Just had a recent physical - I got a low value for a test and it kicked off more tests, a visit to a specialist, more tests and no conclusion besides 'let's wait and see' which I could have done without draining my HSA. If the price of care was reasonable, sure, let's be proactive but because PCPs don't really seem to do anything but refer you to a specialist and any visit to a specialist + tests will immediately trigger thousands of dollars in bills, even if you're insured you're going be paying your deductible plus like 10-30% after that.
I got a random lab bill for like $650 (discounted from $2500) and in the follow up visit everyone agreed that was high but no could explain why it was that expensive - medicare's fee schedule has the same code costing $90. Until we stop this madness of providers basically charging whatever opaque negotiated random amount they want to insurers who then pass that down to charge payers after collecting a % the prices are just going to continue to go up and the broken medical system will stay fucked - with the consequence that the economics aren't going to make sense to seek proactive care.
The issue isn't really that they're expensive - they are, they shouldn't be. Proactive access to care is good.
The article kind of hints at this, but it comes down to Bayes theorem [1]. The general population has a relatively low incidence of disease, so even tests that are fairly reliable in a population with a high incidence of disease become super inaccurate when applied to the general population.
Worse, false positives generally - especially in the US, due to high financial liability risk - end up involving expensive, invasive medical follow-up tests, and the probability of a false positive multiplied by the risk of the exploratory procedures outweighs a later diagnosis.
No wonder annual physicals don't do much good.
High-risk people should get periodic tests for the things they're at risk of, and people should be in a position to report issues they discover in the course of their lives. However testing otherwise-healthy people for things they probably don't have isn't likely to yield good results no matter how good the test. It's just math.
I had a similar mindset as you describe here - but I no longer agree after experiencing long covid. My experience with long covid was made easier because of historical lab data from bloodwork tests that were taken pre-covid when I was a healthy 30 y/o white male. After suffering for months from (what I now know was) long covid, I went in for a checkup for some help.
The blood test comparison of healthy me to sick me was invaluable, because the healthy tests established a baseline of my system at peak condition.
> High-risk people should get periodic tests for the things they're at risk of, and people should be in a position to report issues they discover in the course of their lives.
How do you know if you’re at high risk for something? This assumes a medically literate and motivated person will seek care based on … what? Realizing that grandpa, great-grandpa and dad all didn’t live past their 60’s? High cholesterol and hypertension can be “silent killers” - how do you know to check for them?
> people should be in a position to report issues they discover in the course of their lives
What does this mean? Which issues? How many thousands of diseases are there?
I have a friend who has low level of energy, everyone was calling him lazy his entire life. He thought thats just how life is. He cannot compare how it feel to be him with how it feel to be someone else.
I convinced him to see a doctor about this at the age of 25. First doctor didnt take him seriously, didnt want to do any tests. The complains are very non-spesific. maybe you are lazy, maybe you are depressed.
After weeks of fighting the medical system he discovered that he had a digestive issue, which led to low level of iron and low level of enegy. His entire life he was suffering from an easily treatable problem.
Imagine he treated this at the age of 12, how many sports did he miss out on, how much academic achievement was missed, maybe his career and life trajectory would be different.
A friend of mine struggled with back pain for 3 years. He coupst find the cause. It got so bad, he thought he'd become disabled. He left UK and went back to Romania to have support of his family. Suffenly in Romania he started getting better. Turned out it was vitamin D defficiency.
I started taking Vitamin D agressively, 2,000 units daily, 5 times the recommended amount by the NHS. After taking it for 6 months I went private and did a first vitamin D test in my life - my level is 1/3 of normal.
So how doea one know what is normal, if most people gp their entire life without ever doing a full blood test
Bayes' theorem is not enough, I think you have to weight how expensive is the test, what are the consequences of false positives and true positives.
For example a low price test with almost zero both false positive and negative rate whose associate treatment has low cost and risk and that can save life of patients seems to me a test that should be applied to anyone at risk.
Ok, but then I'd like to see Bayes theorem being actually applied for different cases, instead of just hand-waving the issue away for all cases. Also, for some false positives there is no problem, e.g. vitamin D deficiency, where you can just take extra vitamins without much risk.
I'm not sure how they can be cheaper. The bill for a checkup pays the nurse and the doctor for their time. Claims about some greedy capitalist coming in and taking massive profit margins can be discarded by pointing out that non-profit hospitals do not charge substantially different rates for identical checkup services.
The way to make a checkup cost less is to pay doctors and nurses less. There are no pharmaceuticals, no surgeries, no complicated specialist medical equipment, and no expensive labwork involved in the price.
Society generally doesn't agree with the notion that doctors and nurses should be paid less. Therefore, checkups are more or less priced appropriately. Paying high skilled labor for their advice simply costs a lot of money. Ask any dev contractor here on HN.
This isn't what happens. A huge volume of the people that come in to US hospitals are chronically ill people with no money and very commonly no regard for their own health. Quite often they are also disrespectful and combative to hospital staff. The system pays for their extended care and the healthy majority pays huge premiums to subsidize their care. The vast majority will be paying premiums vastly out of proportion to what they will use.
>> medicare's fee schedule has the same code costing $90.
People would be upset if the gas stations charged different prices after they review your auto insurance policy. With healthcare, they look at our policy and make up price numbers.
Maybe this violates anti-trust laws. The State attorney generals don't seem interested in pursuing such discriminatory pricing.
* you can't get paid by insurance unless you have payment authorization from the patient on an estimate that is within 30% of the actual price (exceptions for emergency care).
* a requirement that all provider participate in an digital marketplace where patents and providers can get immediate quotes for labs/procedures and you get a list of local options+prices.
* anti-trust break up of healthcare cartels
* some price cap like 200% of medicare negotiated rates as a backstop for these really crazy outlier bills.
Your test is consistent with condition A. Its prevalence in the general population is B/1000 people. We can do a follow-up test that involves B, C, D, will cost $E and in cases like yours confirm condition A in F% of cases. Or we can wait and see; we'll redo the test in G time out if you present with other signs and symptoms H, I, J. Other possible causes for the test result are K, L, M. How could you like to proceed?
> PCPs don't really seem to do anything but refer you to a specialist and any visit to a specialist
(Yet another, I live in the US, therefore everyone else does moment)
This is one of the things that surprised me the most in the US. Doctors seem afraid to draw any reasonable conclusion and are more like salesmen. I'm sure the fact that you can sue for pretty much everything plays a role in them not being more confident.
I hope that testing gets cheaper and more data gets public so we can eventually have AI doing the medical scoring and with it routing/prioritizing patients.
I live in the US and have run into both kinds of doctor. If you end up with one that does nothing and only refers you to specialists, it's worth trying other doctors. There are definitely nerdy doctors that know a lot more and are more willing to get their hands dirty.
Ultimately, even the nerd doctors will send you to a specialist if you need it.
I like my current doctor a lot. He runs his own independent practice and is just generally really cool.
Growing up in the sticks, I had a primary care doc who, in retrospect, tried to treat things he should have referred out to specialists. The result was at least one early death in my family, another close call, and avoidable permanent disability.
You can likely get labs and imaging for significantly less by going to specific stand alone lab/imaging facilities.
Health care groups tend to refer you to onsite services and/or specific companies they have relationships with.
It is a pain though because you have to call around to get prices.
Generally, the places with the lowest cash prices will also be the places that are least expensive after you've reached your deductible, but it's good to confirm with your insurance.
Medicare's fee schedule is almost always lower than what you can get, even with all cash, because the US government can set the rates they pay to some degree. It's up to doctor's/medical groups if they'll accept that or just stop taking Medicare completely.
Specialists are great, but it would be so much better if healthcare systems did a better job at properly looping back in the patient's primary care / family doctor in on important health decisions. Primary care physicians, when not stifled by the system, have a remarkable ability to keep track of a patient's health over the course of several years and provide a balanced, realistic view of what might be needed. The way that PCP visitations have become shorter and shorter in a more overworked and hectic environment has done a great disservice to patients.
I think that's basically a fantasy. My experience with primary care physicians is that they barely remember who I am, and they frequently move on to other practices. It's not uncommon to see a new person each time.
On my latest attempt to make an appointment they said that I am no longer a patient because I didn't come in during COVID, and that I would have to wait to get back in.
I decided I'd just go without until something bad happens. So far so good.
I had an abnormal value. Doctors kept telling me to ignore it. Despite me having a lot of issues.
2 years of battling to get tests done. End up having 3 uncommon conditions. One of which was going to kill me without urgent treatment. Drastic quality of life improvement from proper treatment.
Spent years being told I was a hypochondriac for insisting something wasn’t right. That everything I was experiencing was just anxiety.
That lab really gouged you and your insurance provider. I use CPL and I don’t recall ever paying more than 200 for custom bloodwork, not going through insurance either. My insurance prefers LabCorp but their assays are questionable at best.
> any visit to a specialist + tests will immediately trigger thousands of dollars in bills, even if you're insured you're going be paying your deductible plus like 10-30% after that.
A half-lifetime of experiencing and observing modern medicine, in good faith, has taught me that participating in the medical system while not in need of emergency care is risking one's health and life.
Assuming that one doesn't engage in risky behavior, the smartest path is to avoid the medical system altogether. That doesn't mean "seek alternative medicine". It's just what I said.
The Medical system doesn't highlight its failures. It obscures them, and only speaks in bullshit PR terms. Its failures (premature suffering and death) are almost always attributed to causes other than the malpractice that caused them. Even families are hoodwinked.
Laugh at anyone quoting "evidence" without citing it for critique. The medical profession hasn't had broadly-intact scientific integrity for decades.
Much of medicine is charlatanism for billing. Doctors know this though most won't admit it. The consequences range from annoyance, to minor malfunction, to catastrophic.
Having kids has shown me how much of medicine is about incentive alignment, rather than doing no harm. Every time one of my kids gets an ear infection, pinkeye, or a sore throat, my daycare requires a doctor’s note and antibiotics to be given before they are allowed back in daycare. The urgent care doctors always prescribe antibiotics, even though the most likely cause is viral and most bacterial infections resolve within 3-5 days with or without antibiotics. I had one case where the strep test was negative, and the doctor still prescribed antibiotics because it could be a false negative. And my kids are allowed back in daycare after 0-24 hours depending on the diagnosis, even though the medicine takes 3-5 days to work.
I was shocked to go through this the first time, after reading so much about the over-prescription of antibiotics. But doctors would rather write a prescription than explain the evidence to stressed parents and daycare providers. And daycares all copy each others’ policies, because nobody wants to admit that kids are just contagious snot-monsters and medicine can’t really help.
It’s pure theatre, at the expense of kids’ health (antibiotics do a number on the digestive system) and leads to antibiotic-resistant strains. But at least nobody ever had to stop and have a difficult conversation.
That's crazy. I have small kids and the doctors never give antibiotics. They just say it's something viral and to give Tylenol / Ibuprofen to treat discomfort. The daycare doesn't have any rule like that either they just check for fevers and they have to stay out until no fever for 24 hours. When one was really sick with croup they gave him some steroids but that's it. We have even switched doctors 3x and always been the case.
From a friend who was involved in health care analytics decades ago, they'd frequently find that specific norms of healthcare practice depended highly on senior medical personal (e.g., a head physician within a department), and that you'd find major differences in standards both at different-but-comparable groups and at the same group following a major personnel change (retirement, moving elsewhere).
Another friend doing roving-doctor work at a number of smaller clinics and facilities described wildly different standards amongst physicians specifically regarding antibiotic prescriptions (my friend resisted prescribing them without specific indication, other doctors offered them as a default).
As with many other aspects of the world, what we observe directly is very much through a drinking straw (if you can find one of those any more): it's a very narrow view. This doesn't mean your experience is invalid or even infrequent. It does mean that it's likely not especially generalisable.
That said, what seems to change overall behaviours most is standards and norms being applied through policy, whether institutional (think Kaiser in California) or at the governmental level (government-offered services, etc.). Thought comes to mind that much of the US is now experiencing the negative aspects of that last, as with many tools, it can cut both ways.
Must be specific your region. Not my experience around Atlanta.
Around here common illness kids can come back after 24 hours of symptom free (daycares dont ask how they became symptom free). Super contagious like pinkeye requires doctors note that it's not pink eye, or put on a treatment plan.
> bacterial infections resolve within 3-5 days with or without antibiotics.
Citation needed
I do worry about overuse of antibiotics but I know a lot of times it just doesn't "go away without", or the viral infection ends up evolving to a bacterial one
Though what the doctors should do is give the prescription but say just to take it if the situation doesn't improve. This way you save a return to the doctor if it doesn't get better.
> The urgent care doctors always prescribe antibiotics, even though the most likely cause is viral
This is irresponsible, tackling AMR is a WHO priority and local guidance (e.g. NICE, I don't know about the states - is it ICER? the CDC?) should reflect this and steer away from "just in case" antibiotic prescriptions.
This is so skewed towards the US. Eg here in Europe people go to their GP much more often because those visits are free, and hard data says we live longer than in the the US. So the problem isn't "doctors" or "medicine", the problem is the US medical system.
Please. I've been through medical systems in several European countries, and the GP system is frustratingly bad. GPs will at best prescribe you some medication, but will otherwise act as entitled gatekeepers to the rest of the system. Unless you're bleeding on their table, they'll do their best to avoid sending you to a specialist. They'll engage in the same charlatanism that GP is talking about.
Healthcare in Europe is not free. You're taxed for it quite highly.
Calling this system "healthcare" is too generous. It only exists to keep people from complaining, and healthy enough so they can be productive enough to be taxed. There is no care.
The real hack is having friends and family in the medical field. You can skip the chicanery of medical “intake” and diagnosis outside highly specialized conditions, get advice without extortionate bills or misaligned incentivizes, and they can help you get appointments with specialists/tell you who’s the best to see, even write you rx’s directly.
I recently had an infection that, due to being geographically isolated from my typical medical network of friends and family, resulted in $1k of bills after insurance for something that was essentially routine and which I would have been able to treat myself if I had the ability to get medicine without an rx.
The general public who don’t have the scientific/medical literacy to self-serve and lack the network to get treatment without going through the formal process are getting fleeced.
The medical field will soon be over-ran by software and AI specialists applying and graduating from medical school in order to build the modern individualized medicine augmentation systems of the future. Think about the specialization required to build a reliable, trusted and tested GPT-for-medicine, and then give it to all citizens for free, because, hey, it's going to be a huge boon for our country.
> A half-lifetime of experiencing and observing modern medicine, in good faith, has taught me that participating in the medical system while not in need of emergency care is risking one's health and life.
This is rather hyperbolic. And furthermore, your clearly don't have chronic but non-emergency conditions which require regular care if you care to have a reasonable life (3 going on 4 for me).
So you advocate avoiding doctors and prescriptions unless you break a leg? Good luck when you get one of the many things modern medicine does treat pretty well.
Your criticism of it may have some truth to it, possibly particularly when applied to the US, but the conclusions you draw from them are foolish.
And you'll drop them like they're nothing when you get a bacterial infection your body can't deal with, the likelihood of which will increase in the second half of your life. Or maybe you won't, and die much earlier than necessary. We just had this discussion on a societal level.
I think this is a reasonable response to the terrible atrocity that is medical care (in the US*). The way forward is likely going to be the medical form of 'self-hosted': home medical devices for self diagnosis.
There will be many that flock to this comment to make claims about home devices and how they're 'inaccurate' or other nonsense, but the truth is that it is very possible and in many situations already the case that home devices are FDA approved, and often better accuracy than what you may receive in the clinic. Obviously, this is for a subset of diagnostic tests, and certainly nothing dealing with radiation potential, but the opportunity for expansion is certainly there and I think will continue to expand and fill this enormous hole the US has.
You obviously have no clue how this stuff actually works. Most major medical insurers already have programs to distribute connected smart devices for monitoring vital signs to patients that have been diagnosed with chronic diseases such as heart failure or type-2 diabetes. But those devices are largely useless for diagnosis. You can't really get a home HbA1c blood test.
Chronically ill person here, cannot help but agree. "The doctor committed neither malpractice nor acted abusive" is the best outcome you can get out of the average healthcare professional.
It's a profession where practitioners are treated like saints, while having zero incentive to actually do their job- there's no other field in which telling every client "it's all in your head" after running some meaninglessly basic and unlikely to be wrong diagnostics until they give up and go home keeps you employed and paid.
How many people have ever heard the term iatrogenic harm? Basically no one.
"Iatrogenesis refers to harm experienced by patients resulting from medical care"
Studies put iatrogenic harm at about 30%.
It is also estimated that the 14th leading cause of death in the world is iatrogenic harm
Yup. I cannot believe how much insurance providers bend over for actual fake bullshit like chiropractors, dentists or "naturopathic doctors" who use homeopathic remedies, and related quakery, but then try to screw people over on stuff that's actually scientifically more sound.
FWIW, I agree with you, although I experienced the medical system only as a patient / outsider. I live in a former communist country in Eastern Europe.
The real question is why the insurance companies are pushing the annual exams very hard, not just in consumer ads, but using lots of incentives for primary care physicians.
One would assume they would not want to pay for unnecessary tests for healthy people.
So either their own research shows they save money with annual checkups in spite of what the article says, or more sinisterly, they do want to spend money to be able to justify higher premiums, because in several states they are required to spend around 80% of the premiums, and this is one easily plannable way.
Does anyone know? Perhaps someone working for an insurance company?
I work at at a large health insurance company, though not involved in decision-making around annual exams or rate-setting so take that as you will.
A lot the decision-making we do is around trying to improve the health outcomes for large populations of members at scale. When dealing with millions of members, interventions that require lots of effort and time are hard to scale up. If the data shows members with annual checkups have better health outcomes on average than members without annual checkups, that is something that's relatively cheap and easy to do with potentially significant impact.
There are other benefits to annual checkups as well - catching an expensive condition early can be the difference between a $100,000 episode of care vs. a $10,000 episode of care.
To be honest internally I've noticed the tide is shifting on annual checkups. Physician time is limited and every slot is valuable. I believe we're currently exploring virtual care options as a better alternative.
> If the data shows members with annual checkups have better health outcomes on average than members without annual checkups, that is something that's relatively cheap and easy to do with potentially significant impact.
That or it's yet another example of selection bias. There have been so so many things like this where the epidemiological data shows a correlation with health, but there isn't actually a causal link. For example, annual checkups might correlate with better health because it's a more common behavior among people who can afford to do it, and wealthier people tend to be healthier.
Maybe I’m saying the most obvious thing ever, but with that last paragraph, you really make it sound like the American healthcare regimen is decided upon by the for-profit insurance companies.
> If the data shows members with annual checkups have better health outcomes on average than members without annual checkups, that is something that's relatively cheap and easy to do with potentially significant impact.
In the case of annual checkups, I believe insurance companies are required to cover them 100% by the Affordable Care Act:
I feel it's a kickback to the companies that provide care.
If I bring up any health issues I'd like to discuss at my annual exam, it's billed as a doctor visit because it's no longer "preventative" care. For the visit to be free, I have to stay silent. It also gives providers an opportunity to recommend and order expensive tests or procedures that the patient might otherwise not have pursued.
> If I bring up any health issues I'd like to discuss at my annual exam, it's billed as a doctor visit because it's no longer "preventative" care. For the visit to be free, I have to stay silent. It also gives providers an opportunity to recommend and order expensive tests or procedures that the patient might otherwise not have pursued.
They tried to bill me for that in the past at practices I was a patient of. There's a fine line between preventative care and E/M. You can generally walk the "preventative care" line by presenting your concerns as an observed change to be documented rather than a problem to be solved.
If they do charge you, call the office to appeal the billing and they generally drop it as long as you can push the point that you weren't seeking a specific treatment but rather were just informing the doctor of a change in your health or conditions since the last visit.
Wild speculation is a combination of one insurance company offering it and it becoming a relatively low cost competitive bullet point on one hand.
On the other hand, insurers probably have better actuarial data because of annual checkups and can better align their profit margins with fees. Thus reducing their own reinsurance fees.
Imagine you are an insurer and advise free annual checkups. Some of your patients don't bother. Those patients have a higher mortality. You conclude the annual checkup is good.
But you might be deceiving yourself - the kind of people to ignore health advice about getting an annual checkup might also be the kind of people to ignore the health advice on the back of a cigarette packet...
There was a case here in New Zealand where the "not for profit" insurance company "Southern Cross" was owned by a group of doctors.
You can see how something that might not be in the insurance company's best interest could be in owners best interest, particularly if they own the hospital too.
My work offers free annual check ups and it’s mostly DIY. Prick of a finger, punch in weight, height and blood pressure into web app. Eventually once the results on the blood return, you get feedback on cholesterol etc. I get $500 from it and it is psychological to an extent - it helps encourage healthier habits
That's simply not how the medical insurance business works. Since the Affordable Care Act, insurers have almost no ability to pick and choose their customers. And since profit margins are capped there is like little incentive to "save" money by reducing medical expenses.
Under the ACA, insurance companies have a profit cap as a percentage of expenditures, so they need to drive expenses to increase total profit (but still have to be competitive price-wise so it isn't unlimited).
Around here the insurance companies created a billing code that is just for annual checkups, with discussion of ongoing care turning it into a different type of visit (that isn't necessarily free).
They only looked at death, and only two causes of death - cardiovascular and cancer over 10 years. That makes for a pretty stupid study if you ask me..
There are tons of other problems that won't cause death but nonetheless will bother you or subtly impact QOL without you even knowing. Thyroid issues are one. It won't save your life but it will make it a lot more enjoyable and maybe make you more productive too. There are other causes of death too.. so the conclusions they are trying to draw seem completely invalid to me. The study showed equal mortality from 2 sources, it did not show that checkups are pointless..
A lot of the complaints about unnecessary follow-up etc. are down to cost not inconvenience. In most cases, the only follow up is a blood test which is quick and easy. Even a ultrasound/CT is like 1hr. It only becomes a problem when you have to pay $1000s for it.
Apropos to a submission about Vitamin D that was a couple of links above this article is the fact that it ignores quality of life.
Sometimes it seems that medical researchers don't actually care about health, they only care about numbers, because numbers are easy.
During an annual checkup a couple of years back I mentioned that I had "been feeling down and sluggish quite a bit lately" and my doctor said "hmmm, might be vitamin d, we'll see with your bloodwork".
Wonder of wonders my vitamin d was low, I started supplementing it, and once my levels got back to normal I unquestionably, irrefutably, CAUSATIONALLY, felt better. My quality of life improved.
I didn't know Vitamin D was tied to energy and mental health issues. Sure there are at-home tests now, but there weren't any back then and I wouldn't have known to take one anyways.
How many people are living shitty lives because of something simple that could be caught during an annual blood test?
Researchers: "We don't care, those numbers are hard to get. Deaths are easy to count."
> People walked out of their appointments having been told they had a condition they might not have known about before. But those additional diagnoses didn’t seem to save lives. Knowing about a particular condition didn’t, in these studies, correlate with better health outcomes.
Duh...
I am guessing a lot of these diagnoses require lifestyle changes (instead of med) that the patients wont do, e.g. pre-diabetes, high cholesterol, obesity etc
But it would be wrong to say that these visits are a waste.
> Annual physical exams can “do more harm than good”
Key word being "can", one can say this for literally for anything. They chose one bizarre case that led to expensive follow-ups and a bleeding during the procedure. Most annuals likely dont lead to any follow-ups at all. Let alone follow-ups for a possible aortic aneurysm.
> “I'm not sure you need an annual visit to the physician. You're very unlikely to have any serious diseases that haven't shown symptoms.”
A disease does not have to be life threatening to show symptoms and even life threatening diseases (e.g. certain cancers in women) can have no symptoms until you are beyond the point of no return.
Sometime a person has "symptoms" that they think is a part of life and would never go to the doctor for if not for an annual physical. e.g. I personally know people who have had serious vitamin deficiencies found out through annual tests which they got after many years. Their "symptoms" were lack of energy, focus, hair loss, mood swings, sadness etc. Something most people probably wont go to the doctor for. A few months on high potency supplements and their quality of life changed considerably. Would this be classified as a "serious disease"?
Uh, no. Hypertension is a silent killer. Mole checks? Colonoscopies? Testicular cancer screenings? These are all worthless? Preventative medicine has a long way to go, but it's currently the best it's ever been. Thank God I don't see any of these doctors.
According to the study cited, they concede that annual checkups result in more diagnosis, but not in a decrease in morbidity. What you consider worthwhile, or worthless, is up to you I guess.
So to take this to an extreme, if the cohort that got checkups lived a healthy life until age 80, and the no-checkup cohort lived with diabetes and dialysis until 80, this study would say “checkups lead to no decrease in morbidity.”
More relevant for the insurer (which might help explain why an insurer is urging checkups) living until 80 with diabetes and on dialysis is much more expensive than living healthily until 80.
Isn't that a tautology? Of course knowing you have a disease doesn't prevent you from having the disease.
The point is that knowing you have a disease allows you to treat the disease, which one would hope would reduce your chances of dying or becoming disabled.
Generally, yes; for example, routine colonoscopies are not practiced in many developed countries, and it doesn't necessarily translate into any difference in overall health outcomes. One recent study is described here: https://www.cnn.com/2022/10/09/health/colonoscopy-cancer-dea... . One explanation is that such cancers are slow-growing and tend to be discovered late in life, so treating them doesn't actually help much, and any benefits are offset by potential harms of the procedure itself, the risk of false positives, etc.
There is value in targeted screening and education, but annual checkups for otherwise healthy people aren't necessarily the way to do it. Not to mention, many of these checkups are perfunctory.
A lot of the gains in life expectancy have little to do with advanced diagnostics and treatments. Sanitation, hygiene, antibiotics, and increased standards of living do a lot of the heavy lifting here. And when the needle moves in the other direction, the causes tend to be mundane too - e.g., opioid abuse in the US.
> Generally, yes; for example, routine colonoscopies are not practiced in many developed countries, and it doesn't necessarily translate into any difference in overall health outcomes. One recent study is described here:
This overstates the impact of the Nordic study. If you go to the original article[0] you can see why, this study had very low participation and event rates which limits how strong of a conclusion we can draw from this as treatment effects may not be accurately reflected (for example in some countries the colonoscopy arm only had 32% participation). We also have historical studies looking at gFOBT and flexible sigmoidoscopy showing mortality benefits which can be extrapolated to colonoscopies. For a full picture of the evidence behind colon cancer screening I would suggest referring to the USPSTF which provides a publicly accessible summary and rationale[1].
With respect to developing countries, colorectal cancer (and living long enough to suffer its sequela) is mostly a developed country problem although this is changing.
In recent years, we have been seeing a surprising rise in colorectal cancer rates occurring at younger ages presenting with advanced disease which has led to the USPTF lowering the recommendation for screening to 45 from 50. With this trend in mind and historical data, we would really need extremely strong evidence to make the claim that screening colonoscopies are ineffective which the Nordic study does not provide.
> Similarly, while hypertension is a problem, there is scant evidence that routine treatment of it is beneficial.
This is just boldly incorrect and a VERY dangerous statement to make. The article you link to is entirely irrelevant as it looks at acute hypertension which is a very different beast, this article is describing what we call permissive hypertension in medicine. We have known for several years now that we do not need to tightly control inpatient blood pressures (which are often temporarily increased due to stress/illness) and that doing so is harmful. This says nothing about the consequences of untreated chronic hypertension in the outpatient setting.
For treatment (beyond the scope of USPSTF which does provide a grade A recommendation for hypertension screening) we can turn to the ACC[2] which also helpfully provides an evidence synthesis specifically drawing your attention to:
"In a meta-analysis of 61 prospective studies, the risk of CVD increased in a log-linear fashion from SBP levels <115 mm Hg to >180 mm Hg and from DBP levels <75 mm Hg to >105 mm Hg. In that analysis, 20 mm Hg higher SBP and 10 mm Hg higher DBP were each associated with a doubling in the risk of death from stroke, heart disease, or other vascular disease."
These are different and called “preventative screening” and usually not done at a physical. Your GP isn’t going to do a colonoscopy or do a skin check. The article is taking issue with the standard physical, which for heathy people is mostly a few questions to ask if you feel alright and some routine blood tests.
Let's not kid ourselves: Americans are terrible about looking out for their health. If an annual physical is what it takes for PCPs to effectively route people to the necessary screenings, so be it. That saves lives.
But if they're not done at the physical, the physical is where the doctor asks whether you've been screen/checked for things and when, and then schedules them.
If I didn't go in for an annual physical, I'd never get tested or screened for a single thing. I'd never have blood work done. Because when else do I go to a doctor? How else would I know?
That's what baffles me here. Your annual physical is the launching point for everything preventative. It's the only time you ever see your doctor if you're otherwise healthy. Saying no to annual physicals means saying no to literally all screening, or am I missing something?
The standard physical is where your GP teaches you about those things and has you schedule them as needed based on your age and the things they notice during the annual physical.
No joke, getting a colonoscopy was the best decision I've made all year. I'm incredibly grateful that my doctor twisted my arm into getting one even though I'm under 40 and wasn't thrilled about the whole prep situation.
(It was IBD, not cancer, but regardless. One of those things you'd rather catch before it lands you in the hospital.)
I think there are valid questions about the medical efficacy of annual checkups that are heavily weighted by individual patient characteristics such as existing conditions, age, weight, etc.
Seperate from medical efficacy there are a lot of reasons why insurers want you to have an annual visit with a medical provider which has to do with:
1) Assignment of you to a provider. Many, many people are autoassigned a primary care provider by their insurance, they often change this when they actually schedule a visit. Allocation of patients to providers is a very large aspect of manging health plans.
2) Data aggregation and validation of your information. People sign up with unbelievably garbage information and it tends to persist, even on employer provided plans.
3) Baseline medical status such as weight and vitals. Insurers aren't looking at this information directly but it comes through via billing codes for the exact types of exceptional cases insurers want to measure.
These have a huge impact on the actuarial aspects of developing and managing health plans.
PS: Depending on the patient pool, for lots of pools insurers no longer put much economic weight into prevention as it has played out that insurers end up paying for the prevention but patients change insurers so often that they change before the insurer benefits from the effects of the prevention. Incentives are a very messy thing in healthcare between patients, providers and insurers.
I'll agree with this... I had one dumb/obstinate nurse who mis-measured my height 4 inches below my real height... claimed it was that I'd gotten shorter... 2h previous a seperate facility measured me at the real height.
that height is showing up again on my charts. Last 2 visits they measured my height and said, huh chart is wrong, I told story, they were like "we'll fix it". Still not fixed.
She also wanted to put me down in the system as a smoker as I had been in smoking resturants.
At one point someone mis-entered my height as about 4 feet. This obviously caused my BMI to trigger all sorts of alarms! That impact is probably why it got fixed pretty quickly.
Having lived in three countries with universal health care, annual checkups is a bit foreign concept. I mean you could ask to get tests whenever you want to, but it is not something doctors will recommend. Most people go to the doctor when they experience symptoms.
I don't know how to compare these systems, but I guess if we look at life expectancy, similar European countries are doing pretty well.
I think life expectancy is distorted by Americans being fat, driving more, and drug deaths. Probably violence factors in too, but I'm not sure if that's big enough to meaningfully change things.
The US health care system fails on many metrics. Life expectancy might be distorted, but all these other metrics paint a pretty clear story of the failure of the US health care system to provide health care to the general population.
Readit News
I got a random lab bill for like $650 (discounted from $2500) and in the follow up visit everyone agreed that was high but no could explain why it was that expensive - medicare's fee schedule has the same code costing $90. Until we stop this madness of providers basically charging whatever opaque negotiated random amount they want to insurers who then pass that down to charge payers after collecting a % the prices are just going to continue to go up and the broken medical system will stay fucked - with the consequence that the economics aren't going to make sense to seek proactive care.
The article kind of hints at this, but it comes down to Bayes theorem [1]. The general population has a relatively low incidence of disease, so even tests that are fairly reliable in a population with a high incidence of disease become super inaccurate when applied to the general population.
Worse, false positives generally - especially in the US, due to high financial liability risk - end up involving expensive, invasive medical follow-up tests, and the probability of a false positive multiplied by the risk of the exploratory procedures outweighs a later diagnosis.
No wonder annual physicals don't do much good.
High-risk people should get periodic tests for the things they're at risk of, and people should be in a position to report issues they discover in the course of their lives. However testing otherwise-healthy people for things they probably don't have isn't likely to yield good results no matter how good the test. It's just math.
[1] https://en.wikipedia.org/wiki/Bayes%27_theorem
The blood test comparison of healthy me to sick me was invaluable, because the healthy tests established a baseline of my system at peak condition.
How do you know if you’re at high risk for something? This assumes a medically literate and motivated person will seek care based on … what? Realizing that grandpa, great-grandpa and dad all didn’t live past their 60’s? High cholesterol and hypertension can be “silent killers” - how do you know to check for them?
https://en.wikipedia.org/wiki/Base_rate_fallacy
What does this mean? Which issues? How many thousands of diseases are there?
I have a friend who has low level of energy, everyone was calling him lazy his entire life. He thought thats just how life is. He cannot compare how it feel to be him with how it feel to be someone else.
I convinced him to see a doctor about this at the age of 25. First doctor didnt take him seriously, didnt want to do any tests. The complains are very non-spesific. maybe you are lazy, maybe you are depressed.
After weeks of fighting the medical system he discovered that he had a digestive issue, which led to low level of iron and low level of enegy. His entire life he was suffering from an easily treatable problem.
Imagine he treated this at the age of 12, how many sports did he miss out on, how much academic achievement was missed, maybe his career and life trajectory would be different.
A friend of mine struggled with back pain for 3 years. He coupst find the cause. It got so bad, he thought he'd become disabled. He left UK and went back to Romania to have support of his family. Suffenly in Romania he started getting better. Turned out it was vitamin D defficiency.
I started taking Vitamin D agressively, 2,000 units daily, 5 times the recommended amount by the NHS. After taking it for 6 months I went private and did a first vitamin D test in my life - my level is 1/3 of normal.
So how doea one know what is normal, if most people gp their entire life without ever doing a full blood test
Proactive care is good. Testing is good.
However the insurance / healthcare cartel behaviour that's fuelled as a result is devastatingly expensive.
For example a low price test with almost zero both false positive and negative rate whose associate treatment has low cost and risk and that can save life of patients seems to me a test that should be applied to anyone at risk.
The way to make a checkup cost less is to pay doctors and nurses less. There are no pharmaceuticals, no surgeries, no complicated specialist medical equipment, and no expensive labwork involved in the price.
Society generally doesn't agree with the notion that doctors and nurses should be paid less. Therefore, checkups are more or less priced appropriately. Paying high skilled labor for their advice simply costs a lot of money. Ask any dev contractor here on HN.
Your attitude is actively harmful, real people suffer with uncaught diseases because we don’t routinely test “”healthy”” people.
People would be upset if the gas stations charged different prices after they review your auto insurance policy. With healthcare, they look at our policy and make up price numbers.
Maybe this violates anti-trust laws. The State attorney generals don't seem interested in pursuing such discriminatory pricing.
https://legal.thomsonreuters.com/blog/robinson-patman-act-an...
How? You were given a result that was concerning, and rightly wanted it investigated. You needed the test and the test cost money. How do you opt out?
I live in a country with a better (though still troubled) system. I can’t see how you fix the US system, even in hand waving terms.
* you can't get paid by insurance unless you have payment authorization from the patient on an estimate that is within 30% of the actual price (exceptions for emergency care).
* a requirement that all provider participate in an digital marketplace where patents and providers can get immediate quotes for labs/procedures and you get a list of local options+prices.
* anti-trust break up of healthcare cartels
* some price cap like 200% of medicare negotiated rates as a backstop for these really crazy outlier bills.
remove the insurance ability to negotiate prices.
Ensure American's right to Healthcare.
(Yet another, I live in the US, therefore everyone else does moment)
This is one of the things that surprised me the most in the US. Doctors seem afraid to draw any reasonable conclusion and are more like salesmen. I'm sure the fact that you can sue for pretty much everything plays a role in them not being more confident.
I hope that testing gets cheaper and more data gets public so we can eventually have AI doing the medical scoring and with it routing/prioritizing patients.
Ultimately, even the nerd doctors will send you to a specialist if you need it.
I like my current doctor a lot. He runs his own independent practice and is just generally really cool.
Health care groups tend to refer you to onsite services and/or specific companies they have relationships with.
It is a pain though because you have to call around to get prices.
Generally, the places with the lowest cash prices will also be the places that are least expensive after you've reached your deductible, but it's good to confirm with your insurance.
Medicare's fee schedule is almost always lower than what you can get, even with all cash, because the US government can set the rates they pay to some degree. It's up to doctor's/medical groups if they'll accept that or just stop taking Medicare completely.
On my latest attempt to make an appointment they said that I am no longer a patient because I didn't come in during COVID, and that I would have to wait to get back in.
I decided I'd just go without until something bad happens. So far so good.
2 years of battling to get tests done. End up having 3 uncommon conditions. One of which was going to kill me without urgent treatment. Drastic quality of life improvement from proper treatment.
Spent years being told I was a hypochondriac for insisting something wasn’t right. That everything I was experiencing was just anxiety.
For all their problems, Cuba achieves excellent health outcomes. Some of that may be because of the extensive primary and preventive care.
(In the US)
I bet then you would be the apostle of periodic checks.
Here is a list of prices: https://dhhr.wv.gov/bms/FEES/Documents/Clinical%20Diagnostic...
Testosterone is $46.
Toxoplasmosis is a shockingly common and easily-curable brain disease: $12.
Imagine, an entire population held hostage to this racket.
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Assuming that one doesn't engage in risky behavior, the smartest path is to avoid the medical system altogether. That doesn't mean "seek alternative medicine". It's just what I said.
The Medical system doesn't highlight its failures. It obscures them, and only speaks in bullshit PR terms. Its failures (premature suffering and death) are almost always attributed to causes other than the malpractice that caused them. Even families are hoodwinked.
Laugh at anyone quoting "evidence" without citing it for critique. The medical profession hasn't had broadly-intact scientific integrity for decades.
Much of medicine is charlatanism for billing. Doctors know this though most won't admit it. The consequences range from annoyance, to minor malfunction, to catastrophic.
I was shocked to go through this the first time, after reading so much about the over-prescription of antibiotics. But doctors would rather write a prescription than explain the evidence to stressed parents and daycare providers. And daycares all copy each others’ policies, because nobody wants to admit that kids are just contagious snot-monsters and medicine can’t really help.
It’s pure theatre, at the expense of kids’ health (antibiotics do a number on the digestive system) and leads to antibiotic-resistant strains. But at least nobody ever had to stop and have a difficult conversation.
From a friend who was involved in health care analytics decades ago, they'd frequently find that specific norms of healthcare practice depended highly on senior medical personal (e.g., a head physician within a department), and that you'd find major differences in standards both at different-but-comparable groups and at the same group following a major personnel change (retirement, moving elsewhere).
Another friend doing roving-doctor work at a number of smaller clinics and facilities described wildly different standards amongst physicians specifically regarding antibiotic prescriptions (my friend resisted prescribing them without specific indication, other doctors offered them as a default).
As with many other aspects of the world, what we observe directly is very much through a drinking straw (if you can find one of those any more): it's a very narrow view. This doesn't mean your experience is invalid or even infrequent. It does mean that it's likely not especially generalisable.
That said, what seems to change overall behaviours most is standards and norms being applied through policy, whether institutional (think Kaiser in California) or at the governmental level (government-offered services, etc.). Thought comes to mind that much of the US is now experiencing the negative aspects of that last, as with many tools, it can cut both ways.
Around here common illness kids can come back after 24 hours of symptom free (daycares dont ask how they became symptom free). Super contagious like pinkeye requires doctors note that it's not pink eye, or put on a treatment plan.
Citation needed
I do worry about overuse of antibiotics but I know a lot of times it just doesn't "go away without", or the viral infection ends up evolving to a bacterial one
Though what the doctors should do is give the prescription but say just to take it if the situation doesn't improve. This way you save a return to the doctor if it doesn't get better.
This is irresponsible, tackling AMR is a WHO priority and local guidance (e.g. NICE, I don't know about the states - is it ICER? the CDC?) should reflect this and steer away from "just in case" antibiotic prescriptions.
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Healthcare in Europe is not free. You're taxed for it quite highly.
Calling this system "healthcare" is too generous. It only exists to keep people from complaining, and healthy enough so they can be productive enough to be taxed. There is no care.
I recently had an infection that, due to being geographically isolated from my typical medical network of friends and family, resulted in $1k of bills after insurance for something that was essentially routine and which I would have been able to treat myself if I had the ability to get medicine without an rx.
The general public who don’t have the scientific/medical literacy to self-serve and lack the network to get treatment without going through the formal process are getting fleeced.
This is rather hyperbolic. And furthermore, your clearly don't have chronic but non-emergency conditions which require regular care if you care to have a reasonable life (3 going on 4 for me).
Your criticism of it may have some truth to it, possibly particularly when applied to the US, but the conclusions you draw from them are foolish.
And you'll drop them like they're nothing when you get a bacterial infection your body can't deal with, the likelihood of which will increase in the second half of your life. Or maybe you won't, and die much earlier than necessary. We just had this discussion on a societal level.
There will be many that flock to this comment to make claims about home devices and how they're 'inaccurate' or other nonsense, but the truth is that it is very possible and in many situations already the case that home devices are FDA approved, and often better accuracy than what you may receive in the clinic. Obviously, this is for a subset of diagnostic tests, and certainly nothing dealing with radiation potential, but the opportunity for expansion is certainly there and I think will continue to expand and fill this enormous hole the US has.
It's a profession where practitioners are treated like saints, while having zero incentive to actually do their job- there's no other field in which telling every client "it's all in your head" after running some meaninglessly basic and unlikely to be wrong diagnostics until they give up and go home keeps you employed and paid.
Studies put iatrogenic harm at about 30%.
It is also estimated that the 14th leading cause of death in the world is iatrogenic harm
Insurance however is selling to the customer and the government, it's easy to cover the fake bullshit.
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FWIW, I agree with you, although I experienced the medical system only as a patient / outsider. I live in a former communist country in Eastern Europe.
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One would assume they would not want to pay for unnecessary tests for healthy people.
So either their own research shows they save money with annual checkups in spite of what the article says, or more sinisterly, they do want to spend money to be able to justify higher premiums, because in several states they are required to spend around 80% of the premiums, and this is one easily plannable way.
Does anyone know? Perhaps someone working for an insurance company?
A lot the decision-making we do is around trying to improve the health outcomes for large populations of members at scale. When dealing with millions of members, interventions that require lots of effort and time are hard to scale up. If the data shows members with annual checkups have better health outcomes on average than members without annual checkups, that is something that's relatively cheap and easy to do with potentially significant impact.
There are other benefits to annual checkups as well - catching an expensive condition early can be the difference between a $100,000 episode of care vs. a $10,000 episode of care.
To be honest internally I've noticed the tide is shifting on annual checkups. Physician time is limited and every slot is valuable. I believe we're currently exploring virtual care options as a better alternative.
That or it's yet another example of selection bias. There have been so so many things like this where the epidemiological data shows a correlation with health, but there isn't actually a causal link. For example, annual checkups might correlate with better health because it's a more common behavior among people who can afford to do it, and wealthier people tend to be healthier.
s/better/cheaper/
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In the case of annual checkups, I believe insurance companies are required to cover them 100% by the Affordable Care Act:
https://www.hhs.gov/healthcare/about-the-aca/preventive-care...
If I bring up any health issues I'd like to discuss at my annual exam, it's billed as a doctor visit because it's no longer "preventative" care. For the visit to be free, I have to stay silent. It also gives providers an opportunity to recommend and order expensive tests or procedures that the patient might otherwise not have pursued.
They tried to bill me for that in the past at practices I was a patient of. There's a fine line between preventative care and E/M. You can generally walk the "preventative care" line by presenting your concerns as an observed change to be documented rather than a problem to be solved.
If they do charge you, call the office to appeal the billing and they generally drop it as long as you can push the point that you weren't seeking a specific treatment but rather were just informing the doctor of a change in your health or conditions since the last visit.
https://www.nytimes.com/2022/10/08/upshot/medicare-advantage...
On the other hand, insurers probably have better actuarial data because of annual checkups and can better align their profit margins with fees. Thus reducing their own reinsurance fees.
Imagine you are an insurer and advise free annual checkups. Some of your patients don't bother. Those patients have a higher mortality. You conclude the annual checkup is good.
But you might be deceiving yourself - the kind of people to ignore health advice about getting an annual checkup might also be the kind of people to ignore the health advice on the back of a cigarette packet...
If even 10% of those who get an annual checkup succeed in losing weight when the doctor recommends they do so, it's a win.
You can see how something that might not be in the insurance company's best interest could be in owners best interest, particularly if they own the hospital too.
Sure, they could prefer healthy customers, or they could select for lower risk populations. The latter is easier.
So instruction following and hoop jumping are the sorts of test that won't improve health incomes, but will select for good customers.
how are insurance companies (in the US) supposed to achieve this, when it is generally acquired through an employer?
There are tons of other problems that won't cause death but nonetheless will bother you or subtly impact QOL without you even knowing. Thyroid issues are one. It won't save your life but it will make it a lot more enjoyable and maybe make you more productive too. There are other causes of death too.. so the conclusions they are trying to draw seem completely invalid to me. The study showed equal mortality from 2 sources, it did not show that checkups are pointless..
A lot of the complaints about unnecessary follow-up etc. are down to cost not inconvenience. In most cases, the only follow up is a blood test which is quick and easy. Even a ultrasound/CT is like 1hr. It only becomes a problem when you have to pay $1000s for it.
Whole article is just a gross misrepresentation.
Sometimes it seems that medical researchers don't actually care about health, they only care about numbers, because numbers are easy.
During an annual checkup a couple of years back I mentioned that I had "been feeling down and sluggish quite a bit lately" and my doctor said "hmmm, might be vitamin d, we'll see with your bloodwork".
Wonder of wonders my vitamin d was low, I started supplementing it, and once my levels got back to normal I unquestionably, irrefutably, CAUSATIONALLY, felt better. My quality of life improved.
I didn't know Vitamin D was tied to energy and mental health issues. Sure there are at-home tests now, but there weren't any back then and I wouldn't have known to take one anyways.
How many people are living shitty lives because of something simple that could be caught during an annual blood test?
Researchers: "We don't care, those numbers are hard to get. Deaths are easy to count."
Duh... I am guessing a lot of these diagnoses require lifestyle changes (instead of med) that the patients wont do, e.g. pre-diabetes, high cholesterol, obesity etc
But it would be wrong to say that these visits are a waste.
> Annual physical exams can “do more harm than good”
Key word being "can", one can say this for literally for anything. They chose one bizarre case that led to expensive follow-ups and a bleeding during the procedure. Most annuals likely dont lead to any follow-ups at all. Let alone follow-ups for a possible aortic aneurysm.
> “I'm not sure you need an annual visit to the physician. You're very unlikely to have any serious diseases that haven't shown symptoms.”
A disease does not have to be life threatening to show symptoms and even life threatening diseases (e.g. certain cancers in women) can have no symptoms until you are beyond the point of no return.
Sometime a person has "symptoms" that they think is a part of life and would never go to the doctor for if not for an annual physical. e.g. I personally know people who have had serious vitamin deficiencies found out through annual tests which they got after many years. Their "symptoms" were lack of energy, focus, hair loss, mood swings, sadness etc. Something most people probably wont go to the doctor for. A few months on high potency supplements and their quality of life changed considerably. Would this be classified as a "serious disease"?
More relevant for the insurer (which might help explain why an insurer is urging checkups) living until 80 with diabetes and on dialysis is much more expensive than living healthily until 80.
The point is that knowing you have a disease allows you to treat the disease, which one would hope would reduce your chances of dying or becoming disabled.
Similarly, while hypertension is a problem, there is scant evidence that routine treatment of it is beneficial. The drugs have health risks: https://jamanetwork.com/journals/jamainternalmedicine/fullar...
There is value in targeted screening and education, but annual checkups for otherwise healthy people aren't necessarily the way to do it. Not to mention, many of these checkups are perfunctory.
A lot of the gains in life expectancy have little to do with advanced diagnostics and treatments. Sanitation, hygiene, antibiotics, and increased standards of living do a lot of the heavy lifting here. And when the needle moves in the other direction, the causes tend to be mundane too - e.g., opioid abuse in the US.
This overstates the impact of the Nordic study. If you go to the original article[0] you can see why, this study had very low participation and event rates which limits how strong of a conclusion we can draw from this as treatment effects may not be accurately reflected (for example in some countries the colonoscopy arm only had 32% participation). We also have historical studies looking at gFOBT and flexible sigmoidoscopy showing mortality benefits which can be extrapolated to colonoscopies. For a full picture of the evidence behind colon cancer screening I would suggest referring to the USPSTF which provides a publicly accessible summary and rationale[1].
With respect to developing countries, colorectal cancer (and living long enough to suffer its sequela) is mostly a developed country problem although this is changing.
In recent years, we have been seeing a surprising rise in colorectal cancer rates occurring at younger ages presenting with advanced disease which has led to the USPTF lowering the recommendation for screening to 45 from 50. With this trend in mind and historical data, we would really need extremely strong evidence to make the claim that screening colonoscopies are ineffective which the Nordic study does not provide.
> Similarly, while hypertension is a problem, there is scant evidence that routine treatment of it is beneficial.
This is just boldly incorrect and a VERY dangerous statement to make. The article you link to is entirely irrelevant as it looks at acute hypertension which is a very different beast, this article is describing what we call permissive hypertension in medicine. We have known for several years now that we do not need to tightly control inpatient blood pressures (which are often temporarily increased due to stress/illness) and that doing so is harmful. This says nothing about the consequences of untreated chronic hypertension in the outpatient setting.
For treatment (beyond the scope of USPSTF which does provide a grade A recommendation for hypertension screening) we can turn to the ACC[2] which also helpfully provides an evidence synthesis specifically drawing your attention to:
"In a meta-analysis of 61 prospective studies, the risk of CVD increased in a log-linear fashion from SBP levels <115 mm Hg to >180 mm Hg and from DBP levels <75 mm Hg to >105 mm Hg. In that analysis, 20 mm Hg higher SBP and 10 mm Hg higher DBP were each associated with a doubling in the risk of death from stroke, heart disease, or other vascular disease."
[0] https://www.nejm.org/doi/full/10.1056/NEJMoa2208375
[1] https://www.uspreventiveservicestaskforce.org/uspstf/documen...
[2] https://www.ahajournals.org/doi/full/10.1161/HYP.00000000000...
If I didn't go in for an annual physical, I'd never get tested or screened for a single thing. I'd never have blood work done. Because when else do I go to a doctor? How else would I know?
That's what baffles me here. Your annual physical is the launching point for everything preventative. It's the only time you ever see your doctor if you're otherwise healthy. Saying no to annual physicals means saying no to literally all screening, or am I missing something?
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(It was IBD, not cancer, but regardless. One of those things you'd rather catch before it lands you in the hospital.)
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If you're otherwise healthy you're not visiting the doctor at all. So where are these checking and screenings happening for adults?
Seperate from medical efficacy there are a lot of reasons why insurers want you to have an annual visit with a medical provider which has to do with:
1) Assignment of you to a provider. Many, many people are autoassigned a primary care provider by their insurance, they often change this when they actually schedule a visit. Allocation of patients to providers is a very large aspect of manging health plans.
2) Data aggregation and validation of your information. People sign up with unbelievably garbage information and it tends to persist, even on employer provided plans.
3) Baseline medical status such as weight and vitals. Insurers aren't looking at this information directly but it comes through via billing codes for the exact types of exceptional cases insurers want to measure.
These have a huge impact on the actuarial aspects of developing and managing health plans.
PS: Depending on the patient pool, for lots of pools insurers no longer put much economic weight into prevention as it has played out that insurers end up paying for the prevention but patients change insurers so often that they change before the insurer benefits from the effects of the prevention. Incentives are a very messy thing in healthcare between patients, providers and insurers.
that height is showing up again on my charts. Last 2 visits they measured my height and said, huh chart is wrong, I told story, they were like "we'll fix it". Still not fixed.
She also wanted to put me down in the system as a smoker as I had been in smoking resturants.
I don't know how to compare these systems, but I guess if we look at life expectancy, similar European countries are doing pretty well.
https://news.ycombinator.com/item?id=35516775
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