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Old 03-24-2020, 11:24 AM
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What's the Story with Private Hospitals/Healthcare


Disclaimer: Most of the below is based on my understanding of this. I am open to being disabused.

As I understand it, there are healthcare facilities that cater to wealthy individuals who can afford what amounts to a membership.

If this is correct, does anyone know how many of these there are, how big they are, and what facilities they have?

Are these facilities subject to being commandeered in an emergency? Surely in a national emergency they wouldn't be allowed to remain idle while people go without health care? Similarly for their employees.

The reason I bring this up is that we're seeing some wealthy investors supporting the idea that it's more important to get the economy going again, and maybe the lockdown isn't worth it. That's a reasonable debate, unless those pushing the idea have some guaranteed access to healthcare, in which case it's pretty appalling.

Am I way off? Apologies if the premise of this is dumb.
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Old 03-24-2020, 02:37 PM
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All Private Hospitals in the UK (ie hospitals not part of National Health Services) have agreed to offer beds/services to the NHS at cost, effective 21/3.

This will add about 8,000 beds for NHS. I imagine all elective stuff that can be postponed at the hospitals has been to free up capacity.

https://www.ft.com/content/c9a9be78-...f-41bea055720b

These aren't "membership hospitals for the rich", but they are hospitals that bill private insurance or bill patient's directly for services.
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Old 03-24-2020, 10:54 PM
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There's a couple of different concepts all lumped under the label of "private healthcare" so it's important to be precise about what you mean. It sounds like what you're talking about is some variant of concierge medicine which has been in vogue with the ultra rich for quite a while now.

Those people are going to quickly discover how useless concierge medicine is for true disasters. Concierge medicine is really good at taking simple, common medical procedures and applying very fancy window dressing to it to make it look more impressive. As soon as anyone needs anything more specialist, they're dumped into the regular medical system because concierge medicine doesn't have the scale to handle such cases.

I had a friend who went from being an ER doc to doing a 3 month stint in concierge medicine and, even though she was being paid 4x as much, she was bored out of her mind and went back to doing ER because she said if she stayed in concierge medicine for too long, her skills would have completely rusted away and she would never be able to practice regular medicine again. She started off in the night shift and she would see like, 4 patients per shift on a busy night and they were all the most entitled, whiny, hypochondriacs ever. One patient was someone who fell out of bed in the middle of the night and they insisted on getting a CAT scan "in case they had an aneurysm" and they just did it because it was easier than arguing with them. All the cases were cases like that.

The clinic she worked in had two state of the art ICU beds with every single possible machine you could imagine and they were NEVER used because anyone who required anything remotely requiring ICU assistance was sent to the local county hospital as soon as possible as none of the nursing team at their clinic had any kind of ICU experience whatsoever whereas the county had nurses who were seeing ICU cases all day.

It's all a giant scam to bilk the money of rich people who just can't accept that they should even be in a room with "the poors". They were getting objectively worse quality of care for vastly over inflated prices.
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Old 03-24-2020, 11:36 PM
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Concierge medicine is a big thing here in the DC metropolitan area. There aren't separate facilities, per se, but a doctor who goes concierge has
a) a limited number of patients on his/her caseload (about a thousand )
b) collects an annual / monthly fee on the order of about 2,000 a year
c) promises longer office visits, some extra preventive care, better access to same-day or next-day appointments
d) will also visit you in the hospital and help oversee your care there (I get the impression that normally, once you go into the hospital you only see the specialist who sent you there).
e) In some cases, will make a house call

It definitely doesn't cater to the ultra-rich, but certainly to the upper-ish middle class with a bit of disposable income.

I don't know how this model is affected by the current crisis - I mean, I assume they would not go into the hospital, and they are probably also cancelling less-urgent appointments.
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Old 03-25-2020, 06:25 PM
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Concierge physician care is definately a thing for the upper middle class and above. In some cases the doctor will even give you his or her personal phone number so you can call at 3:00 in the morning if you're concerned about your kid's fever. But that's limited to basic office visit type care. In many cases these doctors don't even have the capability of doing routine lab test at their practice so they'll send you to LabCorp or Quest and have them bill your insurance. The math simply doesn't scale up to have concierge complete hospitals. The cost is along the lines of $2000 per bed per day for an average sized hospital and you're simply not going to find enough people willing to pay for concierge hospital care to fill them.
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Old 03-25-2020, 06:49 PM
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Basically what these people are saying isn't "screw the dying people, we just want to to make money", but pointing out that we can't take actions on the sole basis of saving lives without considering the economic cost. Although it sounds callous, benefit cost analysis is just the way things are done. If we didn't that could lead to some decisions like completely banning all forms of motor vehicles to eliminate car accident deaths, or imposing some new industrial safety regulation that might cost a trillion dollars per life saved. You can't say "screw the trillion dollars, we need to save a life".

The actual figures used tend to value a life at well into the millions of dollars. The figure MnDOT uses is 12.3 million. The problem is you know how many people get killed crossing a particular intersection and how much it would cost to build a bridge. We have a lot less of an idea the cost and benefit of our coronavirus actions so there's a lot of varying opinions out there.
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Old 03-25-2020, 07:17 PM
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Quote:
Originally Posted by Mdcastle View Post
Basically what these people are saying isn't "screw the dying people, we just want to to make money", but pointing out that we can't take actions on the sole basis of saving lives without considering the economic cost. Although it sounds callous, benefit cost analysis is just the way things are done. If we didn't that could lead to some decisions like completely banning all forms of motor vehicles to eliminate car accident deaths, or imposing some new industrial safety regulation that might cost a trillion dollars per life saved. You can't say "screw the trillion dollars, we need to save a life".

The actual figures used tend to value a life at well into the millions of dollars. The figure MnDOT uses is 12.3 million. The problem is you know how many people get killed crossing a particular intersection and how much it would cost to build a bridge. We have a lot less of an idea the cost and benefit of our coronavirus actions so there's a lot of varying opinions out there.
Believe me, I understand that. I was just trying to understand whether those putting forth the economic argument are doing so from a position of having extra access to care.
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Old 03-25-2020, 10:28 PM
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The only such hospitals that I am aware of are specialized facilities that aren’t set up to deal with something like coronavirus. These are places like private orthopedic hospitals, where otherwise healthy people might go to have a hip replacement. Another hospital might focus on cataract surgery or plastic surgery procedures. These facilities don’t have an emergency room, and aren’t equipped to treat other medical conditions. As far as I know the type of private hospitals described in the OP don’t exist, at least not in the US.
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Old 03-26-2020, 06:12 AM
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Quote:
Originally Posted by OldOlds View Post
Believe me, I understand that. I was just trying to understand whether those putting forth the economic argument are doing so from a position of having extra access to care.
They may have extra access to a certain level of care - they can certainly see a doctor more easily and possibly even get tested when others wouldn't - but that doesn't mean they have better access to ventilator/ICU care.
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Old 03-26-2020, 07:20 AM
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Quote:
Originally Posted by OldOlds View Post
As I understand it, there are healthcare facilities that cater to wealthy individuals who can afford what amounts to a membership.
As stated above, this appears to be a faulty premise, at least in the US.
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Old 03-26-2020, 08:01 AM
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Private hospitals in Norway are always willing to sell beds to the government system, often in job lots. I don't see why this would function any differently.
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