The other side of removing transportation as a barrier to care is have the doctors come to you. We've started using Heal (http://heal.com) recently when the whole family was sick with the flu and it was great. Doctor and assistant come to your home within a 2 hour window. Cost is same copay you incur at a doctor's office. We used it several times and doctors were great. Seems like a no-brainer to not force sick folk to travel and spread germs. Only downside really was that you don't usually see the same doctor twice although I believe you can request by name.
That sounds like a good plan if you have good insurance, but it doesn't sound like a sustainable way to improve health care service to a wider population. Doctors are a scarce resource, and having the doctor drive around to each patient's house is not a very good use of their time.
At my Doctor's office, the doctors are scheduled for 15 minute appointments. at an optimistic assumption of 15 minutes travel time to and from each appointment, a model where the doctor visits each patient requires 3x as many doctors for the same level of care.
> So the number and composition of residencies is controlled by doctors, even as they’re subsidized by $13 billion in taxpayer money every year. And doctor pay, which almost everywhere is based on Medicare rates, is controlled by doctors. It’s doctors who are directly responsible for both their own high pay and their own low numbers.
> The U.S. spends $13 billion a year subsidizing graduate medical education. Yet almost all of this money winds up producing the wrong kinds of doctors in the wrong places, with America’s most elite teaching hospitals being the worst offenders.
I only don't see how it's a shortcoming of capitalism. I'd say it's the lack of capitalism, with its free market competition. Artificially limited supply is usually a result some state-enforced regulation.
We have this large scale in France, as “sos medecin”.
The key points are the “I need help” focus right in the name, and a triage process done by phone.
They’ll deal with sny unforseen event that needs medical attention. It can be a severe pain in the back in the middle of the night or high fever for a kid, anything that is not a regular check-up or renewing a prescription.
Then there’s pre-filtering of the calls to decide if it’s worth it to send someone, or if the patient better come to the office, or straight up call official emergency services.
Price is higher than an usual consultation but not that much, and interestingly it’s also higher than ER in a public hospital, so you have incentives to choose the right service for you.
We end up using it a lot because usually we detect our kid is sick after picking up from school or during week-ends, when normal offices are already closed and there’s no hope to get an appointment.
> That sounds like a good plan if you have good insurance, but it doesn't sound like a sustainable way to improve health care service to a wider population
A home visit of a physician is hardly a new concept.
If I'm not mistaken, it's a norm in France, and I know that it functioned that way in the USSR (not sure about the modern Russia). The doctors were indeed complaining about the number of visits but somehow it functioned: while booking a specialist or finding quality equipment was an issue, there was rarely an issue to book a visit of a family doctor within a couple of days' notice, at least in a big city.
Highly dependent on the hospital and provider you have. Modern Russian does have a general government health care for most things, but you can also get private insurance. For the general care, you usually end up going to a local community clinic. For paid insurance, typically you can get a home visit within a few hours from a doctor who does the basics and writes you a doctors note for sick leave. (My experience has been that the sick leave is pretty generous; last time I had the flu I was given a week's rest, then for my follow up the doctor told me to take another 3 days)
It's not perfect for other things, but compared to the health care situation I had when still living in the US, this facet is far better. (at my last job in the US, both Insurance and my Work Place refused to approve sick leave for a summary from my in-network GP that suggested that a treatment required several days of recovery after some radiation therapy. They said I'd have to go to another clinic to have the situation reviewed; the second clinic decided I was fit to work so my choices were either burn vacation days or sign a form to accept time off without pay during recovery.)
> At my Doctor's office, the doctors are scheduled for 15 minute appointments. at an optimistic assumption of 15 minutes travel time to and from each appointment, a model where the doctor visits each patient requires 3x as many doctors for the same level of care.
It's not "either/or", there is no reason not to have both systems running in parallel. I would have no issue paying a doctor more for him to come visit us at home, to ensure it makes it as profitable for them to do that.
Yes, but only some things. My brother and best man are doctors, and we have a home doctor service and a GP. The first two provide ample support for most instances.
Cost could be minimized if the particular doctor does not have to pay for a facility. I can't even begin to imagine what the cost per sq/ft of a generic doctor's office is, given all the regulation and equipment requirements. Having them mobile may remove a significant cost (though probably won't come close to the added opportunity-cost you mentioned).
My point wasn't just about cost, but rather care. People need doctors, and "there isn't enough doctors" seems to be a common problem in health care. The cost could also be mitigated by simply charging more, but having doctors spend their time driving instead of treating patients means that the number of doctors needed for the same quality of care goes way up, and in many cases doctors are not a resource that you can simply get more of because you need more.
For every doctor's appointment serviced by Heal, ~3 appointments are taken away from a community clinic somewhere.
You’re actually right about this. My primary care doctor tried one of these “visit people instead” services and absolutely hated it. Her days are usually 100% full at her office but driving around SF all day cut her throughput down to something like 30%.
Maybe the economics work somehow for others, but they didn’t for her (car + gas + parking + large drop in number of patients seen).
Your reasoning is based on assumptions that there is no evidence for. Not all doctors are employed in providing care, you don’t know what Heal doctors are doing between seeing patients, you don’t know how Heal sources or compensates doctors, medical efficiency is not measured in patient-minutes, you don’t know how many patients a Heal doctor sees vs a clinic doctor, you don’t know the bottlenecks of community clinics, etc. etc.
> given all the regulation and equipment requirements.
Um, so how does not having a facility, which is probably required to give care, all of the sudden eliminate all of the equipment and regulatory requirements? I mean, don't you think the equipment and the regulation is probably there for a reason..?
Well, if you build a clinic it needs to be wheelchair accessible, and have access to parking for all the patients that might be present at one time, for example. If you visit patients then they either live somewhere accessible or not and you just need to get one car to their place.
Same way a taco truck is cheaper to operate than a sit down restaurant. You still have to follow the local health codes but your fixed costs would be less.
I can’t see how there would be any cost savings except if you dump equipment that would otherwise be available; making the entire contents of a clinic mobile is surely more costly and complicated than paying rent.
Test kits are mobile, vaccines and bloodwork are mobile, basic diagnostic equipment is mobile. Most people do not need the vast majority of things a clinic contains; nothing you couldn't solve with a small refrigerable unit in a vehicle.
That being said, the downsides of travel time are so negative it's hard to see how they could be overcome.
Its kinda sad to see this sort of service. Home visits are a key part of healthcare, but it doesnt scale and is potentially harmful. Especially when you realise that most people dont really need to see a doctor.
Flu is a great example (not judging you, I have no idea how bad it was!) where most people could self care.
Much better is phone doctors & good websites; the NHS have invested heavily in this. You can self-care for many minor things based on online guides, and are then directed to a phone GP for triaging if you need further help.
(example online guide; https://www.nhs.uk/conditions/flu/ what I like about it is that it gives you clear exoectations about self care and when you should feel better, plus clear (and varied) escalation paths for worsened symptoms)
I was in bed for 3 weeks with real flu - not a runny nose or even a nasty cold. Plus, we just moved to a new neighborhood and finding a (good) primary care doctor you can visit is all but impossible - they're all full and not taking any new patients.
The Heal service was an immense win for our family's situation.
> Especially when you realise that most people dont really need to see a doctor.
With regards to the US, the issue isn't the medical need to see a doctor, it's the bureaucratic need to see one, as you can't get approved for extended sick leave without it.
Such visits (and per this document [1, pg 7-8], many ER visits) are for purely bureaucratic reasons, such as no insurance or no other providers available. I interpret this as largely a workflow issue with regards to the availability of the simple care. A separate style clinic or service dedicated and allowed by Employers/Insurance which deals in low-priority cases for the purpose of documentation (e.g., flu clinics) would solve a lot of these issues, but, as I found out with my previous employer and insurance, flu clinics are "not real doctors", and as such cannot be submitted for sick leave claims.
I think we'd see the numbers for inappropriate/unnecessary visits drop rapidly if Employers/Insurance accepted such documentation more easily/readily.
Most healthcare startups in the US are treating symptoms of the problem (poorly) instead of the underlying issue (a fundamental failure of the healthcare system).
The NHS does that because there’s already a massive problem with too high demand and too little supply. Making health care “free” distorts incentives — so they have to come up with clever ways to implement barriers to care: waiting lists, attempts at convincing people of self care, etc. Does that NHS website provide a prescription to Tamiflu as well? Does the website know our medical history?
If people paid directly for visits, there’s a built in incentive to reserve doctor visits for when they are actually necessary, rather than the British system of “free” (provided you can jump through enough hoops to actually earn an appointment.)
Using the NHS as a model of “good” health care is laughable. What’s “good” about the NHS is that it’s “free.” It isn’t actually good when it comes to access to care or advanced treatments. Compare cancer death rates of the UK vs the US, for example. The French system where you actually have to pay some money for appointments is far better — you don’t have to wait weeks to visit a GP: I can get pediatrician appointments generally same day. That is literally impossible in the UK. I also am not getting referred to a “website” to solve my kids’ illnesses — I am not an idiot, I know how to google. I am not going to waste my time going to a doctor unless I actually feel that the doctor can provide some value.
Want to better allocate a scarce resource? Make people pay a price that reflects the available supply instead of making it “free” but with convoluted access models.
What I love here is that there is clear, documented information about the choices on offer - and background into why the NHS recommends paracetamol/ibuprofen on its website.
> Compare cancer death rates of the UK vs the US, for example
Okay; looks like they are nearly identical for US, UK, France (105, 107, 109 per 100,000).
> That is literally impossible in the UK. I also am not getting referred to a “website” to solve my kids’ illnesses
This is the thing - emotively if your kid is ill it feels like they need a doctor. But likely they just need rest and over-the-counter medications (I've always found the pharmacist to be a good port of call for the right advice here).
If you do need a GP for your kid I have never had any problems getting one; day or night.
> I am not going to waste my time going to a doctor unless I actually feel that the doctor can provide some value.
In which case, great, but then I think you're not the target for these sorts of initiatives as you are using healthcare appropriately.
There's definitely a need for it. I'm working for a startup,
called Carol Health[0], that's trying to do a similar thing but with nurses instead of doctors.
There's a huge need for in-home care, especially in the aging population. For able bodied humans, going to the doctor's office is a pain but not a particular challenge. For aging, disabled, or mobility-limited individuals, it can be nearly impossible for them to get to a doctors office. Not to mention, an office is full of nasty things that can harm immuno-challenged individuals more than the office visit can benefit.
Telemedicine is a really good start, but there are huge limitations without being able to actually interact with a patient. As more of these types of services popup, it's going to be incredibly beneficial for aging and homebound or almost homebound individuals.
It really exciting to see a whole gamut of services, like Shipt and ClickList, popup. Hopefully in 10 years, aging in place will be more common until the point that individuals actually require frequent assistance or medical attention.
How do you deal with patients keeping the doctor there for an hour? Drives taking an hour in between? It's nice and I'd love it, but I can't see how it's feasible against an office where they can see 6 patients an hour. Great pricing however. Is it really $99 total? That's cheaper than driving and a copay.
$99 is the cost with no insurance; with insurance they bill and you pay your normal copay. $99 is probably less than their average reimbursement.
> That's cheaper than driving and a copay.
If you have really high cost of driving, have poor insurance, or are comparing it to average urgent care copays instead of primary/specialist office visits (IIRC, copays for primary average around $25 and specialist around $40; $60-75 seems improbably high transport cost for most people to drive to a doctor, even with non-free parking), sure. But unless appointment availability is really high, it's going to be higher latency, on average, than urgent care, and in any case it seems necessarily to be less well equipped than most urgent care facilities (meaning you are more likely to need to go somewhere else and be seen after your visit when using it as an urgent care.)
Note that $25 is nowhere hear the average for Americans' copay for primary healthcare visit. You've just got really excellent insurance and are assuming everyone else does as well. We've got average insurance in our state, and copay is around $60.
> Note that $25 is nowhere hear the average for Americans' copay for primary healthcare visit.
$24 primary, $37 specialist, though that was published last year so it may have crept up a bit (it's been trending slowly upward.) [0]
> You've just got really excellent insurance
$25 is more than my primary care copay. I know I have excellent insurance; I also don't assume everyone else's is like mine. OTOH, you apparently have really crappy insurance and are assuming everyone else does.
> Once workers have surpassed their deductibles, they pay an average $24 copay for a primary care office visit, $37 for a specialty care office visit,
Note that, as stated in the article you linked, the percentage of plans with deductibles has gone up significantly (67%). So your average is really a veiled figure - many people won't come close to spending as much as their deductible on healthcare in a year to ever actually pay those prices.
In my experiences, they're in and out pretty quickly. I didn't feel rushed but certainly not the mellow chit-chat I've experienced in the past when I visit my regular doctor where I used to live.
My cost is $20 per visit for the copay - I guess they bill the insurance company in the same way as if you'd gone into the practice.
We are nearing crisis mode regarding long term home health for the elderly here in US. Cost per visit for even non-nursing, personal care workers can easily exceed $100. Medicare coverage eligibility is subject to political risk. It's a significant tax on working families. And with 30-40M families requiring such workers. It's trivial to see how there may never be sufficient labor market supply.
But a subscription service model for those that can afford the highest quality home care for the elderly. Represents a phenomenal startup growth opportunity.
I have trouble understanding how doctors can make money with Heal? For me it is great, $99 and I have nice doctor show up when I don't feel well and diagnose and prescribe treatment. I don't understand how they can make money with this.
I’m wondering if a lot of them aren’t working part time while doing something else? Like I can see it being really appealing for a doctor with young kids at home that don’t want to work long hours.
An average gp makes about 170k with tax benefits etc its probably closer to 200k. Assuming they get 3weeks of vacations that 102 dollars/hour. I don't see how 99 dollars per visit makes economic sense.
How many hours a week do they work? How many of those are overhead hours that Heal takes care of for them? How many of them are average? What other costs of running a clinic are there?
We've had home-visit GPs in Australia for a few years now. There's multiple to choose from, and they're all covered by Medicare (so it's "free" to use).
It's super handy for us, having 2 people in our family with illnesses that require regular doctor visits (once or twice a month on average). If it's night time and we need the GP, we don't have to worry about waking up the baby, loading up the kids and nappy bags and everything we need into the car, etc.
We only go and visit our actual family GP if we need prescriptions renewed, or we want to talk to him about a bigger issue or general questions. Eg stuff that isn't urgent, so we don't waste the home-visit GP's time. Then again, the home-visit GPs have told us multiple times that they're happy to come out no matter how small the issue, and they prioritise/triage calls so you're never keeping a more urgent case waiting.
I would bet they have put access restrictions on these because violating hippa can be a felony whereas in general there are 0 legal requirements to restrict access to internal data to a company generally.
I do fully admit that I haven't been keeping up to date on their latest changes, so that may be true. But IMO, 6 months isn't nearly enough time to forgive the major fuckups that they've been doing
They fired basically every executive and the new CEO has been building the c suite from a fresh start. He’s made a bunch of good moves so far and seems like a mensch.
What in the world are you talking about? As soon as he found out about the 2016 breach, he ran an investigation, found that the chief of security was responsible, fired him, and then came forward to the press about it.
Really? You’re aware that people have had their information compromised, including driver’s licenses, and you do an “internal investigation” for months before notifying them?
No, you patch the hole and let them know, not wait until you have a scapegoat for better PR.
Aug 30 is more like "job start date", not "you're aware that people had their info compromised".
This convo sounds like when folks were jokingly asking Dara the week after he started the job if he had fixed all the problems in the company, made it profitable and ready for IPO yet.
Considering that the timeframe in question would be probationary period for a normal person in a normal job and that the guy was jumping into what was effectively a burning transcontinental train wreck, I'd say getting an investigation completed and disclosed within a few months of his job start date is actually pretty commendable. By comparison, it took like half a year for people to see anything come out of the Holden report, and timeframes for resolution for some historically big scandals in other companies have taken far longer (e.g. the Equifax one is still making news with bigger and bigger impact estimate corrections).
Also, I find it curious that you think Joe Sullivan was made a scapegoat out of convenience, since there isn't a single news article about him complaining of being fired unjustly. You'd think news orgs would be all over such a story.
The point isn't that he was outed as only a scapegoat. The point is why you'd spend time waiting to see who you should fire before letting your victims know.
It's not like Dara walked into a whiteboard in the CEO office that said "list of 2016 suckers lol" and then sat on it twiddling his thumbs for a month. My understanding of the incident is that it had been covered up by Sullivan and TK. In my mind, an investigation is precisely for figuring out what the hell happened, who was affected and to what extent.
I don't know the specific details of this investigation in particular, but for the Holden one, it involved a lot of one-on-one interviews with various employees to try to reconstruct the stories of each harassment claim so that an appropriate punishment/course of action could be determined for each case. If this investigation was conducted in a similar manner, it wouldn't surprise me that finding out the blame would occur in tandem with discovering the extent of the breach.
Sure, it is, insofar as a corporation cannot physically quake in its boots. A fine is designed to discourage an entity from doing bad things. TFA says Uber is working with Clearwater, which indicates to me that the incentive of a potential fine is working as intended.
One can try to argue that uber is lying about its hipaa compliance efforts in order to save the few hundred thousands that they would be paying Clearwater and in dev costs, and one can counter argue that that accusation has no reliable sources to back it up and is fueled by a desire for internet karma points.
So if a company stores medical history data it's only required by law to prevent the data from leaking to the public? It's okay if a system administrator employed by the company has read access to people's medical records?
sorry if i was unclear. if a company is storing medical history data that falls under HIPPA which is serious.
If a company just has data about you that is not medical data then there is no legal requirements as to who can have access to it internally. (So Joe's Sprocket's has a list of everyone who has bought sprockets and their phone numbers - anyone in the company could look at that info and there would be no legal implications)
I see. I think I misinterpreted the "0 legal requirements" part of your comment. It gave me the impression employees not involved in the care could access medical data. Thanks for clarifying.
One example. A friend of mine who works at a hospital told me about a colleague (a nurse) who looked up her own test results since she was anxious and could not wait using her login to the main system (for providers). She got flagged in the system and reprimanded. Every access is logged.
it's worth noting for others that this was almost certainly a hospital policy violation, not a hipaa violation. There's nothing in hipaa that prevents a person from accessing their own record (though I have heard hospital administrators try to claim otherwise).
You need to be part of a patient’s care team, using that data to further their care. Any other access is a violation.
Med students get a little grey area on this because their job is to absorb as much info as possible without necessarily providing care, but even they shouldn’t venture outside the census of their supervising physician.
That's absolutely false. Many other people need to be able to access the data just to keep systems working. I've worked in a HIPAA environment (as well as FDA class 1 / ISO 13485) for nearly 15 years now.
Also, many companies who deal with medical data, but are say startups but not an actual healthcare provider gets audited for compliance - and it is fairly rigorous and so think of it like a SOX audit, but even further. Some companies have dedicated rooms with limited, tracked, badge access to the machines in that area which are the only machines that can access the data.
So if any breach occurs, access can be tracked to individuals.
So programs are allowed access to the data, provided they are audited?
In my country, one programmer who unfortunately lost his newborn daughter to sepsis decided to make a machine learning program to help doctors diagnose the infection early. The software has access to patient data and it recognizes patterns that match the development of sepsis. It decreased the number of severe sepsis cases per month from 1.5 to 0.5 and cut the waiting time before effective treatment was administered by 60%.
People have told me this sort of system would not have been impossible in the USA because of the HIPAA. Is this true?
These types of programs do exist in most insurance companies in the United States. Predictive analytics against claims and clinical data to do early intervention care management is a common thing here.
That said, the company has to make sure that only the people that have a clinical need to access the data have access. So the developers would probably use a de-identified data set to write and test the program. Only the clinicians (care management and disease management nurses) would have access to the identified data so they can contact the patient to offer care.
Yep - de-identified data is the best way to assure compliance when developing/working-on/dealing with large sensitive data-sets.
that said, compliance audits are pretty strict if they are doing it correctly, and not-so-fun. It will be an interesting world when there is a medical-data-firehose pointed at an AI that is looking at all the available med records to do predictive analytics against an entire population....
I think there would be significant challenges to do so. I think this is one of the reasons why google's health care initiatives in the US failed so horrifically and one of the reasons why their deepmind NHS initiative is with the NHS and not someone in the US.
Uber executives have specifically stolen health records from a patient in order to attempt to create a media frenzy about how an Uber passenger who was raped by a driver was actually liar and a cheater. Uber executives went on a long-haul journey to insanely attempt to ruin the life of one of their customers, who had already been raped by one of their drivers, by stealing her medical documents and ridiculing her in public. No thanks Uber.
There is absolutely no way I would use this service.
Edit: It should also be remembered that Uber hired this driver, the rapist, as a known rapist (a recorded criminal history of being convicted for rape). Uber hired him without caring about his background or past criminal behaviour. Uber hired him with the knowledge that he could well be a rapist, since they declined to do a simple background check, presumably because it would "take too long" and they consider the occasional rape just a part of doing business. The evil behaviour and willful disregard for the safety of their normal Uber passengers - before trying to ruin their lives with deception, theft and lies - makes it 100% impossible to trust them about anything ever again, especially personal health.
I'd like to agree with your position but in the current environment I can't. Uber is a shitty company, I can get on that bandwagon and ride it to the other end of the continent. But in my country, America, this sort of service is immensely valuable to the elderly community and yet there is a dire shortage of acceptably priced choices to provide for those peoples' needs. If Uber's service is priced better than the entrenched players then I'll sign that pact with blood.
Allowing bad behaviour in order to get something cheaper is IMHO the wrong way to do things. If you want to look at why everything is so expensive, look at capitalism and all of the for-profit layers people add to cost structures - extracting value from society and adding a constant negative pressure to the quality of everyone's lives; whether the amount of extracted is reasonable or not is what needs to be looked at in each case. A certain minimum of transportation should likely be a right.
I agree with your point about minimum transportation as a right. I'd support that ballot. But I don't think it's fair to blame capitalism in an environment where there's only a handful of entrenched players. When I was helping care for my grandfather there were only four services in our area that could take him to doctor appointments if we couldn't and they were all generally expensive unless we used the volunteer service which was free but extremely unreliable because of the sheer number of people they were trying to service.
Obviously my experience is anecdotal, so I'd be interested to see if similar patterns are true elsewhere. But when there are so few companies competing with each other it seems a lot more likely that there's some sort of regulatory burden or capture in play rather than simple greed. Capitalism might explain why a service with few competitors is expensive but it doesn't explain why there are so few competitors to begin with.
>But I don't think it's fair to blame capitalism in an environment where there's only a handful of entrenched players.
This is literally the endpoint of Capitalism without regulation to prevent monopolies and a floor of public goods. You absolutely should blame it and those who fail to either check or dismantle its power.
Throughout American history, corporations have explicitly undermined and destroyed public transportation so they can profit from it. That’s why things are so bad. First they did it to sell individual cars and now to sell taxi services. Uber’s express ambition is to become the transportation monopoly you decry.
I think you're right that I was too general but I still disagree in this context. I agree with your premise that free market capitalism is vulnerable to monopolies. But healthcare services in the U.S. are so heavily regulated that it's difficult to see how capitalism could be the factor limiting competition in this context and not the regulatory environment. That doesn't mean that the environment needs to be removed, but I do think it could be better optimized.
We're quickly derailing from my initial point though, that however things got here I think Ubera new service has the potential to relieve a lot of people in a market which I believe is inadequately served at the moment.
HIPAA violations can cost a lot of money (up to $50,000 per record, depending on the severity level). A single incident can cost a few million dollars in fines, so there's a _very_ strong incentive to do things the right way.
After nearly a decade of lying, cheating, intentionally breaking the laws of various countries, spying on paying cusomters, spying on other people, aggressively attacking and spying on journalists, of attempting to discredit victims of rape by Uber drivers, harassing their competition using illegal tactics and lying about it, etc,
I don't care if they have "strong internal data access controls". They should have had that Day 1, they should never have lied or cheated and they certainly should not ever expect anyone to trust them about anything ever again.
First, I doubt that it's true that they have strong controls. I don't trust organizations that have such a long, clear and bragging history of lying.
Second, that sounds like the Titanic being unsinkable. As if I'm going to trust Uber with personal health data - they are the first group I'd suspect to try to sell that data under the table, the first group I'd expect to abuse the power, and also the first group I'd expect to suffer internal leaks or external hacks.
No way I would trust this given the very recent and abhorrent behaviour of the executives at the company.
Edit: Also this,
> and any user data access need a ticket and a justification before accessing
is not secure. Sounds to me like any user can make a ticket and create any justification they like. This is like the NSA saying "any user of our PRISM system is logged and watched" - but what happens when millions of tickets are going through? Is each one actually being carefully inspected for abuse? If Uber executives are in charge of this decision then no way do I trust it.
What you probably don't know is that this is a problem with almost ALL tech companies in general. Early Facebook engineers can look up ANYONE's personal information. Same with Google. There was an article a couple weeks back about accusing Lyft employees of doing the same thing. This is the problem much bigger than one pre-ipo transportation company.
It will definitely take time for Uber to earn trust back, and it is fair that you feel the way you do. Hopefully Uber will earn your and other people’s trust through us showing over time that we continue doing the right thing.
My intention here is not to go into details, which would not be appropriate for me as an engineer that doesn’t work on those aspects. I am only saying we care a lot about this.
I'm not sure Uber ever had any trust to begin with. As far as I remember, they started off doing shady and illegal things while being rude, demeaning, unsafe, aggressive, etc. They'll never 'earn' any trust either, not from me, as they've done way too much damage without any semblance of humanity, even today.
There are so many alternatives to Uber that are better, safer, and even cheaper that there will never be a need to use Uber and they will never get any trust. The people up-top there have been so thoroughly evil for so long and the damage they have done so great that I have no interest trusting them ever again.
Edit: You downvoters have downvoted me so much I'm no longer allowed to reply or otherwise talk on HN. Goodbye.
You clearly have some very visceral opinions about Uber and I'm sure nobody would be able to change your mind, but when the parent is saying that it'll take time for Uber to earn back trust, I think it is in the same sense as what happened to Microsoft.
There was a time when there was a lot of animosity towards Microsoft, but over the years, younger people that had not been exposed to the drama grew up with a more neutral stance, and many many years of not-really-dramatic developments means that nowadays, people only really think of Microsoft as the company behind MS Office, XBox, etc and not so much about what its ethics framework looks like. Obviously you can still see people referring to it as M$ and similar and making fun on windows users, but it certainly isn't _common_ for average people to outright _hate_ Microsoft on ethical grounds.
Oh come on. A five minute googling session will give you various articles talking about what telemetry was designed for and that the backlash was largely a storm in a cup of water based on ignorance and misunderstanding of the technology. Curiously, I've never heard anyone hate on Apple over telemetry.
Really? You can't blame them? For wanting to and then actually executing illegal methods of spying on someone's private life? I absolutely blame them. That's abhorrent behavior.
Here are some juicy stories for you to read if you want to know the details of all the kinds of stupidity and evil it takes to invade someone's privacy like that.
I didnt say it was OK - im saying "i cant blame them"=="I understand humans, and this is not a surprising outcome from having access to that data in a company known for sexual mis-conduct, crazy ceo egoist stories and illegally accessing an employees medical records, etc etc etc"
HEY! In 2016, I worked on the pilot program that was the predecessor of the product. It was just me and an intern finding ways to modify Uber's core dispatch and billing workflows to make workflows like this possible.
The project started attracting interest in the company, and we handed it off to a newly-formed dedicated team for the project. They made it into a fully-fledged, HIPAA-compliant product with a great UX.
I'm absolutely ecstatic that this launched. Although I probably can't answer any questions about the project, since they probably had to rewrite all of my prototype code.
Unfortunately this happens on the backend, for instance as a built-in feature of a CDN or DNS routing based on your IP, so the only real way around it is to use a VPN that'll let you switch countries and show a different IP address when browsing the web. It's not like a user agent string that can be modified or anything like that.
I remember reading in the Google Forum from an American who flew to Kuwait (War contractor?) and when they loaded up Google on their laptop, it's in Arabic. They were furious...
Non-emergency healthcare transportation is a pretty big market that can't be served well by taxi companies. You may not have noticed the ubiquitous branded vans which drive around large cities ferrying seniors around. They're operated by numerous small-to-medium companies. I'm sure there's a few large regional companies at it as well.
Uber has probably already disrupted that industry in a large way. I'd be quaking in my boots right now if I made my living doing this.
It looks like Uber is looking to put the cost onto the provider. I think it could make sense for large health organizations, but I see it being an issue extending down to the chain.
I'm curious what adoption among patients will actually look like. A provider in Philadelphia tried providing their patients with free rides and found that a free ride made absolutely no difference whether patients missed their appointment.
I believe a missed appointment will cost the provider more than the cost of a ride. Also, I believe CMS reimburses for non-emergency medical transportation, which may include Uber Health.
That makes a lot of sense. The medical providers just need the patient to show up to bill insurance. What does it matter to pay $10, or $20 if you’re bringing a patient in for a $700 service. Not only do you lose the $700 in revenue the utilization of your capital assets decreases (wasted time) which means your fixed costs (rent, debt, fixed payroll, medical equipment, etc) are spread across fewer appointments meaning your net margins are shrinking and you’re either becoming less profitable or raising your prices. Some people may think this is wasteful but I can see how there might be a positive ROI on offering Uber rides if it really makes a difference in getting patients to show up on time.
I would never trust Uber with anything sensitive, health related or remotely private after their history of stealing medical records to attempt to cover one of their drives rape. [1]
Meanwhile, 'Passengers Who Call Uber Instead Of An Ambulance Put Drivers At Risk
Sick people are increasingly using ride-hail to get to the emergency room, putting drivers in an uncomfortable position and a potentially tricky legal bind'
I was in a digital health hackathon a few weeks ago and one of the ideas pitched was Uber for hospital visits.
One of my first thoughts, and one of the risks people couldn’t get over, was if a person isn’t so sick they don’t need an ambulance, why doesn’t a normal Uber work?
The natural assumption is people who have no business getting in a car with someone else would be the ones to use it the most.
As someone who struggles to get my Grandmother to doctors appointments and, as a result, she has high cancelation rates - I think this has the opportunity to be an incredibly valuable two-sided market.
- Doctors are incentivized to have fewer cancelations and help get their patients to and from appointments.
- People get to the doctor more often and have better care.
Uber is easy to hate on, but this seems like a societal net-positive. Good for them.
Maybe I'm the only one who uses spacebar to mean "scroll down" (I find it very convenient), but I'm certain that no one uses it with the intent to open a giant search bar that obscures the article.
What might not be super clear to most folks is that this is one of the last areas that medallion owners make bank. Typically, in many US cities local taxi operators have deals with the govt to ferry the elderly around. So this in effect is uber putting the final nail into the taxi company coffin. I've spoken to taxi drivers which have resisted switching to the gig economy because they made enough from this government tie up to not have to move; I guess that all changes from here on out.
Trained people who can handle mobility and disability needs.
It’s unclear where the gulf is between people who just book an Uber to go to the doctor (which seems to be all this is, just arranged by the provider themselves instead) and services that have trained professionals transporting people.
Every bit of Uber's history says that they are willing to bend rules and ignore ethics in favor of expanding their business. They aren't interested in protecting the public, their employee-contractors, or their employees. All of this is well-documented in stories discussed here on HN.
Why would anyone trust them in any aspect of healthcare?
I would imagine disabled and old people would use this the most (people who use Acess-A-Ride in nyc for example), but obviously this means vehicles would have to be accessible to them, and how can you guarantee that with Uber using shady contractors who have to maintain their own vehicles?
(Physician here) I am so pleased that competent technology companies (Google, Amazon and now Uber) are entering the healthcare space. I really heope this portends the demise of the overcharging, outdated garbage (such as EPIC) that passes for healthcare IT at most hospitals.
Those with acute renal failure (kidneys) largely need to go to and from a dialysis center a couple of times a week. Dialysis is an exhausting, lengthy process. Once the treatment is finished, a patient really is not fit to drive yet many do for the sake of cost. Driving after dialysis is like DWI. It isn't safe for anyone on the road.
If Uber Health can provide affordable transportation services for dialysis patients, it is providing a life changing service that is sorely needed. This is a great idea and I hope that the service succeeds.
How is this different from regular Uber? Will it be billed to my insurance? If so Uber has found a brilliant way to charge 10 and 20x rates for regular Uber rides.
Sorry, I am very skeptical when it comes to healthcare offerings.
It's still taking me a while to dissociate Uber with Travis Kalanick and his army of bros, even though they seem to be trying a lot of new initiatives.
Anyone have a good article on Uber's attempts to de-bro itself?
Uber support still has dark patterns within it - this organization is trying to win by optimizing at all costs. I don't trust them, and worse, based on passed verified behaviour of Uber's - I feel somewhat hesitant even speaking badly of Uber in case of retaliation. We need strong whistler-blower laws with substantial pre-defined payouts to disincentive this kind of behaviour in every organization and at every level.
I stopped because of the sexist culture. They're reforming the sexist culture and seem to be clamping down hard on it.
What else would you like me to think about with them? (Genuine question).
I'm perfectly happy with Lyft, so I'm not dying to resurrect my account. But that was my main concern as that led to a lot of the other cultural problems they had.
Looks like they are trying to tap into the goliath pile of cash that is Medicare by offering better service with the same billing structure. Most of the companies in this space are either regular taxi companies or fly-by-night transportation "companies" because of how easy the money is.
I wonder if there will be a way to pair a driver with a patient who only speaks Spanish. Health care transportation is a huge market for elderly in Miami, especially since retirement homes are taboo in many hispanic cultures.
A handful of cities already have UberESPAÑOL. I'm not certain, but I imagine that the healthcare provider's dashboard should be able to request the product if it is available at the pickup location.
This just doesn't scale. Babylon Health here in London is using machine learning to do more of the triage in app. That's the only way to narrow the pipeline early with any form of scale.
These healthcare companies make a huge amount of money billing insurance companies and medicare, so I imagine at some point its profitable for them to pay for the transport of the patient back and forth.
One thing they could do is coordinate with English NHS Trusts and the "Crisis Care Concordat" to talk about conveying people who are mentally ill, who need to go to hospital, but who don't need a fully stocked ambo.
They'd have to make sure it was free at the point of delivery to the patient. They'd have to have good governance (so, actually doing background checks) and have better training for drivers.
But a non-medical (more normal) conveyance to hospital is probably something many people want.
Absolutely not, while Uber flaunts their noncompliance with TfL et al they should not receive a single penny of taxpayer’s money - and there’s the matter of them dodging employer’s NI thereby directly undercutting the NHS too.
This is interesting. About 2 years ago, I emailed or perhaps filled up their contact form that it would be a good idea to do this for India. India road/traffic condition is so bad and there is no formal/official importance given to Ambulances. If Uber taxis can serve as on-demand ambulances-esque services when needed, it will likely save a lot of lives.
This is pretty much my sentiment. Uber is basically a company that has engaged in illegal, unethical, and reckless behavior over and over and over again. Not exactly the type of company I want involved in health care. On the plus side the inevitable HIPPA violations will (hopefully) carry some teeth and maybe force Uber to change finally.
Its a really nice idea, but will the cost not be passed on to the consumer in the form of inflated health insurance premiums? The health industry already stupidly too expensive in the US. Is having Uber suckling on the heath insurance teat a good thing?
So I am confused - are they going to introduce a new fleet or is it asking their existing drivers to do this? If they are going to introduce a new fleet - how is it different from a normal ambulance service?
It's not for urgent transit. They're probably trying to take a cut of the transportation voucher program available to seniors and those with disabilities to access subsidized rides from existing services.
It's considered non-emergency transportation (NEMT).
The voucher program actually goes direct through hospitals, the hospitals negotiate with transportation providers like Uber (or local taxi companies).
Unfortunately, shit doesn't work like this anymore. Hospitals don't always dispatch transportation out to local taxi companies. For Medicaid, most states have Logisticare which is very much a rent-seeking company paid based on the number of Medicaid subscribers (not runs). This company finds local transportation providers (or ride share services) and dispatches out the patients to them. Their job is to get the taxi companies to blind bid in a race to the bottom.
How do I know this? I part-time drove a couple nights a week for a tiny family owned taxi company that sometimes did voucher runs for a local hospital. They also considered Logisticare but backed off when I told them what it would require and how they'd get pushed into accepting below their usual mileage rate.
Also, Logisticare doesn't give a shit about inspecting the transportation providers, so noncompliance is common since they'll contract with any rando that'll work for dirt. [1][2]
Ambulances are necessary for a few reasons. The obvious ones are acute illness or trauma, where a life threat could develop emergently. Another significant segment of ambulance traffic is psychiatric, where direct monitoring is needed even if there's no likely medical intervention. And another segment is for bariatric or non-ambulatory people.
But this service doesn't seem to be for people who need to be transported so much as for people who need transportation. That is, the target for this service isn't the person who has a medical issue that needs to be addressed in transport. It's for people who need a transport and whose destination happens to be medical in nature. That's why it seems to be marketed primarily to medical providers rather than patients, with the benefit of a reduction in missed appointments and an increase in efficiency.
If there is a new fleet, then, it's likely that the vehicles would have none of the medical equipment that ambulances do. (Though maybe they'd have more leg room, or a stool to help people in, or other minor accessibility considerations.) I'd also expect that drivers would be specially trained in HIPAA, and probably in recognizing imminent life threats so that they could call 911 in case someone was trying to use them as an ambulance.
Given our current understanding of Uber's business model, do you really think that 'specially trained' drivers are going to be subject to more than a powerpoint presentation or two?
> If there is a new fleet, then, it's likely that the vehicles would have none of the medical equipment that ambulances do.
Apropos of anything else, most if not all states require ambulances to be individually licensed as such, and have a specified minimum complement of equipment including but not limited to oxygen, defibrillators, etc.
They also require the company/agency to have a overarching license to transport patients.
Something tells me, as an EMS provider, that state Departments of Health would likely come down hard on attempts to use (or indeed advertise) this service as such.
> and probably in recognizing imminent life threats
If you're looking at that, you're probably getting to 80 hours of training (most Basic Life Support courses are around 160-200 of practical and classroom training). I can't imagine Uber doing this, or the liability nightmare that could ensue.
Where's the meter? Average citizen should be able to "know when to call 911". What would be the training to recognize "when to call 911" beyond that?
And very specifically, if you're talking about wanting to "recognize acute medical emergencies", the half the EMT course I'd be looking at would be exactly the opposite half you mentioned, and more things like "symptoms of acute coronary syndrome", "respiratory distress" and the like. Yes, a non-urgent transport would likely have no need of A&P, etc.
You say that the average citizen should be able to know when to call 911, which is exactly why I'm confused that you'd expect to need 80 hours of training for recognizing imminent life threats.
I agree with that. This service also doesn't seem to cover the situation where you don't need an ambulance but you do need to be met by a specified adult (e.g. out-patient surgery).
I saw no explicit mention of any healthcare training on this. I realize it's more "cabulance" than ambulance (BLS - basic life support, or ALS - advanced), but still... there's probably at least an implicit assumption that there's a modicum of first aid or other training with the drivers.
A whole host of potential liability issues, Uber's favorite thing to avoid.
I think this is aimed not at ambulances but at like all those assisted care ridership services that exist. I assume they are going to need a large fleet of improved accessibility cars though (for wheel chairs, walkers, etc..)
