[rscho]

The big difference up to now has been that US hospitals have been run by a huge layer cake of administrators for a long time, while in other western countries healthcare workers have had much more direct control over how things are run.

This is changing fast though, and Europe is migrating to the US model at a rapid pace, with growing administrative layer and loss of control over prices. Interestingly, european politicians are also telling everyone that the problem is that docs earn too much and people tend to believe them.

[Broken_Hippo]

I have so many issues with this: Europe is a big place and the countries do not exactly work in unison on these things. I only have experience in Norway - and that's only for the last 8 or 9 years. The prices have always been pretty standard - the doctors office doesn't set the rates, at least not in the public system (there is a private system, but the majority of doctors are in the public system). There hasn't been huge layers of administration, at least not in the way of the US - and this is, in part, because the insurances in the US create the layers of administrators. (Doctors offices do not need nearly as much staff for paperwork duties). For the end user, they've actually removed a layer - there were two types of deductibles that were merged into one (and is less than half the cost of the two combined)

And honestly, I find it very difficult to think that this is the administrative cake you were thinking. I also find it really difficult to think that Norway, Poland, Greece, Italy, Germany, and Britain are all taking the same steps and adding complexity.

Where do you get information? Do you have links?

[rscho]

Nope, that's just experience from daily life. I'm a doc in a public hospital in Switzerland, and also worked in the US.

Europe is still a bit behind in terms of admin, but getting there. And yes, american influence is felt all over Europe, with varying degrees of implementation among countries, as you noted.

I can understand that outsiders don't believe what we have to say when political propanganda is so strong. But for us insiders, it's really crystal clear what is happening. It used to be that problems arising in clinical management was solved by asking frontline workers what they needed. Healthcare workers had a lot of control over their working environment. Nowadays, admins are taking all decisions from above. European hospitals are now in competition with the private sector due to changes in the billing and insurance system coming from the US. As a result, european hospitals are now managed much more like your usual run-of-the-mill company than they used to. This is a terrible result for anyone but upper management.