syrup into the bellies of our entire populace. Health care in the USA must deal with the reality of our obese and overweight masses (no pun intended).
Mental health in this country is similarly crippled by rapid societal changes, but that would take longer to explain in detail.
A pregnant women spending a day in hospital after childbirth with zero complications pays about $2000. During this time she sees a doctor for perhaps 15-20 mins total and a nurse for perhaps 30 mins total. There is no medicine or any other procedure cost. It's day light robbery if you ask me by the people who run the hospital and have figured out how to game the healthcare system using political means. I'm surprised by the statement that major component of healthcare is apparently "operational inefficiency".
Exactly! Hospitals don't care about inefficiencies because insurance pays for it. Patients don't care either again because insurance pays for it. Insurance can't negotiate with hospitals as patients don't ever want to lose their doctors and revolt if insurance even brings up dropping a hospital for charging exorbitant rates. Add to it an insane 4 years in college + 4 years med school curriculum that does not incentivize more people to even attempt getting into med school.
It is however possible to consider at least some technology solutions - build a more transparent system. Let patients do some cost comparison and incentivize them to find cheaper (but good options). People do care about their health and they can and should be trusted to make these decisions.
Start more clinics like the One medical group (just an example) to make preventative care easier and accessible.
One thing that bugs me is how limited my choices are. I believe that over-regulation drives that. Getting an x-ray for my dog is much, much cheaper than me getting one, which is just one example of an unregulated market (relatively, obviously there are licensing & safety standards)
Seems that this would be a shot. If it doesn't work, lets try something different. I'm not wedded to any solution, but I think we probably agree that healthcare is mostly broken in the US (and was even before Obamacare).
Final note - I don't distinguish between healthcare & insurance for sake of simplicity in this post.
Seems like in the US the easiest way for universal healthcare would be to extend Medicare to all. Most people seem to like Medicare. I'm sure their would be some tax increases, but I'm sure overall it would lower health care costs for everyone.
> a system that has almost diabolically evolved to create competing interests that deadlock all sides into a sub-optimal solution
The system embodies large amounts of collective dissonance; a natural reaction to the soft corruption that has to be practiced to satisfy policy. Cost shifting is among the most pernicious causes of this; there is little to no correspondence remaining between actual service and the fee that gets billed; it's all about who the patient's payer happens to be, what policies are in play and how much providers can get away with in each case. The seemingly arbitrary outcomes have to get reconciled somewhere and in the doing of that we build up a lot of scar tissue.
Completely agreed. There's something called a Certificate of Need necessary in many states[1] that effectively allows hospitals to veto any new facilities that they don't "need." I don't think it would surprise anyone that low-cost upstarts about to cut into revenue streams aren't needed by any hospitals.
Whenever you have a $500 bottle of orange juice, I think it screams that you're not in a competitive market.
> patients, payers, physicians, pharma, facilities and insurers but competing interests
I think this is made harder to see by a certain stripe of market fundamentalism that almost blends into the background for many people at this point. At this level of analysis, it's assumed that every transaction is cooperative in nature and competing interests are correctly balanced if not aligned by the time a transaction takes place. Since that's the general assumption, of course it's the specific assumption that the market will do the right thing (regulated or unregulated -- the regulations are just clothing on the incentives).
I'm talking about the general level of lay discourse that defends the recent history (and even the ACA status quo), of course. Scholarship and policy research recognizes the problem.
We sell to governments, which is similar to healthcare.
I cannot stress this enough: technology is not the hard part.
Do they have outdated software? Yes.
Can you build better software? Yes.
None of that matters if you can't get it into their hands. Procurement is the hard part. Can you empathize with the needs, fears, desires, quirks, and crazy of ten different stakeholders? Pry proprietary API specs from the cold-dead hands of one-off contractors? Educate users who's technological proficiency peaked at SMS to manage a full-featured SaaS product in 2017?
Don't focus on the software. That isn't the hard part. People are the hard part. People are always the hard part.
Interestingly, we already discovered a mechanism for drastically reducing the cost of healthcare back in 1986. It's a way of crowdsourcing the problem called high copays. Basically, you have to pay out of pocket for 90% of your health care up to a (high) cap.
It turns out that patients are very good at figuring out which health care will improve health and which won't - the high copay group had no statistically significant difference in health from the low copay group, and spent about 30% less money. What a crazy magic bullet, huh?
We ran a directionally similar experiment in 2008, and got much the same result: low copayment causes people to consume a lot more medicine, but with no objectively measurable improvement in health. (Subjectively, people with insurance feel healthier even if they never go to the doctor.)
A one-sided presentation of the conclusions. From the RAND study:
Cost sharing in general had no adverse effects on participant health, but there were exceptions: free care led to improvements in hypertension, dental health, vision, and selected serious symptoms. These improvements were concentrated among the sickest and poorest patients.
Personally speaking, I'm very much in favor of concentrating benefits among the sickest and poorest patients so as to minimize avoidable suffering. The pursuit of economic equilibrium on healthcare is a chimera because the conditions for perfect competition do not apply; patients cannot choose when to be sick, and thus lack the discretion on when they enter or exit the market; nor are competing therapies or competing providers of the same therapy offering a commodity product that can be freely selected between, just as if you suffer a catastrophic injury you won't get a timeout to make choices about which emergency room offers the best bang for the buck.
Like any sane person I want to minimize the overall cost of healthcare, but I also want to minimize avoidable suffering. I would much rather pay a bit more in tax and have a system that was somewhat less fiscally efficient but more accessible to those in the greatest need. This isn't just a matter of altruism or anxiety about high healthcare costs; if you have a maximally efficient healthcare delivery system then it's likely to fail in the event of a black swan public health crisis because all the gains from efficiency have already been booked for profit.
You would predict that discouraging healthcare "consumption" through higher co-pays would cut down on office visits for minor problems, but not for major issues, because with major health issues you have no choice not to go.
How much is an office visit for runny nose? USD 50, USD 100? And how many frequent flyers are thee in the population, one out of ten, perhaps? It's just not plausible that it's the doctor-fetishists that cause US healthcare to be 4 times as expensive as the rest of the developed world.
No, all that plan does is make people not go to the doctor when sick. They put stuff off until it is far too late, and they end up needing more expensive care that's much riskier.
Edit: My apologies for sounding a bit antagonistic. The ACA is currently making use of high copays for that reason and more. It also hopes to force more transparency as well as most people want more than a icd-10 code when they have to write a check for $4k.
It boots nothing to subsidize that which is in restricted supply. So long as there are only 350 othodontists allowed to graduate per year, there's a corresponding limit on how many patients are allowed to have straight teeth regardless of who pays for what or what software is used. Improve the software, and the price of orthodontia must still equalize demand to the limited supply.
Offer free dollar bills, and a line will form until the cost of staying in line burns more than $1. Medicine isn't costly because it's inefficient, rather it can end up inefficient because the limited supply means it must somehow end up costly.
It is not possible to solve the healthcare crisis without somewhat deregulating the supply of healthcare and allowing it to increase. Until then, every subsidy just raises the price, and every efficiency improvement just creates room for more inefficiency elsewhere.
You can't solve the housing problem in San Francisco by building more efficient software for selling houses. Only interventions that somehow increase the total supply of living space can cause more total people to be able to live there.
The article claims that 40% of the cost is operational inefficiencies, fraud, and ineffective care citing [0]. If all orthodontists are fully occupied and there's no demand being cut, then yes, removing those inefficiencies will just boost orthodontic pay.
But it sounds like at least some of those inefficiencies involve:
1. People getting unnecessary orthodontic treatments (eliminating those cuts demand [not just quantity demanded])
2. People getting ineffective treatments and needing a second treatment (same as 1)
3. Orthodontists being allocated in a way that lowers their overall productivity--empty time in their schedules, doing stuff they're less skilled at, etc.
If my orthodontist spends less time on administrivia or repeat procedures, he can fix more people's teeth without us training a second orthodontist.
Similarly, if there are apartments sitting empty for a month because it's hard to match people with apartments, better software can fit more people into San Francisco. (Going deeper, my bedroom is empty 12+ hours a day. I could totally sublet it to someone who works the night shift. I just need an efficient system to find such a person who's as interested in saving money as much as I am. Or as much as I was a few years ago. Now, I might not opt for this plan.)
> So long as there are only 350 othodontists allowed to graduate per year
I'm (moreso, but not completely) sympathetic to this argument when we're talking about (significantly) lesser skilled providers such as barbers or taxi drivers.
But in the context of health care providers, you're hand-waving the inescapable fact that there is a fundamental limitation in the supply of persons capable of acquiring the education and skills, and delivering competent patient services.
I've worked at a top 2 US dental school. I've seen that - even there - there were students that couldn't hack it and failed out. Others failed to graduate on time, requiring remedial and/or additional work.
The relative quality of students generally correlates with the relative quality of the school. So it's relatively downhill from there.
Now, maybe the natural limit is higher than the limit you cite. (Is that even some kind of mandated (by whomever) limit, or is it simply the result of the limited number of seats available in accredited dental schools. If it's the latter, is it really honest to say "allowed")?
Or maybe the work in orthodonture could be unbundled in such a way that much of it could be delivered by lesser skilled, and thus less costly providers.
Universal healthcare is already much more cost effective than fully or semi-privitised health care.
Sorry, I forgot to pretend that all the other developed countries haven't figured out healthcare already.
Geez.
----------------
Oh and btw, when you have a universal healthcare system payed by taxes (none of that bullshit insurance crap that only ends up being costly regulation/financial bloat) you can have entire and fully private hospitals and health clinics where you can get service for cash, and surprise, surprise, it's ridiculously cheap because it has to compete with the effectively free public healthcare system.
>Universal healthcare is already much more cost effective than fully or semi-privitised health care.
That's not true. Most developed countries have some form of privatized system, falling into your 'semi-privatized' definition. It's more cost-effective.
What does this have to do with universal healthcare?
We know how to make healthcare more efficient. We know how to remove the administrative overhead. Other countries already have these systems in place. Look at Taiwan for one example. They have digital medical records and an extremely low administrative overhead because of universal care.
Healthcare will continue to be broken no matter how many YC research programs there are - because the US population lacks the desire and political will for universal healthcare.
I applaud this initiative of collecting more data on this, by starting a small trial in an area with fewer confounding factors, and later applying those lessons learned in places with more interconnected systems in place.
One unfortunate fact is that a small proportion of people 'consume' most of the medical care. Operational inefficiencies, the concept of health insurance, a byzantine cost structure, and in the US, after-the-fact billing conceal -- or at least spread out over time -- some of the financial pain of care. This is a sort of societal compromise to avoid confronting the problem: a society either shoulders (i.e. subsidizes) the cost of care for its most unhealthy, or lets them perish outright.
Today, most civilized societies tiptoe around this subject by subsidizing medical care for the elderly for political expediency, where the marginal benefits (even for the particular individual) of life extension until funds finally run out quickly diminish, while leaving folks of prime working age bear a large portion of their own costs in case of misfortune, to say nothing of underserved minorities and the economic poor.
Perhaps the best value of conducting this trial in a developing country isn't solely to get away from the political machinery of a mature healthcare system, but to escape the political baggage of a post-industrial society and see if technological solutions can work if morals and politics aren't in the way.
Healthcare definitely seems like the land of process inefficiency, even in developed countries like here in Canada, so there's plenty of opportunity for major improvement. There's still plenty of paperwork done on... paper, information that constantly has to be repeated when you go from one provider to another, and plenty of mistakes made.
Some time ago Ontario spent a massive amount of money on computerizing healthcare and it yielded nothing. I figure all the regulations, privacy issues, and overall complexity of the system makes it a tough Goliath to handle. And whatever happened to Google Health?
I feel that the solution has to come from the grassroots: get a bunch of health care providers to sync up for certain simple services, and go from there. Keep adding features little by little, keep expanding the number of participants. Do it using published and open source APIs and software. Don't try to be everything to everyone. Break a few rules, ignore some complicated standards if it can help get you there quicker. Hmmm, maybe for the latter to be possible it makes sense to start in less sue-happy countries.
Founder of Akira here (www.akira.md in case you weren't familiar).
We try not to break any rules, but you're spot on about the grassroots thing. We decided we couldn't wait for the policy to catch up to the serious problems with our healthcare system and decided to tackle them head-on!
Has it been easy? Not at all. Is progress being made? Absolutely!
Something has changed recently because it seems almost everything is electronic now.
A few years ago I even subscribed to get all my test results online; I avoided an unnecessary doctor's appointment because I could see the results myself.
I have argued in favor of Single Payer systems on the basis of https://en.wikipedia.org/wiki/Monopsony . When buyers don't compete on price, then the price goes down. This is also known as "collective bargaining power".
You can see this borne out in the fact every developed country with a universal healthcare plan gets cheaper prices, often for the same or better outcomes than the USA. Including number of doctors per capita, which disproves the "shortages" myth. Domestically in the USA, Medicare squeezes doctors far more than other insurance companies. A "medicare for all" would do even better.
After the libertarians and anarcho-capitalists try to claim superior economic knowledge eventually they must admit simple supply and demand drives prices down in a single payer system.
But then I get the following objection: what about all the R&D that we do? Perhaps all that expensive health care in the USA results in better procedures and medical equipment, better trained doctors etc. ?
> For the initial project, Watsi will fund primary healthcare for a community in the developing world and build a platform to run the system transparently.
Have they decided what country (or countries) in which this will take place?
While I'm sure there are many worthy candidates worldwide, applying the same type of program to under served communities within the USA would be great as well.
Love the ambition. Bring some transparency, reduce fraud, use technology to reduce cost where possible. Great idea, hope it works.
I'm skeptical it could reduce healthcare costs significantly simply because of the massive effort required to change the healthcare behemoth in even small ways. However, given the exorbitant costs of healthcare (currently paying $1800/month for a family of 4), it's worth certainly trying.
If you went back in time - say, 20 or 25 years ago - and you picked up a progressive, left leaning magazine - say, adbusters or mother jones - you would very regularly read warnings about the manufactured needs of medicine and healthcare and pharmaceuticals.
Barely an issue of such a periodical could pass without dire warnings of a future in which big pharma and insurance interests would convince us, through advertising, that we were foremost consumers of "healthcare".
What happened ?
The progressive left is now fully, fervently convinced that "healthcare" is a basic priority of human life. It is a rampant consumerism that reaches far beyond - and profoundly deeper - than the fears that good people have always had.
Healthcare has long been seen as a basic right in many places and even the Republican Party in the U.S. now supports health insurance for everyone.
The parent seems to conflate healthcare with pharmaceuticals and other specific forms of healthcare. IIRC, the warnings were that big pharma was pushing pills on people, something that has some evidence behind it. As an analogy, I think an effective military also is essential, but that doesn't mean I don't think big military contractors don't push needless or dangerous products on the public.
> Watsi’s goal is to improve the efficiency of funding, making universal healthcare possible.
Universal healthcare is already possible.[1] Reducing waste is a noble goal but this is a startling sentence from a health tech startup team. It implies that the primary obstacle to universal care is cost, not political will, which fails to comprehend how universal care was achieved in most of the industrialized world.
> Reduce spending by 40% would reduce US GDP by almost 10%.
No, it wouldn't, because most of that would go straight back to labor and result primarily in increased consumer spending, and secondarily in increased consumer investment (which leads to increased business spending.)
It's not like the money not being spent on healthcare inefficiencies is going to just vanish out of the system.
That's why GDP is a pretty bad yardstick. Spending on inefficiency is spending so it raises GDP, but GDP doesn't indicate whether money was spent making people better off, or just spent.
It's like a natural disaster or oil spill: there is good chance a natural disaster or actually increases GDP short term. People aren't better off for it however, since that money could have been spent better elsewhere.
I doubt the money not spent on inefficiencies would equate to money effectively burnt away. That 40% would probably be spent in other, more productive ways.
Not to mention you're actually making a point for not giving GDP too high a value when looking at economies.
I wonder what the long-term on this is going to look like. It would seem to me like an amazing irony if the receiving nation ended up with better and cheaper healthcare than the US considering that YC and Watsi call the US home.
This sounds like a great project. I love the idea of building technology for healthcare in a small, controlled, active care environment, and then scaling those tools to a larger audience.
The bigger issue in healthcare IMHO is that the American healthcare model, while hugely inefficient, seems to be the system that best incentivizes innovation. We pay 10x what Sweden pays for medical devices, but the US market is the only reason those device companies can be profitable. If we move to a single-payer system in the US, the economic incentives for innovation go way down.
If someone can figure out how to lower costs, while still providing a profitable market in which drug and device companies can innovate, we'll all benefit.
"For the initial project, Watsi will fund primary healthcare for a community in the developing world and build a platform to run the system transparently."
Start with Tuskegee, Alabama, poorest town in the United States.
The article doesn't mention which developing country the trial will be in, but South Africa would make an interesting candidate. It has a public healthcare system that's in shocking condition, and a world-class private healthcare system, funded by health insurance, that's becoming more unaffordable (despite being funded and mandated by employers) each year because of high medical inflation. There are clear parallels to the US healthcare system, and the commodities downturn has stymied the government efforts to introduce universal healthcare, so there would be an ideological willingness to experiment.
I read the other day that here in Costa Rica the health care 'caja' has 1 employee per 85 people, it's more like working there is the plan. I can't wait to see what Watsi does next.
[+] [-] TuringNYC|9 years ago|reply
I'm not sure what the solution is short of a total swamp draining, but our startup went overseas to develop/trial our product in a country with a single payer system. Not perfect, but much more amenable to finding efficiencies.
[+] [-] warcher|9 years ago|reply
Anybody thinking software is going to solve that is way in a bubble.
http://healthaffairs.org/blog/2016/09/19/the-politics-of-med...
[+] [-] maxerickson|9 years ago|reply
We should also work on removing arbitrary barriers to entering the supply side of the market. Not just for individuals that want to be a doctor or other sort of provider, but certificates of need and such too. Currently, lots of states dictate who can operate a CT scanner.
[+] [-] will_pseudonym|9 years ago|reply
Mental health in this country is similarly crippled by rapid societal changes, but that would take longer to explain in detail.
[+] [-] sytelus|9 years ago|reply
[+] [-] 8ytecoder|9 years ago|reply
It is however possible to consider at least some technology solutions - build a more transparent system. Let patients do some cost comparison and incentivize them to find cheaper (but good options). People do care about their health and they can and should be trusted to make these decisions.
Start more clinics like the One medical group (just an example) to make preventative care easier and accessible.
[+] [-] MR4D|9 years ago|reply
One thing that bugs me is how limited my choices are. I believe that over-regulation drives that. Getting an x-ray for my dog is much, much cheaper than me getting one, which is just one example of an unregulated market (relatively, obviously there are licensing & safety standards)
Seems that this would be a shot. If it doesn't work, lets try something different. I'm not wedded to any solution, but I think we probably agree that healthcare is mostly broken in the US (and was even before Obamacare).
Final note - I don't distinguish between healthcare & insurance for sake of simplicity in this post.
[+] [-] vondur|9 years ago|reply
[+] [-] topspin|9 years ago|reply
The system embodies large amounts of collective dissonance; a natural reaction to the soft corruption that has to be practiced to satisfy policy. Cost shifting is among the most pernicious causes of this; there is little to no correspondence remaining between actual service and the fee that gets billed; it's all about who the patient's payer happens to be, what policies are in play and how much providers can get away with in each case. The seemingly arbitrary outcomes have to get reconciled somewhere and in the doing of that we build up a lot of scar tissue.
[+] [-] wyc|9 years ago|reply
Whenever you have a $500 bottle of orange juice, I think it screams that you're not in a competitive market.
[1] https://en.wikipedia.org/wiki/Certificate_of_need
[+] [-] wwweston|9 years ago|reply
I think this is made harder to see by a certain stripe of market fundamentalism that almost blends into the background for many people at this point. At this level of analysis, it's assumed that every transaction is cooperative in nature and competing interests are correctly balanced if not aligned by the time a transaction takes place. Since that's the general assumption, of course it's the specific assumption that the market will do the right thing (regulated or unregulated -- the regulations are just clothing on the incentives).
I'm talking about the general level of lay discourse that defends the recent history (and even the ACA status quo), of course. Scholarship and policy research recognizes the problem.
[+] [-] robbiep|9 years ago|reply
[+] [-] tyre|9 years ago|reply
I cannot stress this enough: technology is not the hard part.
Do they have outdated software? Yes.
Can you build better software? Yes.
None of that matters if you can't get it into their hands. Procurement is the hard part. Can you empathize with the needs, fears, desires, quirks, and crazy of ten different stakeholders? Pry proprietary API specs from the cold-dead hands of one-off contractors? Educate users who's technological proficiency peaked at SMS to manage a full-featured SaaS product in 2017?
Don't focus on the software. That isn't the hard part. People are the hard part. People are always the hard part.
[+] [-] ones_and_zeros|9 years ago|reply
[+] [-] yummyfajitas|9 years ago|reply
It turns out that patients are very good at figuring out which health care will improve health and which won't - the high copay group had no statistically significant difference in health from the low copay group, and spent about 30% less money. What a crazy magic bullet, huh?
http://www.rand.org/health/projects/hie.html
We ran a directionally similar experiment in 2008, and got much the same result: low copayment causes people to consume a lot more medicine, but with no objectively measurable improvement in health. (Subjectively, people with insurance feel healthier even if they never go to the doctor.)
https://www.nber.org/oregon/
In both cases we ignored the result because we don't like it.
[+] [-] anigbrowl|9 years ago|reply
Cost sharing in general had no adverse effects on participant health, but there were exceptions: free care led to improvements in hypertension, dental health, vision, and selected serious symptoms. These improvements were concentrated among the sickest and poorest patients.
Personally speaking, I'm very much in favor of concentrating benefits among the sickest and poorest patients so as to minimize avoidable suffering. The pursuit of economic equilibrium on healthcare is a chimera because the conditions for perfect competition do not apply; patients cannot choose when to be sick, and thus lack the discretion on when they enter or exit the market; nor are competing therapies or competing providers of the same therapy offering a commodity product that can be freely selected between, just as if you suffer a catastrophic injury you won't get a timeout to make choices about which emergency room offers the best bang for the buck.
Like any sane person I want to minimize the overall cost of healthcare, but I also want to minimize avoidable suffering. I would much rather pay a bit more in tax and have a system that was somewhat less fiscally efficient but more accessible to those in the greatest need. This isn't just a matter of altruism or anxiety about high healthcare costs; if you have a maximally efficient healthcare delivery system then it's likely to fail in the event of a black swan public health crisis because all the gains from efficiency have already been booked for profit.
[+] [-] HarryHirsch|9 years ago|reply
How much is an office visit for runny nose? USD 50, USD 100? And how many frequent flyers are thee in the population, one out of ten, perhaps? It's just not plausible that it's the doctor-fetishists that cause US healthcare to be 4 times as expensive as the rest of the developed world.
[+] [-] st3v3r|9 years ago|reply
[+] [-] whyileft|9 years ago|reply
Edit: My apologies for sounding a bit antagonistic. The ACA is currently making use of high copays for that reason and more. It also hopes to force more transparency as well as most people want more than a icd-10 code when they have to write a check for $4k.
[+] [-] Eliezer|9 years ago|reply
Offer free dollar bills, and a line will form until the cost of staying in line burns more than $1. Medicine isn't costly because it's inefficient, rather it can end up inefficient because the limited supply means it must somehow end up costly.
It is not possible to solve the healthcare crisis without somewhat deregulating the supply of healthcare and allowing it to increase. Until then, every subsidy just raises the price, and every efficiency improvement just creates room for more inefficiency elsewhere.
You can't solve the housing problem in San Francisco by building more efficient software for selling houses. Only interventions that somehow increase the total supply of living space can cause more total people to be able to live there.
[+] [-] lkbm|9 years ago|reply
But it sounds like at least some of those inefficiencies involve: 1. People getting unnecessary orthodontic treatments (eliminating those cuts demand [not just quantity demanded]) 2. People getting ineffective treatments and needing a second treatment (same as 1) 3. Orthodontists being allocated in a way that lowers their overall productivity--empty time in their schedules, doing stuff they're less skilled at, etc.
If my orthodontist spends less time on administrivia or repeat procedures, he can fix more people's teeth without us training a second orthodontist.
Similarly, if there are apartments sitting empty for a month because it's hard to match people with apartments, better software can fit more people into San Francisco. (Going deeper, my bedroom is empty 12+ hours a day. I could totally sublet it to someone who works the night shift. I just need an efficient system to find such a person who's as interested in saving money as much as I am. Or as much as I was a few years ago. Now, I might not opt for this plan.)
[0] http://www.who.int/whr/2010/10_summary_en.pdf?ua=1
[+] [-] coolgeek|9 years ago|reply
I'm (moreso, but not completely) sympathetic to this argument when we're talking about (significantly) lesser skilled providers such as barbers or taxi drivers.
But in the context of health care providers, you're hand-waving the inescapable fact that there is a fundamental limitation in the supply of persons capable of acquiring the education and skills, and delivering competent patient services.
I've worked at a top 2 US dental school. I've seen that - even there - there were students that couldn't hack it and failed out. Others failed to graduate on time, requiring remedial and/or additional work.
The relative quality of students generally correlates with the relative quality of the school. So it's relatively downhill from there.
Now, maybe the natural limit is higher than the limit you cite. (Is that even some kind of mandated (by whomever) limit, or is it simply the result of the limited number of seats available in accredited dental schools. If it's the latter, is it really honest to say "allowed")?
Or maybe the work in orthodonture could be unbundled in such a way that much of it could be delivered by lesser skilled, and thus less costly providers.
But this is a poor - and lazy - argument.
[+] [-] lumberjack|9 years ago|reply
Sorry, I forgot to pretend that all the other developed countries haven't figured out healthcare already.
Geez.
----------------
Oh and btw, when you have a universal healthcare system payed by taxes (none of that bullshit insurance crap that only ends up being costly regulation/financial bloat) you can have entire and fully private hospitals and health clinics where you can get service for cash, and surprise, surprise, it's ridiculously cheap because it has to compete with the effectively free public healthcare system.
[+] [-] ameister14|9 years ago|reply
That's not true. Most developed countries have some form of privatized system, falling into your 'semi-privatized' definition. It's more cost-effective.
[+] [-] toomuchtodo|9 years ago|reply
It has always seemed like this was the end goal; to build a proof of concept healthcare delivery platform for the third world. Very exciting!
EDIT: Sidenote: Thanks YC for funding Watsi as your first non-profit and attempting to tackle a hard social problem.
[+] [-] alexmingoia|9 years ago|reply
We know how to make healthcare more efficient. We know how to remove the administrative overhead. Other countries already have these systems in place. Look at Taiwan for one example. They have digital medical records and an extremely low administrative overhead because of universal care.
Healthcare will continue to be broken no matter how many YC research programs there are - because the US population lacks the desire and political will for universal healthcare.
[+] [-] temp-dude-87844|9 years ago|reply
One unfortunate fact is that a small proportion of people 'consume' most of the medical care. Operational inefficiencies, the concept of health insurance, a byzantine cost structure, and in the US, after-the-fact billing conceal -- or at least spread out over time -- some of the financial pain of care. This is a sort of societal compromise to avoid confronting the problem: a society either shoulders (i.e. subsidizes) the cost of care for its most unhealthy, or lets them perish outright.
Today, most civilized societies tiptoe around this subject by subsidizing medical care for the elderly for political expediency, where the marginal benefits (even for the particular individual) of life extension until funds finally run out quickly diminish, while leaving folks of prime working age bear a large portion of their own costs in case of misfortune, to say nothing of underserved minorities and the economic poor.
Perhaps the best value of conducting this trial in a developing country isn't solely to get away from the political machinery of a mature healthcare system, but to escape the political baggage of a post-industrial society and see if technological solutions can work if morals and politics aren't in the way.
[+] [-] esfandia|9 years ago|reply
Some time ago Ontario spent a massive amount of money on computerizing healthcare and it yielded nothing. I figure all the regulations, privacy issues, and overall complexity of the system makes it a tough Goliath to handle. And whatever happened to Google Health?
I feel that the solution has to come from the grassroots: get a bunch of health care providers to sync up for certain simple services, and go from there. Keep adding features little by little, keep expanding the number of participants. Do it using published and open source APIs and software. Don't try to be everything to everyone. Break a few rules, ignore some complicated standards if it can help get you there quicker. Hmmm, maybe for the latter to be possible it makes sense to start in less sue-happy countries.
[+] [-] cal5k|9 years ago|reply
We try not to break any rules, but you're spot on about the grassroots thing. We decided we couldn't wait for the policy to catch up to the serious problems with our healthcare system and decided to tackle them head-on!
Has it been easy? Not at all. Is progress being made? Absolutely!
[+] [-] wvenable|9 years ago|reply
A few years ago I even subscribed to get all my test results online; I avoided an unnecessary doctor's appointment because I could see the results myself.
[+] [-] soperj|9 years ago|reply
[+] [-] EGreg|9 years ago|reply
You can see this borne out in the fact every developed country with a universal healthcare plan gets cheaper prices, often for the same or better outcomes than the USA. Including number of doctors per capita, which disproves the "shortages" myth. Domestically in the USA, Medicare squeezes doctors far more than other insurance companies. A "medicare for all" would do even better.
After the libertarians and anarcho-capitalists try to claim superior economic knowledge eventually they must admit simple supply and demand drives prices down in a single payer system.
But then I get the following objection: what about all the R&D that we do? Perhaps all that expensive health care in the USA results in better procedures and medical equipment, better trained doctors etc. ?
To this I say ... OPEN SOURCE DRUGS! http://magarshak.com/blog/?p=93
If you can introduce a patentleft movement in drugs the same as you have done in software, then innovations can come from anywhere.
And failing that, we can always do this compensation model: https://qbix.com/blog/index.php/2016/11/properly-valuing-con...
[+] [-] koolba|9 years ago|reply
Have they decided what country (or countries) in which this will take place?
While I'm sure there are many worthy candidates worldwide, applying the same type of program to under served communities within the USA would be great as well.
[+] [-] judah|9 years ago|reply
I'm skeptical it could reduce healthcare costs significantly simply because of the massive effort required to change the healthcare behemoth in even small ways. However, given the exorbitant costs of healthcare (currently paying $1800/month for a family of 4), it's worth certainly trying.
Is there a time frame on this experiment?
[+] [-] rsync|9 years ago|reply
Barely an issue of such a periodical could pass without dire warnings of a future in which big pharma and insurance interests would convince us, through advertising, that we were foremost consumers of "healthcare".
What happened ?
The progressive left is now fully, fervently convinced that "healthcare" is a basic priority of human life. It is a rampant consumerism that reaches far beyond - and profoundly deeper - than the fears that good people have always had.
It didn't have to be this way.
[+] [-] hackuser|9 years ago|reply
The parent seems to conflate healthcare with pharmaceuticals and other specific forms of healthcare. IIRC, the warnings were that big pharma was pushing pills on people, something that has some evidence behind it. As an analogy, I think an effective military also is essential, but that doesn't mean I don't think big military contractors don't push needless or dangerous products on the public.
[+] [-] certifiedloud|9 years ago|reply
[+] [-] abalone|9 years ago|reply
Universal healthcare is already possible.[1] Reducing waste is a noble goal but this is a startling sentence from a health tech startup team. It implies that the primary obstacle to universal care is cost, not political will, which fails to comprehend how universal care was achieved in most of the industrialized world.
[1] https://en.m.wikipedia.org/wiki/List_of_countries_with_unive...
[+] [-] intrasight|9 years ago|reply
Your inefficiencies are someone else's revenue.
Or to say another way:
Healthcare is ~20% of US GDP
Reduce spending by 40% would reduce US GDP by almost 10%. That's a tough sell politically you have to admit.
[+] [-] dragonwriter|9 years ago|reply
No, it wouldn't, because most of that would go straight back to labor and result primarily in increased consumer spending, and secondarily in increased consumer investment (which leads to increased business spending.)
It's not like the money not being spent on healthcare inefficiencies is going to just vanish out of the system.
[+] [-] alkonaut|9 years ago|reply
It's like a natural disaster or oil spill: there is good chance a natural disaster or actually increases GDP short term. People aren't better off for it however, since that money could have been spent better elsewhere.
[+] [-] sean_appleby|9 years ago|reply
http://www.investopedia.com/ask/answers/08/broken-window-fal...
[+] [-] aleksei|9 years ago|reply
Not to mention you're actually making a point for not giving GDP too high a value when looking at economies.
[+] [-] conanbatt|9 years ago|reply
[+] [-] dkonofalski|9 years ago|reply
[+] [-] maxerickson|9 years ago|reply
[+] [-] mikekij|9 years ago|reply
This sounds like a great project. I love the idea of building technology for healthcare in a small, controlled, active care environment, and then scaling those tools to a larger audience.
The bigger issue in healthcare IMHO is that the American healthcare model, while hugely inefficient, seems to be the system that best incentivizes innovation. We pay 10x what Sweden pays for medical devices, but the US market is the only reason those device companies can be profitable. If we move to a single-payer system in the US, the economic incentives for innovation go way down.
If someone can figure out how to lower costs, while still providing a profitable market in which drug and device companies can innovate, we'll all benefit.
[+] [-] Animats|9 years ago|reply
Start with Tuskegee, Alabama, poorest town in the United States.
[+] [-] buyx|9 years ago|reply
[+] [-] benologist|9 years ago|reply