[thaw13579]

From what I know, seems like a mix of medical price fixing by the gov't, adoption of lower cost hardware, and universal healthcare. There's apparently less bureaucracy, perhaps because there is no need for negotiation at every step of the process?

[lostlogin]

There are big costs. The hardware, the facility (RF cage and chillers), power, water, staff, RIS/PACS etc etc.

I can’t see how you can do it for $50. Does the ‘universal healthcare’ bit mean that the government is paying most the bill and it’s $50 out of pocket?

[thaw13579]

Yes, $50 was a rough out-of-pocket estimate, the amortized cost per scan for operation alone is probably on the order of hundreds of dollars per scan, assuming high utilization.

One funny thing about MRIs is the magnet is always on, so there could be some clever ways to reduce costs running them after hours.

[fc417fc802]

> there could be some clever ways to reduce costs running them after hours.

It seems like a dedicated round the clock facility housing at least dozens of MRI machines ought to offer significant economies of scale. I wonder if I'm wrong about that or if there's some other reason we don't see this approach taken by governments.

[lostlogin]

The staffing costs then skyrocket. 1.5x or double time. However, the main obstacle is a lack of staff. Good staff are hard to find and worth what they cost. And they usually don't want to work out of hours. The economies of scale are interesting. Eg PACS/RIS cost very little more when you increase scans done, and rent is a fixed cost. The best thing that happens are you increase scanners at a the management of no-shows. Patients fail to turn up regularly (a 'did not arrive', DNA). With more imaging going on, you just grab the next available patient, the gap ends up later on, then you make a new booking. The record at my site is 6 DNAs and no slots missed. I run a small MRI service.

[fc417fc802]

> 1.5x or double time.

Is the premium really that large for the night shift at (for example) a hospital? But even if you can't do 24/7 presumably there are physicians and technicians who would be willing to do either early morning or late evening without demanding much of a premium.

A massive daytime only facility should at least enjoy reduced capex and maintenance burdens if they have enough machines in one place. Less duplicated infrastructure and everything closer at hand.

Although if as you say even a small service can paper over 6 DNAs without missing a slot then maybe there isn't all that much to be gained here.

[lostlogin]

I’ve just checked the contract for the largest employer of techs (in New Zealand) and they only get 1.25X for night shifts. This is the rate at public hospitals. Private employers pay more and the penal rates are more aggressive - due in part to none of us wanting nights or weekends worked.

However that’s a bit meaningless as night shifts don’t exist. MRI is run as an oncall service and only acute scans are done at night - good luck getting a consultant to come in for anything less.

There are staff who like early starts (6am) and a smaller number who like to finish a bit later 6-9pm).

Techs are lucky enough to be in demand and if an employer pushes too hard, they’ll go somewhere that’s a better fit.

We only site 2 MRs next to each other, so savings are going to be minimal but we do see staffing advantages and less downtime. Coils scan swap between machines, one chiller can supply both MR scanners (just… be careful).

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