> The gold standard is probably Kaiser for CA residents.
I love your post but I almost shat myself when I read this. Kaiser is convenient but not top ranked in much. The gold standard is a PPO that lets you go anywhere (else) you like incl. top specialists + a membership primary care network like OneMedical for convenience.
(By the way, I support Medicare4All. Good healthcare shouldn’t just be for wealthy FAANG engineers and even for us the system still sucks.)
I was going to say the same thing. Kaiser (KP) is a "full stack" healthcare provider, which means they save money by being vertically integrated (healthcare payer + provider). The downside is that it means you get very little choice of your doctor, the hospitals you use, etc. I had both KP and UHC, and UHC was far better (more specifically UHC + the providers I chose).
I think the only reason people consider it a gold standard is because they market it really well (especially in the bay).
Kaiser varies significantly based on which center you end up in. I've heard very good things about the Redwood City location and very bad things about Santa Clara. There're probably similar variations among its other hospitals. YMMV.
I've been on various Anthem PPOs of varying quality (Google's covered basically everything with zero copay or deductible, their individual plan wouldn't even cover my PCP, my wife's plan was in the middle but getting progressively worse). There's a convenience/flexibility tradeoff. With Kaiser you know that they'll take care of you but you don't have a lot of flexibility or recourse if your particular needs don't meet what they offer. With a PPO you have a lot of flexibility to choose the best providers available, but you have to fight with the health insurance company for a lot of things, and the administrative hassles can be a huge burden.
I’ve heard bad things about both their Santa Clara and Redwood City locations. I’ve also experienced bad things in their RWC location. For example, I was always exhausted and I requested a sleep study. What I got from Kaiser was a crappy take home gadget that detected no abnormalities in my sleep. When I switched to PAMF, I got a real sleep study in a lab. They were able to diagnose breathing and snoring issues within 30 minutes. There are more stories from both coworkers and friends. Save yourself a headache, pay more for a better provider
The only advantage Kaiser has over many health care providers is price.
For actual healthcare outcomes, Kaiser will outrank most PPOs. Because Kaiser is an integrated health system, they are highly incentivized to actual improve outcomes. PPOs might feel better to you (because they let you have choice and freedom) but I strongly suspect that from a purely what's best for public health is systems like Kaiser. A patient's sense of satisfaction with their healthcare is rarely correlated to outcomes. For example, I worked with healthcare data and we were developing quality metrics and we found for a lot of providers had a negative correlation in metrics to their review scores. I.e there are tons of doctors with high reviews who actually perform quite badly in terms of outcomes. We strongly suspected these are doctors who have good communication and empathy skills but weak clinical skills. I remember looking at malpractice studies and seeing something similar. As a doctor, the probability of getting sued for malpractice is driven by your bedside manner and NOT your clinical outcomes. Essentially, we've found that a doctor with bad clinical expertise but great bedside manner will get sued more than an amazing clinician who has bad bedside manner.
It's a slipper slope if you think your anecdotal satisfaction with your medical provider is a metric of how well the system takes care of you. Unless you are looking at outcomes at a population level it's really hard to see what's going on.
I will say (as others have noted) that Kaiser's mental health support is terrible, but there outcomes outside of that are very strong (if not best in class). They were frequently studied in my partner's master of public health, because of their strong outcomes.
Also don't underestimate the power of primary care in the heaths system (patient's tend to skip primary care visits in PPOs). Many of the life threatening issues my partner sees were caught only due to a primary care visit which exactly why systems like Kaiser are effective.
This type of post is a pet peeve of mine because you use terms like “data” and “anecdotal” but it’s actually a poorly supported argument. This happens too often on HN. It’s certainly true that primary care visits improve health outcomes, but you offer no evidence that people get more primary care at Kaiser. Meanwhile the most significant rankings are not only patient opinions but rather systematic reviews of outcomes, expert analysis and objective metrics. Newsweek did one such ranking that put Kaiser behind 4 other hospitals.[1] US News puts UCSF ahead of Kaiser in many aspects and specialities.[2]
When you need a brain surgery or cancer treatment, you’re definitely going to “feel better” having “choice and freedom” to go to the best.
OP and myself were discussing Kaiser as a health care plan. The ranking you showed was about hospitals not health care plans; a health care plan and a hospital are two completely different things. I also never said Kaiser was the absolute best in every area (I even mentioned their mental heath is very weak), just that their model is solid.
> It’s certainly true that primary care visits improve health outcomes, but you offer no evidence that people get more primary care at Kaiser.
Again, I worked with claims data where we could analyze primary care utilization and kaiser was significantly higher than most PPOs in our systems (and high in general). We specifically built an email targeting patients who did not visit their primary care doctor in the last year and Kaiser was at the bottom of numbers because of the high usage. There is definitely a lot more research you can find studying Kaiser's integrated approach and how it related to primary care usage. Kaiser is pretty good good at preventative care, primary care usage, and some chronic care management.
> When you need a brain surgery or cancer treatment, you’re definitely going to “feel better” having “choice and freedom” to go to the best.
Again, I've outlined research showing outcomes and quality metrics showing Kaiser is pretty solid. Their primary care usage is higher than other health plans, and there are quality metrics and research showing they are pretty good at preventative, primary care, and chronic care management. There are definitely gaps, but from a population level outcomes, they perform at or better than many PPOs given their costs. If you take a step further and look at the economic ROI of their plans, they definitely outclass most PPO and HMOs.
It's not like they have that much secret sauce, the main advantages they have are the same ones a nationalized system has (being integrated aligns incentives better).
> If you take a step further and look at the economic ROI of their plans, they definitely outclass most PPO and HMOs.
You moved the goalpost from “healthcare outcomes for tech workers” to “economic ROI given their costs”. This is what I mean by poor reasoning.
Sure, Kaiser is a good bargain. Lowering costs means more people get care vs don’t get care. It is not the “gold standard” when premiums and deductibles are not an object, like a tech workers company sponsored plan.
> OP and myself were discussing Kaiser as a health care plan. The ranking you showed was about hospitals not health care plans;
This is a bizarre retort as Kaiser generally locks you into their hospitals. Clearly we’re arguing different things.
I love your post but I almost shat myself when I read this. Kaiser is convenient but not top ranked in much. The gold standard is a PPO that lets you go anywhere (else) you like incl. top specialists + a membership primary care network like OneMedical for convenience.
(By the way, I support Medicare4All. Good healthcare shouldn’t just be for wealthy FAANG engineers and even for us the system still sucks.)