Latest news with #doctors
ABC News
13 hours ago
- General
- ABC News
Mental health services plague Australia's largest state
Four days - that's how long a mental health patient at one of the country's busiest emergency departments waited for treatment, according to figures seen by Four Corners. And doctors have revealed they felt pressured to discharge people in severe mental health crisis before they're ready.
Yahoo
19 hours ago
- General
- Yahoo
Cancer warning as two common symptoms that strike at night could be early indicators
Two symptoms that commonly flare up at night may be the harbingers of a potentially lethal condition. Struggling with these nocturnal disturbances could hint at cancer. With over 200 unique types, cancer can present itself in various forms within the human body. While certain symptoms are tied to specific locations, SurreyLive points out that some broader warning signs could easily slip under the radar, particularly those manifesting at night. Cancer Research UK experts note that experiencing intense night sweats or persistent insomnia could both point towards cancer. READ MORE: State pensioners warned they can no longer claim these 6 benefits READ MORE: Two 'common' early symptoms of dementia that are not memory loss It's essential to remember, these symptoms aren't exclusive indicators of the disease, as they can arise from many other ailments too. However, if you notice sudden sleep disruptions or exaggerated sweating at night – which isn't typical for you – it might be wise to consult a doctor. Cancer Research UK emphasises: "It's important to be aware of what is normal for you and speak to your doctor if you notice any unusual changes or something that won't go away. This can help to diagnose cancer at an early stage, when treatment is more likely to be successful.", reports the Mirror. Night sweats. Night sweats can be chalked up to a variety of factors, from the temperature of your room to the climate or even sharing your bed. But Cancer Research UK is sounding the alarm on "very heavy, drenching night sweats" and unexplained fevers, warning that these symptoms could signal something as serious as lymphoma. The NHS is also flagging up that if you're waking up to sheets soaked through with sweat, it's time to book an appointment with your GP. They explain: "Night sweats are when you sweat so much that your night clothes and bedding are soaking wet, even though where you're sleeping is cool." It's worth noting that certain cancers are often linked with causing night sweats, including:. Insomnia isn't just tossing and turning; it's a prevalent issue that affects roughly one in three people at some point, triggered by stress, anxiety, health complications or injuries. Cancer Research UK is highlighting that persistent insomnia might not just be about counting sheep – it could be a symptom of cancer, arising from pain, illness related to the cancer, treatment side effects, or the emotional turmoil like anxiety, stress, or depression that often comes with grappling with a cancer diagnosis. The charity points out: "If you often have insomnia, it can interfere with everyday life. You may feel very tired and have low energy. "You might also have poor concentration, and irritability, and may feel you cannot cope." Other general signs that could hint at cancer include:. Should you notice any of these unexplained symptoms, it's recommended to seek advice from a doctor.
Yahoo
a day ago
- Business
- Yahoo
Mark Cuban Says Taking Low-Premium, High-Deductible Plans Is Great For Insurance Companies. 'You Know Who It's Not Good For? You Guys'
It seems like Mark Cuban has no patience for how America pays for healthcare. In a recent appearance at the Stanford University Department of Medicine, he laid out exactly how he thinks insurance companies are rigging the system—and leaving hospitals and doctors holding the bag. According to Cuban, it all starts with how insurance companies design their plans. Every year, they tweak things so premiums stay low, but out-of-pocket costs quietly increase. This pushes patients toward high-deductible health plans that look affordable on paper but become a disaster when someone actually gets sick. Don't Miss: 'Scrolling To UBI' — Deloitte's #1 fastest-growing software company allows users to earn money on their phones. Hasbro, MGM, and Skechers trust this AI marketing firm — 'Depending on what's going on in the economy, those patients, particularly as they skew a little younger or a little poorer, take low-premium, high-deductible plans,' Cuban said. 'Which is good for the insurance companies. You know who it's not good for? You guys.' By 'you guys,' Cuban meant the doctors and hospitals who end up taking on the financial risk. If a patient can't pay the deductible, the insurer already got its money, but the provider hasn't. 'You take on all that credit risk,' Cuban explained. 'And you also take on the brand and reputational risk... Did you cause the problem? No.' Cuban pointed out that many patients are confused by their bills and blame the hospital, not the insurer. 'When everybody talks about the $400 billion in unpaid medical debt, who gets the blame? You do,' he said. 'And when the patient's angry and looking at all these medical bills, who gets the blame?' Trending: Invest where it hurts — and help millions heal:. He argued this creates a cascade of problems that go beyond money. Doctors feel rushed. Care feels transactional. And fewer people want to stay in the profession. Cuban said his goal is to bring simplicity and fairness back into the equation. One of Cuban's solutions is direct contracting. Through his Cost Plus Wellness venture, he's working with hospitals and doctors to create deals that skip insurance companies altogether. 'We go to Stanford and say, 'We know what happens in the relationship between you and the big insurance company,'' he said. 'Why don't you give us a better price?' He said most hospitals lose 3% to 5% fighting insurance companies for payment and have to hire massive administrative teams just to handle all the red tape. Meanwhile, they also deal with delays like pre-authorizations that often aren't about medical necessity but about how long the insurance company can hold onto the money and earn pitch to providers is simple: stop relying on insurance companies and work directly with employers and patients. Publish your prices. Make it easier to understand care costs. And push back on systems that are designed to extract value from you, not create it. 'If you really want to change the system, you do have the power to do these things,' Cuban said. Read Next: Deloitte's fastest-growing software company partners with Amazon, Walmart & Target – UNLOCKED: 5 NEW TRADES EVERY WEEK. Click now to get top trade ideas daily, plus unlimited access to cutting-edge tools and strategies to gain an edge in the markets. Get the latest stock analysis from Benzinga? APPLE (AAPL): Free Stock Analysis Report TESLA (TSLA): Free Stock Analysis Report This article Mark Cuban Says Taking Low-Premium, High-Deductible Plans Is Great For Insurance Companies. 'You Know Who It's Not Good For? You Guys' originally appeared on © 2025 Benzinga does not provide investment advice. All rights reserved.
Forbes
3 days ago
- Business
- Forbes
Are Drug Prices Really The Problem Behind American Healthcare Costs?
The U.S. healthcare system is the best in the world for complex care. We have the most innovative drug companies, the best medical devices, and incredible doctors and surgeons. The U.S. healthcare system is also the most expensive system in the world. One key component of the medical system that has long been a point of contention is drug prices. U.S. drug prices are extraordinarily high compared to the rest of the world. The exact same medication that's sold in the United States is often sold overseas for a fraction of the cost. This pricing disparity has long been a point of consumer dissatisfaction, but elevated inflation and recent executive actions are putting the topic of drug prices back under the microscope. The history of drug prices in the U.S. and the way in which they've risen could be a much longer essay than the article we are writing here – but there are a few key points that are worth discussing. In particular, we want to call out how the industry has shifted over time to pull pricing power away from the drug companies and to put the power in the hands of insurance companies. The shift involves obvious conflicts of interest, but there are also significant nods to potential efficiency gains and economies of scale. The issue is nuanced and it's difficult to pinpoint what the right balance is to ensure we have access to the best medicine, at reasonable prices, without stifling innovation. If there's any single culprit behind high drug prices, it has to be pharmacy benefit managers (PBMs). For decades, PBMs have quietly amassed power in the U.S. healthcare system. They are the penultimate corporate middlemen - negotiating prices, controlling formularies, and ultimately determining what shows up on your insurance plan's covered drug list. Their influence on drug prices has grown substantially as their parent companies continue to acquire and vertically integrate specialty pharmacies, provider networks, and rebate aggregators into their business models. If you don't know what any of those things mean or how they interact, don't be discouraged. The opacity of the business model is one of the key components that allows PBMs and their parent companies to generate profits and keep drug prices moving higher. So, what is a pharmacy benefit manager? Decades ago, as employer-sponsored health insurance grew to be more complex, insurers needed help managing drug benefits. Patients needed access to a growing number of drugs, and insurance companies needed to know which ones to cover. PBMs emerged to fill this administrative gap, acting as intermediaries to process claims, negotiate pharmacy contracts, and provide 'formularies' - lists of drugs that would be covered under an insurance plan. The job of a PBM, on paper, is to help health insurance plans manage the cost and utilization of prescription drugs. Simple enough in theory – the PBM sits in the middle between doctors prescribing the drugs, pharmacies distributing the drugs, and the insurance companies who are paying for the drugs. Put simply, they were making sure everyone is on the same page. Over time, the economics evolved. PBMs began to consolidate, preaching that bigger scale meant more negotiating power with the drug companies to lower list prices, which in turn meant better deals for the insurance companies and for the end patient. Unfortunately, increased bargaining power also leads to potential conflicts of interest and more opportunities for PBMs to drive profits towards their own bottom lines. Drug companies know that they're going to have to pay the PBMs to get their drugs approved and put on formulary lists. Without being on a formulary list, that drug isn't going to be covered by insurance, which means nobody is going to use the drug. That's where the shenanigans start. Drug companies actually end up being incentivized to increase drug prices, knowing they're going to have to give rebates and concessions to the PBMs. This rebate system ultimately ends up being the biggest conflict of interest, and the biggest hurdle to affordable drug prices. PBMs are supposed to put drugs on formularies because they're effective for patients, not because they're getting big rebates from the drug companies. But you can easily see where the PBM might start to leverage their situation to make a profit. The higher the list price of the drug, the bigger the rebate, and the more potential earnings for PBMs. The PBM has all the leverage, and crucially, end patients aren't really part of the savings equation. And, as if that wasn't messy enough, the PBM's potential conflicts of interest get even messier when the PBM isn't an independent company. Over the years, there's been intense consolidation within the PBM market, with the three major players - CVS, UnitedHealth, and Cigna - now controlling more than 80% of it. Notice anything about those three companies? All three of them aren't really known as being PBMs. They're all actually insurance companies. That's right, the companies who determine what medications are covered or not covered are the same companies who are paying for the medication. If United Health goes to a drug company and says, 'pay us a bigger rebate' and we'll make sure that your drug is on the list of approved drugs for our patients, it's hard to see a scenario where the drug company says no. Tracking the flow of money tied to a single drug transaction can be incredibly complex, given the many interrelated players. Take, for example, a patient buying insulin at the pharmacy. The pharmacy first purchased the insulin in bulk from a wholesaler, who bought it from the manufacturer. Before the pharmacy can even sell the drug to an insured patient, it has to be approved for coverage - placed on the formulary - by the PBM. The PBM is probably only putting the drug on the formulary if they're going to get some rebates from the drug manufacturer. The patient also likely needs to have a prescription for their drug, which means they needed to talk to their doctor – someone preapproved as being in network by the insurance plan. The patient not only pays premiums on their insurance, but then also has to pay a co-pay at the pharmacy when it's time to buy the drug. Given that the pharmacy might be owned by one of the large insurance companies, the co-pay is likely a source of profit for the insurance company as well, either directly or indirectly. If that all sounds confusing, it's because it is! The integration of so many players under one umbrella creates enormous complexity. Of course, the vertical integration of insurance with PBMs and physician groups could also provide scale-based efficiencies. It's natural for these companies to combine like this. Scale brings benefits when you're trying to make sure patients have access to different kinds of doctors, and scale is a huge factor in reducing the cost and risk associated with insurance pools. And theoretically, larger groups should have more bargaining power to demand price cuts from the drug companies. Unfortunately for the insurance companies though, the vertical integration has made it hard for them to redirect the blame for rising costs towards anyone else. In an effort to lower drug prices in the U.S., President Trump recently issued an executive order promoting the Most Favored Nation (MFN) pricing model. This policy aims to align what Americans pay for certain medications with the lowest price paid by other developed countries. The move faced immediate pushback from both drug manufacturers and the parent companies of PBMs, who stand to lose significantly if list prices are slashed. Remember, the rebates the PBMs get are generally going to be higher if the list price for the drug is higher. In our opinion, the move to shake up drug pricing is misguided. The current practice of localized pricing works to find an equilibrium between maximizing access to the drug while also maximizing the drug maker's ability to generate a profit. Artificially lowering drug prices in the United States by benchmarking to international prices simply ensures that the rest of the world has less access to our drugs, while accessibility for Americans is unlikely to change for the better. That's because drug accessibility here in the US is a function of not only price, but also of formulary design and insurance coverage for the medication. Lower list prices could end up meaning smaller rebates and reduced incentives for insurance companies to provide some sort of drug coverage. Forcing drug makers to offer their drugs at lower prices may also stifle innovation. While nobody likes paying high prices, companies need to be able to generate a return on their investment in order for a project to be viable. Keeping that incentive system in place is important. Fortunately, the executive order left room for negotiation; price targets for the U.S. market remain undecided. However, the implications are clear. People are fed up with the high cost of healthcare and politicians looking to garner favor with their voter bases are going to keep on looking for opportunities to attack the space. The opaque profit model and conflicts of interest inherent in the current business structure are easy political targets. PBMs have long profited from the arbitrage between inflated list prices and manufacturer rebates. If MFN-style reforms take hold, PBMs may see their margins compress and rely more on flat administrative fees rather than back-end rebate deals. Increasing bipartisan scrutiny and pressure to lower drug prices generally threaten the opacity of their business model, potentially sparking further consolidation as legacy PBMs scramble to defend market share and margins. Meanwhile, newer market entrants offering direct-to-consumer delivery - effectively bypassing PBMs - could align with the current administration's embedded directive to facilitate direct-to-consumer purchasing programs at MFN prices. Expect some form of rebate pass-throughs or the elimination of spread pricing to try to make it into a bill, both of which would dent margins, but would be substantial undertakings. The rise of rebate aggregators, entities often owned by large PBMs that negotiate rebates on behalf of multiple clients, significantly complicates regulatory efforts to trace rebate flows and the logistics of pass-throughs. PBMs, for their part, maintain that these entities and rebates in general help to lower insurance premiums and fund broader plan benefits, but Americans have grown increasingly skeptical that these benefits ever reach them. For large insurers owning PBMs - like CVS (Caremark), Cigna (Express Scripts), and UnitedHealth (OptumRx) - reform could trigger a shift in profit centers toward more stable revenue sources such as medical services, specialty pharmacy, or basic insurance premiums. But reducing intermediary involvement might also force PBMs to spin off their pharmacy operations entirely. The conflicts of interest clearly run deep in a system where the middleman influences which drugs are covered by insurance while simultaneously owning the pharmacies dispensing those same drugs. Still, reform momentum is building. Increased transparency could usher PBMs into a new era of accountability and structural change - though whether this benefits patients or merely reshapes profit flows remains to be seen. Healthcare stocks have had a rough go this year, but the system is still ripe with subsectors set to benefit from continued innovation in artificial intelligence. Playing the politics game and picking the winning PBMs and insurers is likely to leave investors disappointed, but structural tailwinds like AI and an aging population in the US aren't going away any time soon. Progress in drug discovery and genetic research has been constrained by trial-and-error methods that are extremely cost-intensive. With AI, we're entering an era where whole-genome sequencing can be done in hours instead of weeks, and AI models can predict molecular interactions with stunning accuracy. This leap in computational power means we're not just speeding up what we already do - we're enabling entirely new approaches to medicine. As sequencing becomes cheaper and more accessible, the efficacy of drugs only stands to increase. Think about a biotech firm that sequences the DNA of thousands of cancer patients. With AI, it can quickly identify recurring mutations and design drugs that specifically target those genetic flaws, potentially leading to more effective and personalized cancer treatments. As the traditional PBM model comes under pressure, new pharmacy models emphasizing transparency, affordability, and direct-to-consumer pricing could also gain traction. GoodRx (GDRX) offers cash pay alternatives and coupons that bypass PBMs. Mark Cuban's Cost Plus Drugs also aims to offer radically transparent pricing by selling drugs at cost plus a flat markup. Even Amazon has entered the arena to offer direct-to-consumer shipments and a direct-pay option that's potentially cheaper than using insurance. Amazon Pharmacy is expected to be available to over half of the U.S. by the end of 2025. Ultimately, what was once a sleepy and steady sector of the US economy is starting to become much more dynamic. Drug innovation is accelerating, and established insurer and PBM business models are coming under scrutiny. In a shifting landscape there will be opportunities for savvy investors who look for innovation and can handle volatility and uncertainty.
Forbes
3 days ago
- Health
- Forbes
Should You Be Worried If Your Doctor Uses ChatGPT?
6 years ago, I wrote a piece, 'Doctors Use Youtube And Google All The Time. Should You Be Worried?' In 2025, it's time to ask, 'Your doctor may be using ChatGPT. Should you be worried?' In a recent unscientific survey, technology entrepreneur Jonas Vollmer asked physicians how many used ChatGPT. 76% percent of the respondents answered 'yes.' According to Volmer, a physician friend also told him, 'most doctors use ChatGPT daily. They routinely paste the full anonymized patient history (along with x-rays, etc.) into their personal ChatGPT account.' My own unofficial conversations with colleagues bears this out, with younger physicians more likely to regularly use AI than older ones I think AI tools such as ChatGPT, Grok, Claude, and other LLMs can be very helpful for physicians after they take a good patient history and perform a properly thorough physical exam. The physician can describe patient signs and symptoms with appropriate medical precision for the AI to analyze In particular, the AI can frequently suggest diagnoses that would not otherwise occur to the physician. For example, Vollmer noted that in a busy urgent care clinic, a patient might be taking some 'alternative medicines' with unusual side effects that might not be widely known in the traditional medical literature, but have been discussed in recent online articles and discussion forums. Thus, ChatGPT acts as an extension to a good physician, not a replacement. As always, the physician has the final responsibility of confirming any novel hypothesis offered by the AI with their own human judgment, which might include running additional tests to confirm the diagnosis. We've already seen non-physician patients report how ChatGPT made a diagnosis on themselves or loved ones after stumping doctors for years. And there are multiple studies showing that AI tools like ChatCPT can be surprisingly good at diagnoses when offered patient case reports. Of course, physicians need to be careful to adhere to all relevant medical privacy laws in their states/countries. And they may even consider getting explicit consent from their patients ahead of time to run their (anonymized) data through AI. Currently, physicians are allowed to seek second opinions from fellow doctors all the time, as long as privacy rules are met. The same guidelines should apply to consultations with AI. In many ways, this is comparable to how AIs in driverless cars perform comparably to human drivers. Driverless Waymo taxicabs in selected cities like Los Angeles perform as safely (or better) than human drivers in appropriately restricted settings. Tesla owners who use the self-driving mode can rely on the AI to drive safely most of the time, although they still have to be prepared to take control of the wheel in an emergency. Robot cars are not yet ready to replace human drivers in all settings (such as icy Colorado mountain highways in wintertime), but they continue to improve rapidly. Similarly, we may soon reach the point that a physician who does not use an AI consultant to double-check his diagnoses will be considered practicing below the standard of care. We are not there yet, but I can see that coming in the next few years. Summary: Tools like ChatGPT can be enormously helpful for physicians, provided that the doctor retains ultimate responsibility for the final diagnosis and treatments, and respects the appropriate privacy rules.
