[Keegs]

> If the service sucks, they’ll lose customers.

We’re talking about hospitals. Many areas are served by one local hospital. And where there are several, it’s typically the ambulance who decides where you go. It’s also pretty difficult to compare one hospital with another.

IMO hospitals resemble utilities where market forces aren’t enough to guarantee good service.

[happyopossum]

> And where there are several, it’s typically the ambulance who decides where you go, not you.

Don't necessarily disagree with most of your sentiment, however the vast majority of hospital patients do not arrive in an ambulance, or even through the ER.

A lot of hospital services are elective or planned (surgeries, pregnancies, etc) and for those I've found it very helpful to 'shop' for the best options.

Also, the one time I was in an ambulance, they asked which hospital I wanted my daughter transported to.

All that said, it isn't always possible or feasible to choose - but it's not because of an ambulance.

[vundercind]

Yeah, it’s usually insurance network that decides where you can go (if you don’t want to go bankrupt)

[FireBeyond]

> We’re talking about hospitals. Many areas are served by one local hospital. And where there are several, it’s typically the ambulance who decides where you go. It’s also pretty difficult to compare one hospital with another.

Paramedic here. It's typically, effectively, your insurance that dictates how we decide where you go.

If you're an acute, time-sensitive patient, then from a multitude of angles, "closest appropriate facility" makes sense.

Perhaps you dislike a hospital, or it's inconvenient, and you're not as acute or timely a patient, and your view is "I want to go to X hospital, and since I'm paying, why shouldn't I get to choose?"

As a paramedic, personally, I don't care.

However.

Your insurance does. And their perspective (sometimes rightly, and quite regularly wrongly) is that if you are well enough to bypass a hospital or multiple hospitals en route to a "chosen" facility, then did you need the ambulance? And if you didn't need it, why are "they" paying for it? And they can, and absolutely will, kick bills back to the ambulance company with a "please justify why an EMS transport was required versus advising POV (privately owned vehicle) transport or physician followup".

What they want to see happen, and what generally is actually the better option, as a provider is "we will go to the closest facility where they will assess and stabilize you as needed. if you then wish to be -transferred- to your facility of choice, they will organize that" (and, since the insurance criteria and questions are met, and a physician ordered the EMS transport, you should be covered). Though it is certainly less "convenient" for you.

Even beyond that, the area I'm in we have two hospitals. One is a Level 2 Trauma Center, one is a Level 3, but they're mostly comparable except for, well, acute trauma. We as providers will have a solid perspective of patient load in the ED of those hospitals, so I might ASK, not TELL you, hey, we might want to go to Hospital B, not A. And occasionally, though diversion is a convenience, not a concept under EMTALA (we can still absolutely show up at the ED with a patient even if they're "on divert"), some of the facilities here will round-robin to balance patient loads.

(Also, don't start me on Certificates of Need, where new hospitals essentially have to get the permission of existing hospitals in the area before they can open - essentially, "will you be okay if we take patients away from you"...)

[thayne]

And if you have several in the area, you might only have one that is in your insurance network. And that one may actually be substantially farther away than ones that aren't.

[wernercd]

maybe if regulations and taxes weren't so high, there could be more competition? Transparency and the like would help...

Increasing taxes and removing alternatives is never a good deal.

"market forces aren't enough" government forces aren't enough either.

The VA is the penultimate example and I wouldn't wish that upon my worst enemy. That's where our veterans go to commit suicide in the parking lots waiting on help.

22 Veterans.

[rqtwteye]

"The VA is the penultimate example and I wouldn't wish that upon my worst enemy. That's where our veterans go to commit suicide in the parking lots waiting on help."

The people I know who use the VA are quite OK with it. It's not perfect but none of them would want to put up with the insanity the rest of us has to.

[Clubber]

It really depends on the hospital.

[Arrath]

I know vets who have moved states simply to leave a poorly run VA region and find a good one, so yes it very much does.

[wernercd]

Yeah... and the people that commit suicide in the parking lots waiting on help? They are chopped liver? They don't matter.

"it's not perfect" It's garbage and a prime example of government programs. Works for a few and fucks over the rest.

The ACA helps a few... and is built on lies - keep your plan? keep your doctor? save $2500 a year? Lies, lies, lies... a few million get help. The other 100m pay more, higher deductibles, lose their plans, lose their doctors.

But who cares about the 100m if the 1m get helped, eh?

the biggest problem is the wasted money, the lies and the people dying in the parking lots.

But who gives a f' about them eh?

[int_19h]

If you care about the people, look at the numbers across many different countries, not just US. The picture is pretty clear: US, with its mostly privately run and for-profit healthcare system, spends significantly more money per patient while achieving worse results for that money. The vast majority of Americans would get a better deal as far as their healthcare goes in literally every other developed country.

[wernercd]

And it's gotten worse the more the government steps in to help.

The problem is the suggestion that government solutions will solve government created problems.

I have no problem admitting things can be fixed... but stuff like the unAffordable Care Act which is built on lies (Like your plan? Like your doctor? save $2500/year) is not going to solve the issues - nor is single payer, government ran solutions.

You'll never solve government created problems with government ran beauracracy.

[int_19h]

Those other countries that have it better than we do have healthcare systems either run directly by their governments, or tightly regulated by it in a way that effectively means that the government decides how things are run.

[systemvoltage]

You're making an assumption that a hospital is a monopoly. I explicitly said "unless it's a monopoly".

Ok, if "many areas have one hospital"... I don't think that's true at all. Most areas have multiple hospitals. Most people live in metropolitan or suburban areas.

[jandrese]

Depends on your definition. Do you only have 1 local hospital if there is another in a city that is a 2 hour drive away? Maybe only 1 hour? 30 minutes? Where do you draw the line?