Comment by tptacek
2 days ago
This is a huge problem in US health care financing: we have a fee-for-service model, no price transparency, and a consumer base (insulated from a lot of the costs of procedures by indirect payment through employer-provided insurance) conditioned to think procedures are inherently good. We waste billions annually on procedures that shouldn't be delivered at all.
I'm fond of pointing out the stat (true as of a year ago) that Massachusetts (I think it's MA?) has more MRI machines than the entire country of Canada.
I would posit this is more of a function of Canada having too few machines, with a median wait of 10 weeks for an MRI. [1]
To me it's crazy that people are waiting an average of nearly 3 months to get imaging. This is probably after waiting a couple months for their doctor's appointment to get the MRI scheduled in the first place.
[1] [https://getmrifast.ca/mri-wait-times]
One of the reasons I left Canada was it took me 6 months to get an MRI after a severe head injury in 2017. I have since gladly paid nearly 500k in taxes to other countries. Fuck Canada.
If I were waiting that long I’d fly to SE Asia. I got one in Cambodia same week for $1200.
2 replies →
Clearly you had the means... was it not possible to pay for private healthcare?
20 replies →
That is kindof crazy! Imagine you are suspicious that something is awry in your soft tissue, in which case I think MRI is the main diagnostic (?). Then you don’t find out for ten weeks, plus some for analysis!
MRI's are expensive and difficult to amortize for poorer countries or ones that don't have a great healthcare system.
https://www.statista.com/statistics/282401/density-of-magnet...
Japan is a standout, and then you see most of the West just below them... Canada is way down the list.
2 replies →
Waiting 10 weeks for an MRI is consistent with my experience in the US. This could be a regional thing. When my mom lived in her home state, she had nearly same-month or even same-week access to specialists. Now, living in my state, most appointments are booked more than a year out. She has talked about flying back to her home state every year to have her annual appointments. This is medical tourism within the country.
Not only did I have to wait for my MRI, but as the date approached, I got a call saying that they had canceled it because the insurance refused to cover it. I offered to pay out of pocket. Nope, they simply canceled it.
Of course if you can pay for quicker care in another country, it will seem like care in that country is quicker, but the people living in that country might not have the same privilege. Most of the people I know who move here from outside the US think our system is insane.
There's a billboard on my way to work for a private medical imaging service that offers shorter wait times.
Fwiw I’ve had next day non-emergency mri (and sadly same day emergency mri). And this was across 2 states. I absolutely believe that coverage is spotty. But mri machines are extremely common in most places in the US.
>https://getmrifast.ca/mri-wait-times
It's sad that seemingly the top result for this search term is an AI slop lead-gen site, rather than the actual source:
>Disclaimer: Wait times shown are estimates based on publicly reported data from the Fraser Institute, CIHI, and provincial health authority reports.
Also citing Fraser Institute, a known extremely right-wing hack "think tank" is like citing a used car salesman on the benefits of buying a car. Their entire raison d'etre is to privatize any remaining public good in Canada, so they will always hunt for any kind of information or data they can to paint whatever picture they want from their lobby funds.
> I'm fond of pointing out the stat (true as of a year ago) that Massachusetts (I think it's MA?) has more MRI machines than the entire country of Canada.
I'm also quite fond of pointing out that Canada and the state of California have roughly the same populations.
Canada's population is incredibly spread out, but also concentrated in about 5 major cities.
When I needed an MRI on my brain is was roughly a week, and that was in a smaller (under 100K people) city.
It's a triage system, although I wouldn't want to suffer through a "less important" issue.
[dead]
>"I'm fond of pointing out the stat (true as of a year ago) that Massachusetts (I think it's MA?) has more MRI machines than the entire country of Canada."
Long wait times (6-12 months+) for MRIs (due to a lack of both machines and technicians) are a frequent complaint by Canadians.
Yep. Wealthy Canadians often come to the USA as medical tourists and pay cash to skip the queue at home for elective procedures like MRIs or joint replacements.
You can pay for MRIs in Canada. My friend needed one and he had it within the week for $800.
I think private MRIs have been around, at least in my province anyways, for close to 30 years.
9 replies →
[flagged]
2 replies →
Patients globally think that procedures are inherently good, it's not inherent to the US system.
I'm a doctor working in a government funded public healthcare system, where there is every incentive for the system to NOT do investigations and procedures where there is a poor evidence base. Yet we still waste $BILLIONs every year on them and the majority of this is driven by patient demand.
I frequently get patients where the evidence is for intervention A - that requires the patient to do N amount of work (for example physiotherapy, strengthening exercises) with slow, but real, results. After 15 years of medical practice I can honestly count on one hand how often a patient has genuinely taken an interest in this approach and committed to it. This sentiment is shared across colleagues. The vast majority of patients want a 'quick fix', even when there is no evidence that a quick fix exists.
So they push for intervention B, creating long waits for patients who would genuinely benefit from seeing the interventionist who offers B, resulting in worse outcomes for that cohort.
As the system is free at the point of access patients can simply 'doctor shop' and see as many doctors that are needed until they get one who agrees that intervention B is what is required.
I think it comes from an assumption that lay people have that the body is a machine and if a part of it is broken it can simply be 'fixed'. The truth is, is that the human body and biology are messy. We can't even define broken in a lot of cases, you can have two people with the same finding on a scan and one is in pain and the other is completely symptom free. People find this concept really hard to understand, but most of biology is happening on a microscopic level for which we don't have tests and scans, which again people find hard to accept, that we do not always have an answer. Human biology is not a solved science, not even close. There is also the whole complicated factor of human perception.
Two people can have the exact same experience but have completely different feelings and ideas about it. For one person, post-nasal drip maybe completely distressing and make their life miserable. Another person may have the exact same level of post-nasal drip but it does not bother them at all and they live their entire life with it without ever consulting a doctor. So what partly drives health demand is a patients tolerance and perception of their symptoms, which can change over time.
To be fair to your latter point, Massachusetts is arguably the biomedical research capital of the world, those MRI machines are being put to research purposes.
I’m reminded of a quote from my biomed days: “If there’s ever a zombie apocalypse, you can bet it started in Cambridge.”
I just thought it an amusing anecdote until COVID, and then realized it’s less that said virus would be developed here and more that we have the business idiots to let it loose.
Careful which Cambridge you are on about. I take you are referring to Cambridge MA, US and not Cambridge, Cambridgeshire off of England, UK.
I'll note that COVID-19 "broke out" in Wuhan a city which has a virology laboratory nearby - the Wuhan Institute of Virology, who perform research on viruses.
I'm sure that is completely incidental to the pandemic of 2020-21. Clearly, some rather nasty live food markets are to blame.
It wasn't your numpties wot did it then, it was another lot that time!
4 replies →
That's an odd point to make when in the actual world we live in, Cambridge was where the first COVID vaccine was developed.
1 reply →
An elderly relative of mine went to get an MRI to prove the occult fracture of the sacrum that was hobbling him.
It took about 12 hours, much of it waiting for his blood pressure to subside low enough to get admitted (a pre-requisite for the MRI).
This is in a city with of about 750k people and nowhere near Massachusetts.
Did that study involve contrast?
1 reply →
At least most medications and interventions have to go through RCTs and tend to be quite standardized.
Don't even get me started with mental health therapy...
A lot of surgery that isn't directly saving you from death is worthless if you're lucky...
People love to complain about health insurance companies denying claims and prior authorization requests. While there are frequent errors and abuses on the payer side, the reality is that about a fifth of all treatments are "low value care" which aren't justified by evidence-based clinical practice guidelines and may even harm patients. If we want to reduce healthcare costs and improve outcomes then we've got to get that under control.
https://www.bloomsbury.com/us/price-we-pay-9781635574128/
It's not strictly a US health care problem either - I've been dumbfounded by foreign coworkers pressing for totally unnecessary medical interventions as if there's no risk associated with doing such things. It's most apparent from the socialized states where the healthcare is ~free.
My impression is this is a modern civilization stupidity in general.
apropos Dead Kennedys track: https://www.youtube.com/watch?v=lVULKYbAeEo