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Showing posts from August, 2013

Teasing out hospital budgets, especially how subsidizing doctors’ salaries can be financially sound

I have been doing locum tenens work as a hospitalist for nearly two years. One of my reasons for doing this is that the practice of medicine in the US is very interesting, and by working in very different places I get to see how things work and don't work, and make up cool theories. I have time to read and listen to people and have become curious about several true things which don’t seem to fit together.  Hospitals are paid an absurd amount of money to take care of patients.Small hospitals can barely survive financially.Small hospitals, rural ones with 25 beds or fewer (critical access hospitals) are paid more generously by Medicare than large hospitals.Hospitals that employ physicians subsidize them above the money they bring in as professional fees, to the tune of about $100,000 per year per physician.Hospitalists and hospitalist programs are expensive, in the range of 1-2 million dollars per year for a 25 bed hospital.Hospitals are willing, even happy, to start hospitalist pro…

Health care in Eastern Europe, Singapore and the US: How could pre-paid and concierge medicine help us be great?

American healthcare is expensive. We pay lots of money for it and we have outcomes that we aren't proud of. We gnash our teeth at how terrible we are and look to other countries with lower costs for ideas on how to improve. I have been combining personal and second hand experience of countries that spend very little on healthcare with what I know about medicine in the US, and we really aren't entirely bad. In some ways we are outstanding.

Singapore is a city-state comprised of 20 islands, near Malaysia, which began its modern prosperity when it was reinvented as a port by the British empire. It spends a tiny proportion of its GDP for healthcare, on the other hand, and ranks in the top 20 countries in the world in both life expectancy (15th) and infant mortality (1).

So how do they do it? There are many factors that might enter into the overall health of the population of Singapore. One very striking thing about Singapore is how strict their laws are and how rigidly enforced. …