Category: Miscellaneous babble

The other day, I was listening to a news story about how there are more people in healthcare working in billing and administration than there are doctors and nurses combined. And for the most part, largely brought on by managed care, the HMOs. So much for the premise that they were supposed to be saving money and reducing health care costs. Imagine that, there are more people working to figure out how much to charge you for your hospital stay than there are people taking care of you while you’re in the hospital.

Actually, after having worked in US hospitals for the past few years, it’s not all that hard to imagine. I noticed shortly after moving to the US that healthcare was definitely much more business oriented than it is in Canada. One of the first things I noted was that I saw a lot more administrative and non-patient care people than I did doctors, nurses or techs while I was walking along the corridors.

Healthcare billing is big business. There are companies that don’t do anything except handle billing and coding for doctors’ offices and hospitals. There are graduate programs in medical billing. The CPT code books are thicker than most unabridged dictionaries.

And the billing process is convoluted. I haven’t seen the entire billing process from start to finish, but this is what I’ve encountered of it. After the doctor sees you, he might check off a few diagnosis codes on a form. Then there might be a dictated report, which is listened to and transcribed by a transcriptionist. From the form and transcripted report, a CPT coder (hopefully a properly trained and certified one) will select the appropriate codes to be billed for, which would then be sent to the billing group (internally or external). So between the doctor and your bill, there are several layers of people (at least 3) with minimal medical training deciding how much it’s going to cost you.

Where am I going with this? Oh, nowhere in particular. Just that getting sick in the US is expensive, and staying healthy in the US is almost as expensive.

UPDATE: And to top it off, who knows where your medical records end up. An article in SFGate (via slashdot) talks about how dictated reports from UCSF Medical Center ended up in a transcriptionist’s hands in Pakistan, apparently through several levels of subcontracted transcription services. So hospitals contract out transcription services to a company, who in turn subcontracts out excess work, which gets subcontracted out to some other company, ad infinitum.

Oh, the insanity…

Well, seems pharmaceuticals aren’t the only thing that’s cheaper to re-import into the US, rather than buying them domestically.

There’s an article at the New York Times (registration required) and discussion over at Slashdot about how a lot of textbooks can be bought for significantly cheaper from overseas markets than locally. Textbooks from Amazon UK can be as much as half the cost of the same textbook purhased from Amazon US.

Apparently, this is starting to cause textbook publishers quite a bit of consternation, which is about time. I’ve always thought textbook prices were outrageous. One of the most expensive textbooks (on a price/page basis) I ever bought was was a skinny little 8×4 textbook on classical mechanics, probably less than 200 pages. The book cost me about $100Cdn at the time (maybe about 10 years ago). I remember textbooks being a significant portion of my education expense during my undergrad year, and that was 10 years ago!. I wasn’t unusual for me to spend $400/semester on textbooks. With my wife back in school, textbook expenses are about the same, but she’s taking fewer classes than I did and most of the books we buy are used, from places like Amazon Marketplace and Classbook.com to name a few. If we bought them all new, I’m sure we’d be close to the $600/semester mark. Now that I know about this overseas thing, it’ll be one more source to check out at textbook shopping time.

Happy Canadian Thanksgiving!

That turkey yesterday was soooo good…

On the other hand, seems that our desire for big plump turkeys means we need to help them out a little to keep making big turkeys.

Picked up my new glasses yesterday. The new glasses are amazingly light compared to my old pair, which were even lighter than the ones before that. My new glasses are Easyclip titanium frames with these nifty little magnets designed to hold some clip-on sunglasses. The sunglasses just stick to the magnets, so no fumling around to slide them on, or prongs poking me in the nose. The lenses are high index glass with UV, anti-reflection (AR is a must-have) and anti-scratch coatings.

Over the years, my wife has been slowly migrating my glasses to smaller and smaller sizes, which runs counter to my preference for larger frames that preserve my peripheral vision (which now falls outside of my glasses). The smaller frames look more stylish, but now I’m limited to just detecting large blurry moving objects with my peripheral vision.

One of these days, I’ll have to talk to my optometrist about maybe getting some LASIK or some other laser surgery done on my eyes. My glasses are pretty pricy at $450 a pop. If laser surgery can improve my vision so I don’t need as strong a prescription, I’ll be happy.