At my Doctor's office, the doctors are scheduled for 15 minute appointments. at an optimistic assumption of 15 minutes travel time to and from each appointment, a model where the doctor visits each patient requires 3x as many doctors for the same level of care.
https://www.motherjones.com/kevin-drum/2013/11/its-doctors-w...
> So the number and composition of residencies is controlled by doctors, even as they’re subsidized by $13 billion in taxpayer money every year. And doctor pay, which almost everywhere is based on Medicare rates, is controlled by doctors. It’s doctors who are directly responsible for both their own high pay and their own low numbers.
https://washingtonmonthly.com/magazine/julyaugust-2013/first...
> The U.S. spends $13 billion a year subsidizing graduate medical education. Yet almost all of this money winds up producing the wrong kinds of doctors in the wrong places, with America’s most elite teaching hospitals being the worst offenders.
The key points are the “I need help” focus right in the name, and a triage process done by phone.
They’ll deal with sny unforseen event that needs medical attention. It can be a severe pain in the back in the middle of the night or high fever for a kid, anything that is not a regular check-up or renewing a prescription.
Then there’s pre-filtering of the calls to decide if it’s worth it to send someone, or if the patient better come to the office, or straight up call official emergency services.
Price is higher than an usual consultation but not that much, and interestingly it’s also higher than ER in a public hospital, so you have incentives to choose the right service for you.
We end up using it a lot because usually we detect our kid is sick after picking up from school or during week-ends, when normal offices are already closed and there’s no hope to get an appointment.
A home visit of a physician is hardly a new concept.
If I'm not mistaken, it's a norm in France, and I know that it functioned that way in the USSR (not sure about the modern Russia). The doctors were indeed complaining about the number of visits but somehow it functioned: while booking a specialist or finding quality equipment was an issue, there was rarely an issue to book a visit of a family doctor within a couple of days' notice, at least in a big city.
Highly dependent on the hospital and provider you have. Modern Russian does have a general government health care for most things, but you can also get private insurance. For the general care, you usually end up going to a local community clinic. For paid insurance, typically you can get a home visit within a few hours from a doctor who does the basics and writes you a doctors note for sick leave. (My experience has been that the sick leave is pretty generous; last time I had the flu I was given a week's rest, then for my follow up the doctor told me to take another 3 days)
It's not perfect for other things, but compared to the health care situation I had when still living in the US, this facet is far better. (at my last job in the US, both Insurance and my Work Place refused to approve sick leave for a summary from my in-network GP that suggested that a treatment required several days of recovery after some radiation therapy. They said I'd have to go to another clinic to have the situation reviewed; the second clinic decided I was fit to work so my choices were either burn vacation days or sign a form to accept time off without pay during recovery.)
It's not "either/or", there is no reason not to have both systems running in parallel. I would have no issue paying a doctor more for him to come visit us at home, to ensure it makes it as profitable for them to do that.
For every doctor's appointment serviced by Heal, ~3 appointments are taken away from a community clinic somewhere.
Maybe the economics work somehow for others, but they didn’t for her (car + gas + parking + large drop in number of patients seen).
It sounds to me like you may be making unjustified assumptions to get to that conclusion. Citation?
I have no horse in this race, but I found it interesting that the above was followed by four “you don’t know…” statements.
You’re making assumptions as well. The person to whom you are responding may know a great deal more than they have revealed.
> given all the regulation and equipment requirements.
Um, so how does not having a facility, which is probably required to give care, all of the sudden eliminate all of the equipment and regulatory requirements? I mean, don't you think the equipment and the regulation is probably there for a reason..?
It's required for certain levels of care, but not every encounter requires those.
That being said, the downsides of travel time are so negative it's hard to see how they could be overcome.
Compared to an urgent care facility, they pretty clearly have to be doing that.
Flu is a great example (not judging you, I have no idea how bad it was!) where most people could self care.
Much better is phone doctors & good websites; the NHS have invested heavily in this. You can self-care for many minor things based on online guides, and are then directed to a phone GP for triaging if you need further help.
(example online guide; https://www.nhs.uk/conditions/flu/ what I like about it is that it gives you clear exoectations about self care and when you should feel better, plus clear (and varied) escalation paths for worsened symptoms)
The Heal service was an immense win for our family's situation.
With regards to the US, the issue isn't the medical need to see a doctor, it's the bureaucratic need to see one, as you can't get approved for extended sick leave without it.
Such visits (and per this document [1, pg 7-8], many ER visits) are for purely bureaucratic reasons, such as no insurance or no other providers available. I interpret this as largely a workflow issue with regards to the availability of the simple care. A separate style clinic or service dedicated and allowed by Employers/Insurance which deals in low-priority cases for the purpose of documentation (e.g., flu clinics) would solve a lot of these issues, but, as I found out with my previous employer and insurance, flu clinics are "not real doctors", and as such cannot be submitted for sick leave claims.
I think we'd see the numbers for inappropriate/unnecessary visits drop rapidly if Employers/Insurance accepted such documentation more easily/readily.
It goes to show that healthcare is intrinsically linked into so many parts of our daily lives in weird ways.
If people paid directly for visits, there’s a built in incentive to reserve doctor visits for when they are actually necessary, rather than the British system of “free” (provided you can jump through enough hoops to actually earn an appointment.)
Using the NHS as a model of “good” health care is laughable. What’s “good” about the NHS is that it’s “free.” It isn’t actually good when it comes to access to care or advanced treatments. Compare cancer death rates of the UK vs the US, for example. The French system where you actually have to pay some money for appointments is far better — you don’t have to wait weeks to visit a GP: I can get pediatrician appointments generally same day. That is literally impossible in the UK. I also am not getting referred to a “website” to solve my kids’ illnesses — I am not an idiot, I know how to google. I am not going to waste my time going to a doctor unless I actually feel that the doctor can provide some value.
Want to better allocate a scarce resource? Make people pay a price that reflects the available supply instead of making it “free” but with convoluted access models.
Well, no. And this is why: https://www.nhs.uk/news/medication/effectiveness-of-tamiflu-...
What I love here is that there is clear, documented information about the choices on offer - and background into why the NHS recommends paracetamol/ibuprofen on its website.
> Compare cancer death rates of the UK vs the US, for example
Okay; looks like they are nearly identical for US, UK, France (105, 107, 109 per 100,000).
> That is literally impossible in the UK. I also am not getting referred to a “website” to solve my kids’ illnesses
This is the thing - emotively if your kid is ill it feels like they need a doctor. But likely they just need rest and over-the-counter medications (I've always found the pharmacist to be a good port of call for the right advice here).
If you do need a GP for your kid I have never had any problems getting one; day or night.
> I am not going to waste my time going to a doctor unless I actually feel that the doctor can provide some value.
In which case, great, but then I think you're not the target for these sorts of initiatives as you are using healthcare appropriately.
There's a huge need for in-home care, especially in the aging population. For able bodied humans, going to the doctor's office is a pain but not a particular challenge. For aging, disabled, or mobility-limited individuals, it can be nearly impossible for them to get to a doctors office. Not to mention, an office is full of nasty things that can harm immuno-challenged individuals more than the office visit can benefit.
Telemedicine is a really good start, but there are huge limitations without being able to actually interact with a patient. As more of these types of services popup, it's going to be incredibly beneficial for aging and homebound or almost homebound individuals.
It really exciting to see a whole gamut of services, like Shipt and ClickList, popup. Hopefully in 10 years, aging in place will be more common until the point that individuals actually require frequent assistance or medical attention.
$99 is the cost with no insurance; with insurance they bill and you pay your normal copay. $99 is probably less than their average reimbursement.
> That's cheaper than driving and a copay.
If you have really high cost of driving, have poor insurance, or are comparing it to average urgent care copays instead of primary/specialist office visits (IIRC, copays for primary average around $25 and specialist around $40; $60-75 seems improbably high transport cost for most people to drive to a doctor, even with non-free parking), sure. But unless appointment availability is really high, it's going to be higher latency, on average, than urgent care, and in any case it seems necessarily to be less well equipped than most urgent care facilities (meaning you are more likely to need to go somewhere else and be seen after your visit when using it as an urgent care.)
$24 primary, $37 specialist, though that was published last year so it may have crept up a bit (it's been trending slowly upward.) [0]
> You've just got really excellent insurance
$25 is more than my primary care copay. I know I have excellent insurance; I also don't assume everyone else's is like mine. OTOH, you apparently have really crappy insurance and are assuming everyone else does.
[0] http://time.com/money/4044394/average-health-deductible-prem...
Note that, as stated in the article you linked, the percentage of plans with deductibles has gone up significantly (67%). So your average is really a veiled figure - many people won't come close to spending as much as their deductible on healthcare in a year to ever actually pay those prices.
My cost is $20 per visit for the copay - I guess they bill the insurance company in the same way as if you'd gone into the practice.
But a subscription service model for those that can afford the highest quality home care for the elderly. Represents a phenomenal startup growth opportunity.
It's super handy for us, having 2 people in our family with illnesses that require regular doctor visits (once or twice a month on average). If it's night time and we need the GP, we don't have to worry about waking up the baby, loading up the kids and nappy bags and everything we need into the car, etc.
We only go and visit our actual family GP if we need prescriptions renewed, or we want to talk to him about a bigger issue or general questions. Eg stuff that isn't urgent, so we don't waste the home-visit GP's time. Then again, the home-visit GPs have told us multiple times that they're happy to come out no matter how small the issue, and they prioritise/triage calls so you're never keeping a more urgent case waiting.