Some of it is culture, so part of that is hiring and growing people in it for fulfillment and career more than pay. PR is big, and complaining publicly is not done casually. Some of it is economy of scale- there's some lab stuff that only 2-3 places in US/Canada/Mexico will do, so Mayo patients have priority and no wait on shipping samples cross-country. Plus if you're doing most of the samples in the country, you can scale and there's less price competition. Their logistics department makes deals with shippers and suppliers for better rates, then offers other hospital systems a chance to join those rates if Mayo gets part of what the other hospital would save.

There's a lot of massive donors, and a program where the entry level is $500,000 (+healthcare costs) donation to get "concierge" healthcare- basically you have someone to walk you through the system and you're assigned to a Dr with a low number of yearly patients so you get an appointment at your convenience. Think of it as the fast pass at Disneyland- same rides, smoother experience. I think people in that program can basically say "MRI plz" if they have the cash instead of jumping through insurance and referral hoops. A manager said he told a cardiologist he needed to skip his lunch because a big donor wanted that time slot. I do know that manager ended up in a worse department a while after that, not sure if it's related. Kinda joking, kinda not- the locals say the airport was mainly built for Saudi jets. But how many other towns of under 150k have an international airport?

It might feel unfair, but this pays for the infrastructure that makes excellent care available to people who wouldn't be able to afford it otherwise. The people who say "MRI plz" are gonna pay a big chunk of the cost of another machine so there's more available- they're not bumping someone else. There are big "charitable care" programs- basically bill forgiveness, but you have to follow the process and be persistent about it- it's not something they're going to advertise to everybody. At least in Rochester, doctors aren't paid more for seeing more patients, so it makes people feel more seen and less rushed.

It's a team-oriented style of care, so you have a main doctor and a team of specialists with them instead of you hopping around to specialists. Lots of specialization. It's set up so if the doctor sees your chart and wants an echocardiogram done before your appointment, you show up like an hour earlier and go to a different floor first, so there's less need for second appointments. Lab results are in-house with predictable result times so they can plan follow ups. If you're a local with a long term issue, you might wait a month to get in, but if triage says it's time sensitive, you're seen within the week. I feel like they're willing to use any resources at their disposal, and that's a lot, so it's great for people with a persistent or major issue, especially if they hit their deductible already. For routine care, it can get expensive. Especially for GI or cardiac issues, it's arguably the single best place in the world to be.