Part of the problem is awareness on the part of providers. I had no idea that even outpatient imaging at most academic hospitals is more expensive than that done at imaging centers. I had always just ordered them within my health system because it's easy to do, I trust the radiologists here, I don't have to rely on the patient to get the disks transferred over and uploaded into the system, and because I didn't know there was a significant difference in price.
And I don't have the first idea how to figure out what things cost for my patients. I think there's maybe some way to find out the sticker price of an individual test (though that isn't easy either) but since that's almost never what the patient's actually going to be expected to pay for it, this doesn't help me figure out how much it impacts my patient.
3
A number of years ago my son fell and hurt his wrist. I took him to his pediatrician, who thought it was pretty likely my son's wrist had a small fracture. To be sure, an X-ray was required. The doctor sent us to the local Children's Hospital. The hospital was in our insurance network, so I went ahead and took my son there. I did know my insurance plan had a high deductible, but I had no idea how much an X-ray could cost.
Color me shocked when I got the bill for $475! That was my discounted price, too! This was an X-ray, not an MRI and it was almost 10 years ago. I gave my son's pediatrician a bit of a hard time when I took my son in for his follow-up appointment a few weeks later. By that time my daughter had slipped and twisted her ankle on the edge of the sidewalk. I knew not to take her back to the same doctor. My podiatrist had an X-ray machine in his office, so I took her there. His charge was a mere $75.
The pediatrician told me the radiologists at the Children's Hospital were better at reading X-rays of growing bones. For a difference of $400, I'd take my chances.
3
@Marie Here is the entire article in one comment. Marie chose the risk of lower quality care for her child to save some cash. Plenty of anecdotes where this turns out OK. But across a population, a podiatrist reading your kid’s ankle X-ray will work out poorly with some frequency.
1
Several years ago when I was without health insurance I went to the financial aid office at my university hospital and requested a price list. Well, I was told that there is no price list.
As this is a relic of our health insurance system, the least that could be done is legislate some uniformity on perhaps a state by state basis. It's the capitalist way that dictates our health insurance system. If I can compare prices on auto tires, I should be able to get medical care prices on demand. I have good insurance now but I would still seek out the lowest prices because I don't feel entitled to luxuries that most people can't afford.
3
What's ridiculous is that we even have a system that requires "shopping" for an essential service like health care. And it's more complicated than one would think.
I developed sudden sensorineural hearing loss in one ear and required an MRI to rule out acoustic neuroma (a type of tumor.)From the excellent website clearhealthcosts.com, I was able to obtain estimates for the cost at various MRI providers.
However, I soon realized that many of the facilities only offered 1.5Tesla MRIs, which have a lower resolution than the newer 3Tesla MRI. To visualize a tiny (maybe only a millimeter or two) tumor on the acoustic nerve, it is best to have a very high resolution scan which is facilitated by the more powerful 3T magnet. It's no surprise that these scans, on newer, more modern equipment, cost more. But what is the cost of missing a tumor, or having to repeat the scan due to insufficient resolution?
So it's not that simple. I was able to suss this out because I have a nursing degree. I chose the more expensive, higher resolution test and luckily, it came out negative.
I shudder for the less sophisticated health care recipient who may not possess the education to navigate these complex decisions.
4
How many people in this study did't have insurance or had spent some time when they had that experience because they would no how to shop.
If single payer plans were high deductible plans they would not cost $32T over 10 years like Medicare for all. If we could provide every American with such a plan and then take the payment for care, while we are paying out-of-pocket, and put that $1 Trillion dollars of spending into a transparent, free market we could make healthcare affordable.
There is no reason why private insurers should be burning our money, administering the payment of low dollar routine care and testing when we should be paying with cash or credit. The cost for that is easily $300B-$400B / year.
Here is a reform plan that restructures healthcare along those lines.
www.theintelligenthsa.com
I've tried to shop on price for health care, and 90% of the time can't get a price quoted. And when I have had a price quoted, it's not been honored.
7
European countries manage to cover -everyone- through various mixes of national health care systems, insurers, fees and taxes. None of them are perfect; they all have tradeoffs, e.g. less of a personal doctor patient relationship, delays in treatment, limits in what's covered and what drugs are available.
However, they do it for less per person and a lower fraction of the GDP. Their people live longer than we do. And again, they cover -everyone- - rich and poor, employed and unemployed, even citizen and non-citizen.
So, they've picked their bundle of advantages and disadvantages, just as we've picked ours. I'll suggest that ours is a particularly poor set of choices for reasons that this article highlights.
For instance, choice works well in markets for discretionary consumer goods. It doesn't work so well in markets for services (look at all the queries for "someone who's really good at ___"), and works even worse for medical services, where services aren't always discretionary (you can't go without an operation when you appendix is inflamed or when you're seriously injured in an accident), where neither the quality of the service nor its price are clear, and where serious permanent disability or death are among the outcomes.
Of course, bearing arms is a right here, but adequate health care is not.
6
No system that costs as much as 30% of U.S. payroll for every man, woman and child is remotely effective or rational.
2
Luckily I had few medical problems before I turned 65. Now for five years all the prices for procedures are set by medicare. You need to require medicare procedure numbers on all your medical bills. Look them up on the medicare web site and confirm that was the service(s) provided and then match it to your insurance notification. I don't mind paying for the services my insurance doesn't pay for but I want to make sure I am paying for the procedures I received.
Recently had an MRI of the knee; when I was discussing the results with the radiologist, I was gently informed that, in the future, I should be aware that that location had an MRI known for giving less sharp images. How do patients shop for quality and price? I doubt the ordering physician is always aware.
3
@DJN I’m a radiologist who specializes in musculoskeletal MRI and there are huge difference between MR scanners and facilities. It is so irksome to always see one of the most new technologically complex exams we do used as an example for this kind of drive to the lowest price.
There are low field magnets, 1.5T, 3T and all sorts of iterations and options. At my facility, a famous midwestern acadmic health center we are asked to look at many exams done elsewhere and we often have to include comments in our reports of those studies like “the exam is of poor technical quality”. The problem with all kinds of imaging studies is that the insurers , private or government, don’t pay for quality -a crappy unreadable MRI still is paid for by insurance or counts toward your deductible. I wish that patients would care about that as much as the price.
3
@Me
Good point - but only in principle.
In order to make the right choice the consumer needs INDEPENDENT data to gauge whether the image quality of the chosen provider is going to be good enough or not. In the absence of these comparative data, even I as an MD would not be able to know beforehand whether the data quality is good enough to make a tricky differential diagnosis or not.
Sure, one could say that one should always use the most recent and most modern instrument available, but that means that the amortization costs will increase tremendously, making the exam just that much more expensive for everyone.
We are caught in a spiral of ever increasing technological improvements and consequently cost. That the overall medical benefit does not proportionally increase is being forgotten. We are talking about the very tip of the iceberg of diagnosis for which these technological shenanigans are actually required. And we are only reading about the 0.1% of the cases in which a diagnosis may have been missed because the most cutting edge technology had not been used.
Sorry, that is just not sustainable! The vast majority of unfavorable medical outcomes is caused by too many people not having ready access to the most BASIC medical care, not because they do not have access to the most ADVANCED diagnostic procedures.
1
As a primary care physician myself, I can tell you this is a very complex issue. As other physicians have written here, we are indeed concerned about cost both for our patients and for the system as a whole. But this is not a true free market model where pricing and competition truly work. If there was a true single payer type system where everyone was covered then there would either be a set price, or, price competition for a facility to be listed as a "preferred provider". Similarly, if health insurance direct payment to facilities was eliminated altogether, (where insurance would instead reimburse patients for what they spend up front), this would put huge price competition on facilities and consumers alike. (watch the cost of a procedure come way down in such a scenario). With the current mixed and very confusion system , facilities often have no major motivation to compete for price, and frankly patients still often have no motivation to shop around for it either.
1
@dbm Why can't private insurers be removed from financial transactions made while we are paying out-of-pocket. We do not need insurers in the middle of every transaction when they are not even paying the bill.
This would save the insurer medical loss cost, provider's cost for billing through the system, and eliminate most insurance fraud on low dollar transactions. It would free insurers to do what they do best which is to administer complex, high dollar claims.
@dbm
This would cheat the medically uneducated consumers, i.e. the vast majority of Americans and lead to excessive denial of insurance coverage. Not to mention the days one would have to spend on the phone arguing about reimbursement, which may or may not be granted.
This is the worst! No, we need a single payer system that pays for all essential medical care with OPTIONAL additional private insurance available for those who cannot live without the bells and whistles. Then we will see how many people really want to cover that additional cost. Right now, the only choice is nothing or something that may not be sufficient when disease strikes or something that is so expensive that too many people cannot afford it. That's like playing Russian roulette!
2
I agree that having transparent pricing would help physicians direct patients to cost effective care but we are in the dark most of the time too. As a family doctor, we try to spend our patients money wisely for them (learned a lot in guiding uninsured patients and bracing to go back to high rates of lack of insurance again). High penetration of primary care does improve cost effectiveness of money spent vs quality outcomes in medicare data. Physicians do care about costs but do not have the info other than insurance preferred provider/sites but most comparative non prescription info is not clear when insurance is included.
@ctg As a doctor would you provide a discount to patients who pay with cash or credit card? What is your cost for billing through the insurance system?
It is long premature to declare the ineffectiveness of shopping around for care. As mentioned in many other posts, healthcare facilities often can't get you a consistent quote until you've actually had the procedure. The comparison tools mentioned in the article are often inaccurate, which is not surprising when a facility doesn't have a consistent price. Lastly, most patients are not aware of the price comparison tools there are. I point out our comparison tool to my patients all the time, and I've yet to have a patient who knew about it before I told them. Until people can really see and compare prices, and until they get used to doing that, we can't declare the ineffectiveness of shopping around.
How can you expect anyone to shop on price when the name of the game is to OBFUSCATE the price? People blame the insurance companies and they are not exactly transparent since they sell hundreds of different policies across the country. But the healthcare industry is not any better: they are basically using pricing tactics that Uber and the airlines to squeeze money out of the system.
The U.S. system is completely busted. It is time to start over.
4
@Larry L start with this?
www.theintelligenthsa.com
high deductible single payer + free market for out-of-pocket expenses.
As much as most people didn't want to believe,
Obamacare was a starting point for some of these
issues. Self-employed for 20 years, sole proprietor,
put over 2,000,000 into economy and still no
healthcare system that can work for us in mountain
west region.
1
@coloradok, Obamacare began in 2014.
These problems are already severe in 1997, when I broke a toe and asked about prices more than once, and still got surprised and burned.
Most of the time a receptionist at a clinic is limited to making an appointment for you and that is it. There is no profit in providing help to patients for free. All of the labor involved in trying to figure out your health care will be on your part. I can't tell you how many weeks of my life I have wasted just trying to get my prescriptions renewed. The system is deliberately not transparent, keeping you from knowing the true costs of procedures until you start getting completely unexpected bills months later.
1
I am a radiologist (I interpret studies such as MRI) and would add not only is it true that most patients do not know the price differences between facilities, but in most cases the referring doctors themselves are not aware of these differences or what is charged by providers. Price shopping-and measuring whether it's impact is or is not meaningful-would only work if patients had to bear the much or the full cost of their care or procedure-which is almost never the case. Insurance companies seem to have no problem paying wildly different prices for the same procedure, so why should patients behave any differently?
2
@rs then restructure the system so the financial benefit of shopping for pricing accrues to the patient. Then stand back and watch 200,000,000 motivated consumers bend the cost curve down.
A statistic is a collection of anecdotes. Some of the anecdotes will differ from the average. Let people shop who want to and can, even if most don't, rather than impose one-size-fits-all on diverse people. "Doesn't work for most people" differs from "doesn't work."
And sure, let doctors and insurance companies help with shopping. Prices convey information, so messing with prices tells lies.
And shopping may not be my favorite thing to do. President Obama promised we could keep our insurance plans and our doctors. Even if breaking his promise forced some people to find an actually better plan, hunting for insurance may not have been what they wanted to do, and the breach of promise, even if beneficial, was a vile tyranny.
@Andrew Lohr
You have to work pretty hard, and sink rather low, to justify your apparent faith in the present Liar-in-Chief.
1
The article is as off the mark as the patients it is criticizing. Neither quality, nor cost, are known to the patient. Even if the patient were to get the cost information as suggested, quality would remain a mystery. And quality is far more complex than this article would make it out to be. In the MRI example discussed, it is absolutely true that the 5 cheaper centers the patient passes en route to their exam could also have wildly different quality, and there is no way to really know which is the optimal combination of price and quality. As a radiologist specializing in MRI, I wish I had penny for every second opinion I am asked to provide, where I had to say that the exam is of insufficient quality to be diagnostic. I work for a hospital and have no personal incentive to suggest repeating the exam. The reason these studies are seldom repeated is *not* because there is no quality difference, but because the ordering physician may not know the exams are low quality, and/or because repeating them will most likely be denied by the insurance and the patient/hospital/both will be stuck with the fallout.
The problem is a that healthcare does not behave as a normal market, which relies on the customer having knowledge of cost and quality. We need a pay system that considers both. Insurance companies are currently incented to assess only cost. The system will remain broken until we try to understand both.
8
@Freaky While it may be true that there are differences in the quality of the scans produced by radiology centers it's also true that those differences in quality are disconnected from pricing. In the world of medical testing high pricing does not equal high quality.
2
I recommend Consumer Reports for expert *and*independent research & recommendations. Notably, website CR.org also offers public services such as its "Patient's Financial Bill of Rights". P.S. they only ask $10/year for "membership" which gives you full online access to every level, filter, comparison etc. of its main product evaluations – from air conditioners to automobiles, and everything else including your ability to vote on officer-type operational matters.
1
@WmJMarston LEED AP
Sir:
Yes, CR.com is a good tool. It is not the only tool to be used when your health care is at stake.
I consider myself fairly well educated. So when my pulmonary doctor told me that I needed an MRI, I did the cost research.The costs ranged from the local hospital (where he has medical privileges), a fee of $800 +, to Colombia University Medical Center, $600+, Mount Sinai, $500 +, North Harlem Hospital $300+, an outpatient MRI center, $250+.
I chose Mount Sinai- the least costly NYC teaching hospital, but mid-range...
- I have a $100 copay.
- I have an allergist at Mount Sinai.
I am a college educated, mid-level Sales Director working full time in NYC- my company offers Blue Cross or Oxford through United Health Care.
- United Healthcare is a 'gatekeeper.'
In this day and age, one needs more than one tool in their tool box to make an informed decision.
PS I used to have Aetna individual healthcare, but they stopped offering the premium in 2013, staying ahead of the Obamacare initiative. Yes, this young baby boomer I went back to full time work to ensure that I have healthcare options.
@WmJMarston LEED AP
I just went online and saw a digital membership fee of $35. If this simple exercise showed a discrepancy, imagine navigating the medical bureaucracy like we're supposed to be able to do. Good luck everyone...
Part of teh problem is even the price you see is not what the insurance companies pay. You do the 20% copay on that amount and they may pay 50-60% of the remaining amount. Unless someone is a skilled negotiator one should never pay cash. get insurance.
1
@GUANNA It's a lie that insurers save us money. Often if you pay in cash you will pay less even accounting for the "discount" that the insurer claims to have negotiated for you.
For those of us with insurance the deductible is the same regardless of the total price. So what we if we shop for a loer price it is to save the insurance company not us. Admittedly that would lower premiums in the long run but only if everyone did it. And lower premiums means less profit for the insurance company as the ACA has a maximum that administrative costs can be.
Time for single payer.
3
@Adrian L
In a system with a high deductible single payer plan, the savings you negotiate would be yours to keep on the money you spend out-of-pocket before your deductible is met. So except for years when you have very high costs that's all the money you spend.
before the ACA I was 5 years without insurance of any kind. I had a good doctor who charged me $50 a visit, and sent me to an affordable lab.
One day I needed a knee exray. I asked about the most affordable place, and no one had any idea, so I went to recommended facility. As I checked in I asked for pricing up front, to make sure I could pay for it. The admin was confused. We don't have that information, she tells me. I pointed out the sign that says "all co-pay is due at time of service." I explained I had no insurance. She frowned and went to ask about this.
Upon return she quoted me nearly $400, and I confess I teared up, because, you know, ouch. Her colleague came by and asked her if she'd consulted such-n-such a manual. She hurried off to get it: a large loose-leaf tome. Flipping through poorly organized material, she eventually zeroed in on the procedure. a bit more puzzling over and she said that the cost was now $55, per knee. I said fine, that I can pay. We went ahead with the exray. The tech shot both knees. the desk charged me $55. **sigh**
7
@Patrise Henkel I had a similiar experience except with an EKG. My doc told me to go downstairs (at the hospital) and they told me it would be $550. I went back upstairs and my doc called a heart specialist in the building who had an EKG in his office and he charged $50.
Patients would be happy to shop around if the financial benefit of shopping around accrued to us instead of our insurer. Restructure the healthcare system like that and things will change.
Here is a reform plan that both conservatives and liberals could love. free market + single payer
www.theintelligenthsa.com
2
In the US, it's too hard for patients to find the exact price for a procedure. There is no price transparency for healthcare because hospitals have to sign a non-disclosure agreement with insurance companies. Without the price information, we simply do not have a free market for healthcare, which all humans need.
7
@Ed You have that exactly right and this point needs to be made more often. Because they are not transparent, you actually are more often surprised by high health care bills than not, even when you do all you can to figure them out beforehand. I did not know that there was an NDA involved, but of course, because they are for-profit corporations, not entities that care about your health.
2
The mailings i receive from my health insurer explaining what they are paying for, what i owe and the supposed care provided are unintelligible to me (I have a graduate degree). I couldn't spot an unjustified expense if i wanted to, which makes me wonder, what sort of forces are at play? Is anyone truly happy with the status quo? And if the answer is no, why do we maintain it?
6
@M Because big PHARMA is one of the largest donors to political candidates and politicians. Our politicians put corporate profits over the health of American citizens because the DONORS PAY THEM TO. We must reform campaign finance laws.
@M We are paying for those mailings, 33 cents out of every dollar we spend goes for private insurers to administer the payments + the doctors cost for billing through that system. It's insane.
My oncologist scheduled an MRI in his hospital. He said he would get the results very quickly. He wanted to pencil in my surgery date before I even got the MRI. He told me we need to move quickly. I had this done today and am waiting to hear. Price shop? It already took me 10 hours to find a Dr. who would take my insurance and was available before October! I hate this system and I hate this country for allowing this system. I am most afraid of the financial and professional devastation that are possible.
12
@CEN My doctor recommended a CT scan on an emergency basis. I did it at an associated hospital facility that I already knew the location of. I was worried enough about the mass in my abdomen without navigating halfway across town (I have no sense of direction and driving stresses me out). Got home from the procedure, had about a dozen messages from my insurance company recommending "discount" imaging facilities 45+ minutes away. Where it actually would've cost more, I found, once I got my final bill! Anyway, didn't matter in the end as there was surgery scheduled and a 5-figure hospital bill the insurance company was on the hook for after I got my diagnosis (thankfully just a fibroid) so I blew right through my deductible and the CT scan could've cost $500 (like it actually did) or $7800 like I was initially billed (before insurance) and it wouldn't have mattered. Anyway, best of luck to you.
1
In 1990 I had a very specialized brain surgery, in a city 60 miles from home. In the aftermath of insurance paperwork I discovered a $2,500 debt remaining after all claims were paid. Why? Neurosurgeon’s fee was “beyond reasonable & customary.” I was supposed to find a CHEAP brain surgeon? Huh?!? We’ve clearly made no progress in the intervening 28 years.
3
I know of an MRI Center in Georgia, First Look MRI, https://www.firstlookmri.com/ which has a business model of pricing transparency. Someone should do an article on that and maybe there will be a Healthcare revolution if others follow their lead.
3
Only the NY Times and Austin Frakt would pretend that the idea that shopping for a cordless drill or washing machine was ever thought of as a process similar to getting an MRI scan.
Does Frakt really mean to imply that people shop for a fire department to call when their house is burning down?
6
@Yaj Shopping for an MRI scan or a lipid panel is exactly like shopping for a TV. Except the TV decision is more complicated. There is no connection between the quality of an MRI and it's price.
How often does a clinic visit wrap up with "Let's get an MRI, just to make sure"?
Can't think how many times I've heard a provider say those words in my 30plus years in Orthopedics, nor how many patients felt they weren't getting the proper care till an MRI was ordered. The information that's wanted is how often does an MRI provide (rather than just confirm) a diagnosis, and how often is it linked to a better outcome for the patient. First principles need assessment of how useful an MRI is, at whatever the cost.
It helps neither the costs nor the outcomes of care to substitute an MRI for some other useful but more traditional (ie, less expensive) imaging study. It shouldn't need saying, but an MRI should also never substitute for a decent physical exam.
7
This is eye-roll-worthy. When we scheduled our daughter for a necessary surgery, well in advance, the hospital could not even tell us the morning of the surgery who would be in the operating room, let alone if they were all covered by our insurance, and not even touching the eventual cost of it. Our attempts to discover if the anesthesiologist would be covered yielded 6 conversations, a call to the department, and nobody knew. We had to wait for the bill to find out.
When I ask for ANY price information, I'm told it varies by doctor, insurance, and the exact procedure done. Nobody even wants to name a range. When I try to shop, I look up the covered places under my insurance and start calling them, having to call 6 before finding one that didn't change their coverage. Once I call, they have to look up the pricing under my specific insurance, and sometimes they want time to do it and I have to call back.
And you want a doctor to learn about pricing? They would also have to know your insurance, and which imaging place takes your insurance, and the deal negotiated regarding price for that place. That's not even possible, let alone feasible.
Pricing in this country is 100% opaque and shopping is completely impossible.
23
@AL Eliminate insurer participation in pricing when we are paying our deductible. That will solve about $1T of the problem and create a huge free market at the same time.
Only in America could one claim "shopping simply doesn't work" when prices are perfectly hidden from consumers. Without transparency, a functioning market isn't possible. The English got this even in the Middle Ages. Why do we insist on being so dense about it?
11
@Boltar It's a feature, not a bug. Your politicians, whether R or D have been paid millions by the health insurance industry and big pharma to keep it thus.
2
@Boltar Since this is "only in America" could you fill us in on how it's done in every other country in the world? TIA
You (patient or doctor) cannot get real cost data. No one has the answer. It’s just as opaque for the doctor as it is for the patient. I’m a physician, and I wish I had the information on costs, and the time to address it with patients - but frankly - I don’t. Prices are different depending on what your insurance is - that’s right - rates are negotiated with insurers. Even the billing department can’t give a simple answer in a timely fashion and are likely reluctant to share this with a patient.
Also - consider this: as an ordering provider the only reason I want you to get the image in my hospital is because that’s the place I know, with radiologists I trust - and, the report will show up in your medical record! I don’t order a study in a practice or hospital system and say ‘get it wherever you want’.
If you shop around, how do I get the images? You have to shlep them over on a CD like it’s 1995, then I have to ask for them to be uploaded and for one of our radiologists to ‘over-read’ it and get their report in our (your) medical record. This is a duplicative radiology charge so there go your savings. Alternatively, I trust the opinion of a radiologist working for your ‘imaging center’ who I have never worked with before. Furthermore, if any surgeon plans an action based on your “outside” imaging, they are likely to want another opinion with an ‘in house’ image and radiologist read before subjecting you to an invasive procedure - it’s not so simple on any front..
25
@Cal Yes! I got a CT scan at a facility in the hospital network associated with my doctor's office and she could see the results right away. Got a call from her barely an hour after I got home from the procedure, and my gynecologist (in the same network, and who ended up needing to do surgery) could also see the results easily. So the hospital scan was wonderful for my peace of mind -- no wait, no stress, just fast answers.
1
There are many reasons why a free market system is disastrous in medicine, but one is that patients are terrible at being discerning consumers. As an anesthesiologist, I can tell you that the popular, so-called “best” surgeons are often more about marketing, charisma, and social connection than skill in the OR.
Regarding MRIs: my orthopedist sent me to his place, but I was savvy enough to shop around and got one at another location for about 20% of the cost. When I told him why, he said, “you should’ve told me! We would’ve matched that!” So there you go.
7
Trump said he was going to come up with a plan. I suggest we wait until he does that.
6
@Areader This is sarcasm, right?
1
@Areader
It always advisable to wait for the most beautiful plan ever. Even if HE could not have imagined that health care could be so complicated.
If we die in the meantime, that's our problem, not that of that very stable genius.
People will never learn!
Shopping for Health Care Simply Doesn’t Work. So What Works ?
The German system - see expat Robert Keller's post
The Germans had Universal Health insurance 1883 and with Teutonic thoroughness fine tuned ever since.
So why not copy it ?
15
I tried finding costs once and had to call my insurer who then had me call the hospital who then had m call their accounting to get a tax ID to then give my insurer to tell me the price, at which point I discovered that it was th only on network option nearby so all my time was wasted.
Our system is broken! Time for single payer!
8
Whatever doctors do or do not do is increasingly micromanaged by the mostly private businesses which employ them, which generally are engaged in some version of those black box pricing arrangements that generate those obscene prices that no one wants to regulate. Single payer appears to be the most likely way this mess could be cleaned up, if only Americans had the political will to demand it.
5
The ACA, ("ObamaCare"), stinks. GOP proposed revisions stink even worse.
Here is MikeCare. It almost doesn't stink:
You know how the government pays to provide us with universal necessities like cops, education, libraries, road construction and repair, fire departments, snow removal, defense, garbage removal and the like? That's what we need in regard to medical care to make sure that everyone in the country, regardless of wealth or income, is equally covered. Just like with the other services it should be paid for using the taxes which we pay.
You go to whatever doctor you want, you pay a deductible to discourage frivolous medical visits, and the medical providers get paid according to a reasonable government schedule that is tailored to region. Medical providers who do not want to accept what the government is paying can do so by posting a notice in their offices to that effect. You either pay the difference or go elsewhere.
And that's the end of it. Welcome to the 21st Century!
9
@MIKEinNYC
i think thats called medicare.
What might? Medicare for all. Good lord.
1
On July 31st of this year ,I noticed my wife who has Parkinson's
for 18 years walking just two steps and falling down .
I have learned from past episodes of" freezing and falling"with her Neurologist that before I call that PD Doctor I must get a UTI test for my wife to rule out that a urinary infection might be making her walk unusually slow and fall which we have learned affects the elderly with our without a movement a disorders disease.
I then took my wife to our hospitals Urgent Care center where they did a UTI fast test and a culture of that urine that would show us results in 2 days, fine we were ready to go home BUT WAIT ,the ER doctor on call said Mr ._____" I want to tell you that your wife may have a life threatening infection that our Urgent Care lab cannot Dx and I therefore I urge you to take your wife to the ER for more blood work ,"I will call an ambulance immediately", I said , "Can't it wait till the morning when I can call her internist for advice ?" (this was in the evening) and he said "no ,If she has a serious infection she could even die that night" he then said "If you do not to this I must ask you to sign an AMA form "i.e Leaving our care against medical advice.
So they called an ambulance not allowing me the two block walk with her as it was their rule.
We went to the ER ,seven hours later no Infections and a probable cost for of thousands of dollars for un needed testing her issue was really dystonia which they did not test her !
4
@Carlyle T.
Sorry for the typo's ,might it be we have a pre posting edit prompt one day.
1
If I had to deal with this nonsense I'd rather move to Cuba or Mexico. Medicare makes it all go away and should be available to everybody.
4
Pay attention to this venture between Jeff Bezos, Warren Buffett, and Jamie Dimon. Healthcare is in a bubble. But, in the coming decade, healthcare prices are going to CRASH because of technology and fierce competition between providers. By 2030, there’s a good chance you’ll be able to get an MRI at a drug store using a compact machine that is better than anything we have today. Have you seen the services CVS is providing now? I put a link below. I got a tetanus shot there for less than $100. When I was growing up, we didn’t have anything like that. There are so many things I went to a doctor for that a nurse practitioner at CVS can do now. Many family practitioners are going to be put out of business and hospitals are going to struggle to compete with drug stores, online doctors, mobile physicians, and Americans going to Mexico for care in the years ahead. Mark my words.
https://www.cvs.com/minuteclinic/services
Talk about shop till you drop....
1
What's sadly ironic about your sad tale on obfuscated MRI pricing...
You don't even begin to get to the sad tale on obfuscated MRI technology...
Go ask your circle of clinical advisors on the diagnostic value of a 3T MRI vs a 1.5T MRI...
PS
For anyone thinking this is esoteric and abstract - look at smartphone technology, by comparison...
9 out of 10 of you know you better get a 5G smartphone before the end of 2019 - or risk getting left behind with a horse-drawn 4G device...
Actually, here's a more direct analogy...
Get on YouTube, and look at videos from the first ten Super Bowls, vs the most recent ten...
> Standard-definition TV, stored to a VHS tape...
> HDTV (4K, soon), stored perfectly and digitally...
If it's your home team, what sort of camera technology do you want used for the instant replays...
1
@W in the Middle Many times the outcome of fa very expensive diagnostic tool won't even determine how you are treated, so your analogy is incorrect. There is a profit motive for ordering expensive, unnecessary tests, which is exactly why health care would be cheaper if single-payer. The doctor would use whatever test was necessary to diagnose, not the most expensive and high-tech equipment that exists on Earth. That's what we need. Utility for all rather than elite health care for the upper 10%
You often hear that health care is like mo other. But you know what health care in the US resembles? The finance industry.
Shopping for medical care is like shopping for financial products: unlike the simple world of supply and demand curves, in the real world, people cannot always predict how much products will be worth to them, especially when it comes to complicated instruments like mortgages.
Plus, predicting the future is hard. How many people lost their homes because they didn't foresee that their income wouldn't cover their mortgage payments?
The result? As everyone knows, the advocates of the financial "free market" deregulated us into the Great Recession. In health care, the "free market" advocates have produced the equivalent: a system so bloated, inefficient, destructive and complicated, it is on the verge of collapse.
How do we fix it? In health care, just as in finance, we need a "provider of last resort." Guess what? That would be the government.
3
This is the legacy of the Affordable Care Act: A top-heavy bureaucracy that has done nothing but increase the cost of medical care with the burden of rules and regulations that are unintelligible and illogical to the common man.
It should be called The Unaffordable Care Act, for that more aptly describes its result. The only beneficiaries have been the insurance industry, hospitals, and pharmaceutical companies.
@Michael Blame Romney since he and the Republicans came up with it. Obama used it simply because it was the fix most likely to have some appeal to Republicans! We need single payer now. The obfuscation of costs and ridiculously complicated rules and regulations and plan information are there BECAUSE of the private, for-profit industry. If health care were not run for profit, there would be no need to try to keep consumers confused.
2
According to OECD statistics for 2017, just over 17% of health care spending in the US was needed to finance administrative costs. However, what these data don't include are the costs of searching for a health insurer and an insurance policy: Costs that are borne by consumers alone. As this article indicates, the share of of administrative costs in total health care spending would be much higher if these search costs were included instead of being swept under the rug.
3
Facts and figures: 19% of America's GDP spent on health care; 5% on defense.
The days of the 'family doctor' who made house calls, who lived in your community, who you knew tangentially through your church, your friends - your community - are gone. Americans born after 1975 or so simply do not remember what good medicine is.
"If anyone tells you medicine is a science, they simply don't know what they are talking about. It is an art - the art of knowing your patient." Knowing your patient takes time which our modern medicine paradigm has eliminated in the drive to maximize profits. Specialization is rife as it generates more 'billables'.
Ah, for the good old days, when my father's medical philosophy reigned - "the art of knowing your patient."
4
Shopping for health care simply doesn’t work? No it does, only if the doctors who work for hospitals should stop sending their patients for more expensive hospital-based imaging. People don’t know what care they need, which is why they consult doctors and rely on doctors for medical advice so doctors shouldn’t take any advantages of that. The more advantages doctors take, the fewer consumers will be. In our country too, most doctors sent patients to more expensive locations than they had to. So patients would rather drove by average of six other places where the procedure would have been done more cheaply and worth it. Moreover, it is ridiculous that there is no evidence that the quality of low and high-priced M.R.I.s differs. Health is not something to bargain about so shopping for health care simply works too.
1
Hospital charge masters are notoriously difficult to obtain. Many physicians have no idea of the cost of labs, drugs and procedures they order up. The lack of price transparency is one of the reasons healthcare costs are enormous in the US. The price “hides” behind the insurance plan.
5
Shopping for Health Care Simply Doesn’t Work. So What Might?:
Single payer healthcare.
It’s not rocket science but it seems the US won’t consider options until 25% of GDP is squandered on ludicrously expensive healthcare services. It’s currently 17% of GDP and approaching being twice as expensive as the rest of the industrialized world, while mystically achieving worse outcomes and less longevity.
19
This story is written from an Atlantic or Pacific Coast perspective. If someone is passing by 6 MRI possibilities, chances are the insurance company is paying each the same amount, and the patient is not learning the actual rate.
My husband once had a throat culture in a rural hospital out of our insurance company’s area, the only place in a 50 mile radius to have it done. He received a bill for $1200 and sent it to our insurer, who paid $69, case closed. The hospital surely wouldn’t tell him they would accept that fee.
So looking at “most people” doesn’t really explain problems with the health care market.
10
@Stephanie Cooper You were lucky, most hospitals would have tried to make you to pay the difference It is a crazy system. That test and everything else should cost the same amount no matter who is paying it.
4
The issue is that there is often no way to know what the pre-negotiated price is between your insurance company and the medical provider or hospital for an MRI (or other medical tests). After speaking with both the hospital and my insurance company for days, nobody could tell me the price for an MRI I needed and I was told by my insurance company that I would know the price only AFTER I got the MRI. I laughed and told her "that's like buying a car without telling me the price". I could hear her shrug on the other end of the line.
9
Looking online for a cost comparison site where they have a printout of MRI costs by facility. I must not be typing in the correct question because no such sites are showing up in the Google search.
Lots of general info but not pricing across individual facilities and locations in a given metro area.
Maybe this type of information is not so readily available by design. Some enterprising individual could make a lot of money if they were to create and app or a site that provided this granular level of pricing detail.
6
@medianone Look up our Medicare Benefits Scheme (the pricing for absolutely everything in Australia with how much Medicare will pay).
http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Home
MRI: Fee: $855.20 Benefit: 75% = $641.40 85% = $773.50
There is a bulk billing incentive on most services too so that providers will accept just the refund fee for low income with a health care concession card or a pensioner (this includes disability pensioners too).
There is no such thing as exclusion for pre-existing conditions and despite what you may have been told there is no 'rationing'.
Our local hospitals are world class facilities and many of our GPs (physicians) bulk bill (no out of pocket charge to patients).
All paid for from a little 2% levy on our taxable income, which is surely much less than you pay out in insurance, with hospitals covered by state taxes and the GST which everybody pays on their shopping bill.
Why on earth can a little country like ours have such a scheme when the supposedly richest country on earth has costs that send people bankrupt.
5
@Amybee
I am paying close 6% just for the insurance premium then an addition 10% to get the policy to start paying for things like Emergency room visits, required lab tests, and x-rays. Add another $2000 in out of pocket Rx costs if I want to get the $250 per month copay for RA medication instead of $500.
Still this is a step up from pre-Obamacare when I could not get insurance at any price.
@medianone Actually, you are correct--this type of information is not readily available BY DESIGN because we have a for-profit system that makes more money the less informed a citizen patient is. The private health insurance corporations use some of that profit to buy politicians that will make sure the status quo continues. All you have to do to answer questions like this is follow the money.
As an advanced practice registered nurse for nearly four decades, I can say with certainty that the sheer number of unnessary imaging studies (MRI's, CT's) ordered contributes mightily to the cost of health care for patients. Medical providers are pushed to see too many patients (more than double the number since I entered practice.) It's far easier to order an expensive test than take a detailed medical history of the presenting problem, make relevant treatment recommendations, and provide education that includes basic diagnostic considerations and the rationale for the plan of care as well as clear follow up. Such patient-centered practice often keeps me documenting and coordinating care long after the patients are gone but I know I'm practicing both frugal and ethical medicine. And patients appreciate it -- a lot!
11
I don't see how it is possible to "shop around" for the best price. If you are actually able to get a person not a computer or voice mail on the phone and ask them how much, they will say "It depends", "I don't know", "I can't tell you for sure", "You'd have to call your insurer". Call your insurer and they will say "It depends", "I don't have that information", "I can't tell you for sure", or "Call the provider."
If the government wants us to shop around, the government needs to pass a law making price disclosures mandatory and easily obtainable for all procedures, tests, and exams for all providers. Part of the reason providers and insurers can overcharge is that they are not upfront with telling people how much it is going to cost.
25
We are in this mess because there is no connection between reality and medical pricing. How about regulating prices like other countries do? Why should there be a 5-fold difference in cost for identical service? I can understand some price variation. But 5x?
15
When I needed abdominal aortic bypass, I can assure you I looked for the best, not the cheapest. 10 yrs on I have zero regrets.
3
@Terry.
I did an extensive search for the "best "hand surgeon prior to having hand surgery. The surgeon I used was recommended by a friend who is an M.D. The surgeon is the Chief of Hand Surgery at a teaching hospital in New York. He trains other hand surgeons.
I emerged with a crooked finger.The surgeon insisted
that my finger had been crooked before the surgery. I have time-date stamped photos of my finger that were taken the week before surgery, which prove otherwise. I consulted another hand surgeon, who said that the surgeon removed too much bone.
I'd had he same surgery done by a less well known surgeon several years prior, which resulted in a finger that turned out beautifully.
So much for using "the best."
@DJS HSS ? Upper East Side?
Shopping for health care will work when there is sufficient transparency. Consumers make all sorts of decisions regarding very complicated products and services. It isn't necessary that every consumer be astute.
What we need is:
1. Federal law requiring absolute price disclosure to the patient before treatment. The health care provider would be barred from padding the bill later with extras. Complications? That should never be an extra charge to the patient. The health care provider should absorb it. If hospitals didn't profit from, for example, post-operative infections, maybe they wouldn't be as common?
Note, for services (like a root canal which I had today) which are not generally covered by insurance, this disclosure is common. I got a telephone call before my appointment specifying the total cost. Note the cost was the same whether the procedure was able to be accomplished in one step, or a second visit was required.
But, insurance is used to obscure pricing.
2. Discounts should be outlawed or at least limited. A health care provider should not be able to charge one patient 10 times what it normally charges just because the patient doesn't have insurance, or, the patient's insurance company hasn't negotiated a deal with the provider. (Imagine if grocery stores didn't put any prices on the shelves and charged each customer according to some deal that had been negotiated with a club that the customer had joined.)
10
I have a high deductible plan. I shop for price. Don't do an MRI at a hospital. Do it in the basement at a non descript building at the mall. Its fine. Unless you have chest pains or are bleeding profusely,never go to an ER. Also, when ever you have a health problem, see your primary first, they can often save you an expensive trip to a specialist.
2
Shopping for health care doesn't work because...
One, the system is designed to be opaque. It is virtually impossible to extract a priori pricing information from a heath care provider.
Two, the system favors third party payers (insurance). All providers are forced to make "deals" with insurers where they provide "discounts" from their official prices. Since much of their business is paid for by insurance, the discounted price is really the normal amount and the list price is inflated. Consumers are punished for paying out of pocket.
Three, the system puts the ultimate responsibility on the consumer. A hospital or a primary care physician doesn't take responsibility for the costs charged by providers and procedures that are engaged by or through them. Your surgery may be covered but the anesthesia isn't.
In summary, the health care system has evolved to make shopping for health care, and any normal, marketplace-like interaction between consumers and providers impossible. Maybe health care is not really compatible with a market based system, or maybe it just went down the wrong path.
In conclusion, single payer is the only realistic way to go from here.
The alternatives are: keep the current mess and eventually everyone goes bankrupt; or destroy the entire system and build it up from scratch on a true market basis (in that case there will also be some Darwinian selection of the healthiest because people with health problems are as good as dead).
18
One might have luck investigating costs if one happens to get a common condition. Try it when you get an uncommon disease. The condition doesn't even show up in my health insurance search function. Fine. I had to look hard just to find a surgeon with the requisite skills to treat me---no help from the insurance company. Recently my surgeon strongly recommended a specific imaging center because they have better machines but mostly because he knew and trusted one of the radiologists on staff to read the image properly. It's easy to read them if one has a common problem....so what's a patient to do? Just tell the doctor to go fly a kite?
9
"There are over 15 M.R.I. locations within a half-hour drive for most patients." I find this extraordinary. How is there a need for this many MRI providers?
9
@Lynn
The author suffers from a severe case of megalopolis syndrome. For most of the US, this is not reality. I could see the need for imagine centers on every corner when there are millions living in a 20 mile radius. But this only applies to a geographically small part of the US.
1
If you have insurance, you can shop only in-network in most cases. Otherwise your procedure won't be covered and won't apply to your deductible. If you don't have insurance, good luck getting any estimate, much less an accurate one. You can spend hours on the phone getting exactly nowhere.
Then you have insurance policies where the annual physical and associated screening tests are covered at 100% or with minimal copays. But if any problems are found, the patient has to pay for 100% of treatment until meeting a several-thousand-dollar deductible. It's ludicrous. "You must have your annual mammogram or prostate exam. 'It only hurts if you don't do it!' Besides, it's free! But if there's a problem? You'll have to pay for that yourself."
6
Part of the reason health care costs are so high in this country is that patients can drive by an average of six other places on their way to their MRI. We're paying for convenience. Its expensive to build, staff and maintain MRI labs. Why have so many in such close proximity to one another? If we Americans expect lower costs from single-payer we need to stop our obsession with consumerism or we're going to be very disappointed.
7
I’m kinda surprised that more doctors have not gone cash only with reasonable rates and had patients sign a disclaimer to limit liability. Seems like they’d have little need for all the overhead and could pass on savings and do their doctoring without a stopwatch ticking.
So you’d sign a release? I wouldn’t. No other trade or profession asks for that, and they wouldn’t get one from me either.
3
@Gentlewomanfarmer That's not true. Lots of trades/professions require a release before proceeding with work.
@KH
I doubt those releases would hold up in court.
I try to shop for care and it's a joke. Good luck getting an actual answer when you ask how much something as simple as an office visit with a GP will cost. Whoever you get on the phone will not know. Then they connect you someone in billing who does not know the answer. If you actually get an answer it's a crapshoot if it's right or wrong.
Out system is completely absurd and utterly maddening.
23
This is so ridiculous. Just provide healthcare for all and get rid of the insurance racket. Because it is a racket folks. Other countries have figured this out and they do it so much better. People in these countries live longer and healthier lives. It’s not rocket science it just means understanding that everyone is going to get sick (yes, even you!) and we all (every one of us) benefit from helping each other be as well as possible while we are here. We are the “wealthiest country in the world” with a huge swath of poverty-stricken people who have just enough money for their bottom-of-the-barrel insurance premium and not enough to afford the copays.
25
Medicare and Medicaid do the last approach mentioned. Providers can charge whatever, but Medicare or Medicaid won't pay more than an established amount for a particular procedure in a given area. Medicare & Medicaid can do this because these government programs have a much larger clientele than any of the health insurance companies. Health insurance companies have a much more difficult time negotiating prices with providers, who often come to the negotiating table with deeper pockets than the insurance company. Not so with Medicare or Medicaid.
It's why Medicare for everyone, or any Single-Payer plan is the way to go in America.
Joseph in Missoula
18
@Joseph
Many doctors will not see Medicaid and or Medicare patients. Those that do limit the number of both. The whine is that the reimbursements are too low. This might be true but how can taxpayers know what the true cost of a procedure is let alone determine a fair price.
1
@Joseph
Doctors are leaving Medicare in droves. Trump has proposed paying one rate for all doctor visits, regardless of specialty, complexity , or duration. If Trump prevails. specialists will flee en masse. You need look no further than the front page of this paper from several weeks back, if you wish to confirm this.
1
Several assumptions seem to be made here: 1.) That enough people know they can even shop for any care and tests. 2.) That even if people know they can shop for care, that they know which care they can shop for. 3.) That people know cost comparison tools exist.
I did not know any of these things! Because this is not how health care has traditionally been delivered. This involves a MAJOR shift in consumer knowledge about what we can do. For consumer behavior to shift, there needs to be huge advertising campaigns to inform us that we can shop around. (Who will run those? Who would have a financial interest?) And, about which services it's safe to shop around and which we should not (this second point is, frankly and honestly, way too complicated a message for most people nowadays - it's not scannable and visual). The cost comparison tools need to be advertised.
Without basic awareness that this capability and these tools exist, you should not expect to see these consumer behaviors.
We have been trained (brainwashed) that we're at the mercy of insurers. The easiest approach is to take the doctor's advice and referral, and to look at the in-network list from the insurer which gives minimal info - no cost comparisons. The majority of people will take the easy route despite any abstract, long-term negative ramifications that they cannot connect to that decision. My MPH is in behavior change regarding prevention - I know this painfully all too well.
4
A simple solution would be for the doctor to recommend that the patient visit the insurer's cost calculator. That being said, the online cost calculators always come with the disclaimer that the estimate is just that - an estimate - and that true costs may vary. This is not very reliable information on which to base spending decisions.
3
This article's focus on getting bargain MRI exams brings up another critical issue, the quality as well as price of such exams. A friend of mine had an MRI exam while wintering in Florida and asked a radiologist friend to look at it after returning north. The radiologist friend was shocked by the poor quality of the exam which had been performed on a long obsolete low field MRI unit incapable of producing state of the art medical imaging. The radiologist flatly stated that no patient or insurer should be paying for such inferior diagnostic care and my friend ended up paying for another MRI exam that was the same cost as the original non-diagnostic one. There should be minimal quality standards for diagnostic or therapeutic care. Poor quality care is more expensive in the short and long term.
8
@MGerard
What reason do you have to believe that your friends radiologist friend was objective or remotely correct?
I try to get the prices of simple procedures. Most of the time, I fail. When I've succeeded, the price billed is usually much higher than the price quoted. Like the mammogram where the price didn't include reading it.
The only place they quote you a higher price than they bill you is for procedures not covered by insurance. Ask about the cost of removing wisdom teeth and you'll get a good answer.
In short, this isn't rocket science.
7
I recently signed myself up for some physical therapy to help an ailing knee. They did not bill my insurance for 6 weeks, and no one in the treatment office would admit to knowing what the rates were. The billing office did not provide me with that information, which was useless anyway without knowing what was allowed by my plan.
When I finally got the EOB, I found they were not only billing me for PT in the form of exercises, but also for ultrasound therapy which involved 15 minutes of rubbing my knee with the wand from a (per Amazon) $200 ultrasound machine by the physical therapist... $118 for each service, and incredibly my insurance allowed most of it. Blew out most of my deductible, leaving me with a $1,200 due right now bill and more to come. I never would have gone beyond one week had I known what the true cost would be. Everyone passes the buck on this, from the insurance companies to the providers who won't even tell you their standard billing rate, which I suspect is different depending on the insurance company and how much they think they can get.
As with most things these days, it's far beyond time that we started paying for what things are worth instead of what some people believe the market will bear.
I'm going to buy myself an ultrasound machine and can easily find appropriate exercises on the internet... too bad the insurance won't pay me $200 a pop for that, and by the same token, a PT provider is out a customer because of profiteering.
12
My AHA insurance was so awful it required 5k out of pocket before I could get one covered PT appointment when my back went out. I went on YouTube and found some exercises that were outside physician care that may or may not have been helpful. American “healthcare” indeed.
3
I shopped for a hearing aid. That device exactly the kind of healthcare that is easiest to shop for. I had strong motivations for doing so.
Yet the last obstacle was my disinclination to saying "no" to the audiologist, who had, after all, helped me. So I had to talk myself into it, despite my having good reasons. I had to invent a nice way of saying "no" to the audiologist.
1
Aaron Lercher--Same with eye care. Just ask the doctor for the prescription, and then order your glasses online. No reason to pay hundreds for something that is made for pennies.
Cutting back on so-called "wasteful care" tends to get you ejected from your doctor's practice as a bad patient. I know because I've tried it. Calling to ask for prices gets you either the wrong information or no information at all. Until we have single payer, none of this is going to be fixed.
13
Person: "Hi, my head hurts. How much will it cost to treat it?"
Doctor: "Well, you'll have to come in so we can take a look at it and diagnose it. Only then can we prescribe a course of treatment. How much that costs depends on what we do."
Experts: "People just won't shop around for health care. We really don't understand why."
Estragon: "I can't go on like this."
Vladimir: "That's what you think."
7
@acblack
Person: "Hi my car is making weird noises. How much will it cost to fix it?"
Mechanic: "Well, you have to come in so we can take a look at it and diagnose it. That'll be $100.00. Only then can we prescribe a course of action. How much that costs depends on what we do."
Person: "Hi my toilet is not working. How much will it cost to fix it?"
Plumber: "Well, I have to come in so we can take a look at it and diagnose it. That'll be $100.00 for the service charge. Only then can we determine a course of action. How much that costs depends on what we do."
And on and on and on.....
@acblack : People who actually try or would shop around for health care have more specific questions than "my head hurts; how much to fix it?".
A decent analogy would be cars. Most people understand that there is a cost associated with diagnosing the problem, and you can get price quotes for specific procedures. Say, "there is a weird noise from the engine and my gas mileage got really bad'. The mechanic charges an hour or two to find the problem, say, your water pump is broken. Then, you may choose to have the same guy replace you water pump or shop around ,or get a second opinion.
So yes, we dumb consumers really do understand such subtleties. The problem is that in health care, nobody is willing to answer even specific questions such as "how much for a CT of my left foot"?
Prices are not posted, and you're instructed to go in-network if you have insurance. You assume that the cost will be the contract rate, so as long as you stay in-network, it shouldn't matter. Is this not true? Then make it clear. Make the prices clear up-front. Make a law to make the prices clear and give firm quotes. Final cost should exactly equal up-front quote.
8
I think a law that requires cost transparency to consumers would go a LONG way to solving the health care cost problem. The well-funded medical associations and medical corporations will unfortunately fight it until the end of time.
2
Except the PPACA required every clinic, doc, and hospital to post costs for their hundred most-common procedures over five years ago. They can be hard to dig out, but they're there.
1
Since MRI's are mentioned.
My wife gets an MRI every 2-3 months for her GBM. This has been ongoing for 10 years. She has amassed 55 cd's of mri's and I've become adept at being able to point out changes and ease her concerns once we arrive home and I can see if there are differences.
We've gotten 90% of the MRIs from the same imaging center which was affiliated with her 1st neurosurgeon. A few years ago, changes required her to enter a clinical trial, she switched neurosurgeons and her new one left that practice to go elsewhere. Her new NS requested she stay with the old imaging center. Last year when more changes were discovered and we were tired of shuttling into Manhattan so often, we tried using a different imaging center affiliated with the neurosurgeons new megahospital. It was about $1,000 less, but the images were like looking at a snowy black and white tv. We went back to imaging at the usual place where it costs on average $5,000.
So now we trek back into Manhattan, pay $40-$50 for parking, take a day off from work and satisfy her $5k deductible with the first scan of the year. That is unless the imaging center or insurance company messes up the claim, which then messes up the payments for the rest of her treatments.
Ugh - get me single payer.
15
When will Americans (and the NYT) come to the obvious conclusion that Single Payer, free and financed by progressive taxation, is the only way out of this horrible mess?
Medicare for all is better than what we have now, but I have Medicare and suffer from arbitrary exclusions. It also involves considerable other expense for many who can't afford those expenses.
Medicare Part D is the worst part. The more privatization, the more the cost. We need to get rid of insurance and profiteering by Pharma and others.
20
dr. c.c.--When will rich people pay their fair share of taxes, so our country can have the things it needs? If you have more, your contribution should be more. This is not a serfdom, where the masters get the most, and the best, and the serfs get next to nothing. We serfs keep the economy going.
6
@dr. c.c. Many Americans know this. Do the insurers want to allow it to happen? Does pharma? They unfortunately have far more power and say than consumers all together. It's time for political parties to support a single payer agenda and for voters to VOTE for it.
2
@dr. c.c.
A Single Payer system is not without its very soft underbelly. One of most egregious is the monopolistic effect a single payer can have on reimbursement - which, as is shown with the dropout rates of physicians across the US from Medicare plans, creates access issues. You cannot go to any nationalized healthcare plan and not have to deal with access.
I have to disagree with you wholeheartedly about your comment about more privatization. You will not find any economist in the country that will agree that the more privatization the lower the cost. It is exactly the opposite. With competition comes reduced costs.
1
Sorry but I have no idea what "unnecessary healthcare" is supposed to mean. When I was 21 and living paycheck to paycheck, it never occurred to me that I would suddenly develop a seizure disorder and require a prescription drug that costed $600 per month but that's exactly what happened.
When you buy health insurance (or choose not to), you're effectively placing a bet on your likelihood of getting sick or injured in the near future. Because insurance companies employ thousands of actuaries, they understand exactly how much they stand to make off every insurance product they offer. (The house always wins).
Meanwhile, individuals are forced to spend hours going over cross-tabulations of insurance products hoping they might end up with the care they need without going broke. It's like gambling at a casino, only instead of taking home a jackpot, all you get is the ability to keep yourself alive, something that should never have been commodified.
20
Noah Fields--Insurance is legalized gambling. You bet that you'll need it. The insurance company bets you won't. Furthermore, you would be horrified to learn what they do with most of your premium, and it's not paying claims.
7
@Noah Fields
"all you get is the ability to keep yourself alive..." Seems like a pretty good option to me as opposed to the alternative. I appreciate that the house wins and is able to keep the lights on because I can't imagine not having a house at all because they went bankrupt!
@Noah Fields
The house doesn't always win, when it comes to the insurance industry. My late father started purchasing life insurance at a very young age. He was a healthy young man, who married at 20, and has his first child at 21. Every time he had a child, he purchased a policy for the child. He continued to purchase additional life insurance policies over the years .He had no medical problems, but he had a wife and five children and was concerned about protecting his family. .
One day, at age 51 and 2 weeks, he dropped dead at his office , suddenly.
He had purchased so much life insurance such that my brother joked that the life insurance companies must have flown their flags at half mast the day my father died.
How I wish that "The house always wins." If that were true, I'd still have a father.
2
How about this instead? Nobody worries about price, because everything costs the same everywhere and everyone is insured.
You know, like that hated Commie system Medicare, which robbed Americans of the joys of comparison shopping.
10
How about this? No one needs insurance because everyone has access to healthcare at no charge.
3
It seems to me that even the premise of this study is flawed. As many of the similar studies referenced in this article point to, we seem to want to test if healthcare behaves as a free and open market. It is not. The cognitive limitation of patients is a factor of course, and the guidance provided by care professionals are not limited to the prescribed procedures, it includes the referral recommendations as well. In the current system, these referrals tend to maximize the providers’ profit above all – according to many other studies.
But more importantly, we tend to neglect that the structural relationship between supply and demand is not between the patients and the providers, it is between health insurance organizations, negotiating on behalf of patients, and a network of providers with a very unequal level of competition. With almost 50% of the healthcare costs covered by one of the government programs, it is easy to find where a more effective shopping should be done. As evidenced by the comparison with other countries, the solution turns out to be a lot more political and less one of an open market dynamic. As Elisabeth Rosenthal suggests, prices will continue to go up as long as we – collectively – are willing to pay more, even if the extra costs feed profits as opposed to better care.
6
@CarolC Right...NON-PROFIT healthcare.
No Doctor has ever stopped a patient from pricing and comparison shopping to get their tests. It’s a free society. All it requires is picking up the phone. The American public would sooner spend more time shopping around for a car or an Airbnb than spend the time calling test centers. It is always easier to complain.
4
Have you tried it? I work in the medical field and even the docs performing surgeries cannot list the costs that will be incurred.
9
Please go ask a doctor, any doctor, how much something costs. I dare you. Because they have absolutely no idea. None! And their staff have no idea either until you pony up the bucks and go do all the consultations and diagnostics. That’s if you can even afford the copay...
7
@RachelK. They largely are ignorant because each insurer sets their own cost and within an company there are many plans. There is no requirement for prices to be uniform.
"Shopping for health care" has got to be one of the most nauseating and disgusting phrases in the English language. But it's one that seems to roll off the tongues of Americans so easily, as if "shopping for health care" is the most normal and natural thing in the world.
It's not. Treating health care and health insurance like commodities akin to ice cream and bicycle tires is not normal or natural. It is the product of years of brainwashing. Americans may not be brainwashed quite like North Koreans, but don't tell me that the ways in which many Americans think about health care and insurance are even remotely close to being "normal."
I long for the day when private-sector, for-profit health insurance companies are viewed in the U.S. with the same kind of suspicion and derision reserved for for-profit "universities" like DeVry or Walden or Trump.
20
The healthcare system is designed to discourage patients from comparing doctors' prices, and prices are never shown in doctors' advertisements, a sign that they do not want to appear to be competing with each other. Usually, if you want to know what the price is, you have to become a doctor's patient, undergo the procedure or examination, and then wait to see the price paid in the insurance payment information which arrives in the mail. Sometimes, especially at a walk-in clinic, if you don't have insurance, they might divulge the price prior to treatment. Calling or visiting a doctor's office to ask the price rarely works.
6
There is a significant parameter that is ignored in this discussion. And that is that medical care is not the same at all facilities. Doctors are not interchangeable. Some are simply better than others. The lowest priced doctor or facility does not equate with the best option.
Doctors are forced to accept the same payment regardless of their expertise or quality. I think that you will find that the higher quality physicians have much longer waiting times to be seen. In all other professions, these higher-quality professionals would command higher fees. There is no reward in medicine for providing higher-quality.
I am a doctor who orders MRI scans frequently (although I receive commendations from insurance companies as being a "low test user", so I guess I order less MRI scans than other physicians). I take price into account, and only rarely use the hospital facility as the cost is much greater. At the same time, the facility I recommend performs high-quality MRI scans. Fortunately, their cost is not outrageous. MRI scans from some of the cheaper facilities are not of the same quality and obtaining one of those is money wasted. I personally would drive by six less expensive places to go to the higher-quality facility.
11
@The Eyewitness.
I am highly in favor of a single payer system. It would sure make my life easier. The amount taken out of the system by insurance companies is not to anyone's benefit. In Canada or anywhere, there will still be a difference in the quality of medicine depending on the provider.
2
Let's just face it, the US medical industry is run on what I call the "dairy" model.
In a dairy, cows are fed in order to produce milk. The waste is hauled to the manure pile.
In the US medical industry, profits are the 'milk.' Your role is to be the fodder. You are fed into the medical industry and "processed": examined, tested, drugged, operated upon - and then excreted.
Obviously, the more "processing," the more profits. That is why the medical industry has little interest in 'wellness.'
Once 'processed,' patients can be discarded - like, well, waste.
Why is our system set up in such a perverse way? Basically, because we built it, over time, on health insurance. Get rid of the health insurance model, and we could transform the medical industry into a service responsible to OUR needs.
How? One possible model is the airline industry. Every year, airlines fly millions of people - SAFELY - from one place to another. US medicine could do something similar - move sick people to health - if we transformed the business model to one more resembling that of the air industry.
That would mean (1) the role of government is to ensure common standards for safety, training, maintenance and fair marketing, (2) firms are responsible for providing the services and - importantly- determining pricing (no more billing hell), (3) crucially, patients are responsible for deciding where to spend their health dollars - which, for fairness, could be fully tax-funded.
@VCR Putting patients in control: as I see it, that's the secret to transforming the medical industry into your personal heath service.
One way to do that is to give every person a medical debit card. Every time you pay for medical care, all you need do is present the card and the provider debits a national medical account, much like a national checking account.
MRIs, shots, surgery - everything goes on the card. Presto! Universal coverage.
Funding the national account could be accomplished in a variety of ways. I prefer a highly progressive tax. No one should go without necessary care because of lack of funds.
Gosh, you mean like the PPACA already does?
3 years ago a group of UCBerkeley Masters students participated in the BayesHack hackathon put on to assist government organizations with tough problems. Our team chose to work on a Health and Human Services project to make it easier for people to shop for ACA policies. We prototyped a site that made shopping for policies like shopping at Amazon - easily compare policies like you might compare luggage of different sizes and colors - plus make suggestions based on information from the user. For example, a user was able to use the voice input to say, "I'm a single mother of 2 with type 2 diabetes and one child that has allergies..." and we could use that to rank the policies based on their provisions for those conditions. We later used that same prototype to create the real thing, using the public data required by the ACA on insurance policies. HHS started doing something similar in the changes they made on the federal ACA exchange. My point is that there are technologies in existence that could make a lot of this much easier than it is. But in our current state of affairs I would not expect governments to bother trying make their constituents lives easier unless they were among the 1%.
3
@Adam Smith
And what happens when the mother gets cancer, or she or the children get something else that was not on the shopping list?
While your invention would make the shopping easier under the current system, the real problem is with a system that requires shopping in the first place.
3
How would a layperson have any clue what healthcare is "necessary?"
18
Thank you.
1
There is only one way to kill this scam of pricing, preferences, and confusing choices: Single payer Medicare/Medicaid for all.
Let the insurers remake themselves into agencies that perform the accounts receivable/payable for one giant, all encompassing federally administered Medicare that costs nothing but a small percentage of earnings during the years people work. We already do that to support Medicare. Up the ante...4% of earnings seems fair when based upon gross earnings from all sources. Well, la-ti-da......gross earnings of $5,000,000 means a contribution of $200,000 from someone who has the means to give it up in support of a $20,000 earner who needs surgery in spite of his/her measly $800/yr contribution. That's a comfortable $67/mo in health insurance for the average Joe Blow in this country. Wouldn't we all love to have more from the Kochs, Manafort, etc........?
When will "I am my brother's keeper" become the motto for the real American way? We Americans have a lot to learn from more civilized countries who manage good health care for everyone. Real, altruistic and civic-minded socialism does, in fact, work for the common good.
Do we, as humans, deserve the support of each other?
8
Consider the circumstances of state border lines. If you live in one state but the closest hospital is on the other side of the state border, you can’t buy insurance that will allow you to get care in the adjoining state. For example, like other cities, Bristol TN and Bristol VA are separated by a state line. The large regional medical center is on the Tennessee side, and most physicians practice on the Tennessee side. But if you live on the Virginia side, the hospital and doctors are “out of network” for the health plans that are available to you.
We need a healthcare system that is nationwide, without variations in plans and coverage from state to state.
11
It has to do with practice. If you are chronically ill, you will have had enough practice to find out what the variables are and how to minimize cost to yourself.
If you are just suddenly in need of your first MRI or other procedure, you are simply lacking the information necessary to get the best deal at the lowest cost.
And that applies even to those of us working in biomedical research. There are simply too many variables and the only way to find them is by delaying and spending half a week on the phone and on the internet. Nobody has time for that. And certainly not during an emergency.
7
Health insurance companies could be regulated so that price-gouging doesn’t cause a cascade effect which leads to every tier of profiteering middlemen jacking up the cost for medical procedures and treatments.
‘Regulation’ isn’t a dirty word. It’s just regular.
3
As a practicing Oncologist who orders a lot of these tests,here is what I can say:
1. All Labs and Imaging tests are cheaper when done as an out patient rather than in the ER and Hospital.
2. Hospital owned Facilities are almost always more expensive than non-hospital or physician owned facilities.
Its not always practical to shop around;but when it is,follow this advice.
3
This leaves out something significant, with things like MRI's many people have insurance where they have in network providers, that we are supposed to use because they have negotiated deals. With out of network facilities, then yes shopping around would help, though with the way deductibles work it still is very expensive.
Besides lack of info on pricing, there is another thing at work here you don't mention. A lot of doctors groups now have bought into things like labs and MRI clinics and the like, so when you go to see them they often will recommend their own facility (legally they are supposed to tell you that, at least in NJ, but that may not be true elsewhere). As with the hospital example, there is a conflict of interest with pricing.
6
I recently went in for a routine MRI to monitor a chronic condition. My doctor instructed me to make an appointment at the radiology department of the hospital he works in. Wary of big bills, I called my insurer, who informed that the cost would be $1,800 -- WITH insurance. I was shocked, and my insurer directed me to an imaging place where I paid about $300 out-of-pocket for the same scans. I was actually a little embarrassed to be getting a "cut-rate" MRI, but my doctor assured me it was perfectly reasonable to shop around. I wish he would have advised me that I had the option to shop around in the first place -- it would have saved me a lot of legwork.
5
I recently had an MRI. My first. No one told me I could 'shop' for a provider. At that, I had to drive 60 miles to the closest Scan center. The next closest would be another 15-20 miles away. That town's where I went to see my pain management doctor. He just opened a clinic there. Otherwise, 90+ miles to see his dad or brother.
Do you get the idea? The only way for me to shop involves driving 3-4 hours to medical care. Not really practical except for major expenses. 3 1/2 hours to Dallas, TX for a 4 way cadiac bypass. About half of that in an ambulance. (I was having a test done at about the half way point). Avoid ambulance rides if possible.
Just the hospital bill was over $100000. Add the surgeon, anesthesiologist, nurses, x-rays, another medical team I never saw, but I believe in. They took a graft vein out of my leg, two holes, neat as anything.
There was no shop for any of that. I had been looking at various centers so I was familiar with where I was sent. But I didn't 'chooses it. My cardiologist did. I agree with his choice afterwords, but I had nothing to do with it then. Sometimes you just have to pick your people and go on.
3
This article was timely for me as it has been for some other commenters. After an echo cardiogram my doctor wants to do a chest CT angiogram for my aorta. Given that our insurance has changed I needed to know what my cost would be. I started last week calling the doctor's office, the hospital billing dept, my benefits manager, and the insurance company. I've lost track of the time I've spent. This was to find out what the cost would be for one procedure at one location. And am still uncertain. The insurer says if they are in network it will be 20% of the contracted amount for the in network price. The hospital was just willing to give me their price. The difference between the two is about $2300. That's a high degree of uncertainty. I can't imagine to try to "shop" this information given the difficulty I had with this one item.
12
"An alternative approach is for insurers to refuse to pay more than a reasonable price — like the market average — for a health care service, though patients could pay the difference if they prefer a higher-priced provider."
Insurers have contracts with providers under which they pay a set amount. That amount is already discounted because it's a "bulk pricing" contract. Therefore, insurance companies don't pay above "market average" now!
The patients, especially those without insurance, are on the hook for the often outrageous, arbitrary retail prices set by providers beyond what insurers pay. This is partly why we need transparent, clear menu pricing before services are scheduled.
Some of the author's suggestions seem based on poor research.
5
It's nice at least that most doctors' recommendations are divorced from self-interest.
In my opinion, based on their level of expertise, training, entry costs (loans), and low earning for years during training, doctors are generally underpaid.
I am a US citizen living in a European country with single-payer system. It is SO MUCH EASIER in Europe!
I had to have a surgery in the US and then another one in Europe. The US experience: Ended up getting bills for 12 months afterward for things I could not figure out; total out-of-pocket cost (with what I thought was "good" insurance): >$7000.
The European experience: Went to the top clinic for the procedure; received the price list for what my surgery would cost; the only variable cost was my room (since I wanted a private room, I would have to pay based on number of days I stayed). I paid, had surgery, and after being discharged covered the room costs -- and that was it. Total cost: $4500. The only reason I had to pay anything at all was that I did not want to wait the 4 months for the publicly-funded spot.
In this market, people DO shop around for MRIs, CT scans, and doctors. Because those prices are easy to get.
Granted, the comfort level in Europe is lower, but I am happy not to have a TV in the room if it means that I do not stress out about paying insurance bills that I do not understand.
There is no comparison. If people knew how much peace of mind they gain with single payer there would be uprisings in the street.
19
It is lamentable that this is deemed worthy of publication because its relevance would have been timely 20 years ago. Market medicine is a poor nonsustainable substitute based on making profits rather than providing a necessary service. until this is changed by having a single payer system that covers basic needs in a cost controlled manner we are doomed
6
This is an excellent article.
I have an advanced degree, had worked in hospitals for ten years, have done a lot of work with health plans for over 15---and I miss things all the time.
Not to mention that I'm about as capable of making serious decisions about, say, medical treatment as your average peanut. The inly difference is that unlke most, know that this whole "shopping," thing is silly.
It isn't just what Frakt mentions, though. It's that almost nobody has the technical expertise and detachment that allow them to make real choices.
You can see it in the comments here. The cheering for single-payer from those who don't know what it is, don't know which countres have it (almost none), don't know what its costs are, don't know it would be rationed. Heck, they think Medicare's free and covers everything.
And the yelling about "socialism." Wow, that's dumb. And then there's the yelling about costs....know what, folks? Half your costs come from the fact that we're fat, flabby, and stressed-out, and we demand pills, surgeries and machines for these problems rather than diet, exercise, and less commuting.
Frakt's right about our irrationalities, including mine. We'd be way better off with universal health insurance at moderate costs, with some limits on what we get, clear directions from professionals, and a lot of lifestyle changes.
Good luck with that.
3
If this is so important for the consumer to locate the lowest cost for services why did the author of this article not include a link to a quick and efficient and accurate wait to do it?
11
I also have an HSA -- for 14 years. I am more careful with my expenses, where I go, charges my health and healthcare than with my grocery bill. I shop, niggle, negotiate. If you don't have more money than you know what to do with -- why not. I only pay $30 a month for the coverage, thanks to my generous employer. I dutifully deposit the max into my account every paycheck. It saves me tons on my taxes, and pays for most of my needs. Do you really have to be a financially savvy attorney (like me) to be able to do this? Maybe so because how do you explain the laissez-faire attitude for most folks. Being conscientious is a trait associated with intelligence, social status, education, and health. So it fits that such types would also apply that trait to their health. I don't drink, smoke, eat junk food, etc. Therefore, my health is good and I don't need much doctoring anyway. Anything I do spend is carefully scrutinized. And to those who are too lazy, uninformed, or uneducated to do so -- you get what you get.
2
@Leonora Cheers to your good health, but what if, God forbid, you were to be hit by a drunken driver or suffer another accident at no fault of your own? Even people with "intelligence, social status, education, and health" need affordably priced and transparent healthcare.
10
@Leonora
Most people do not have access to a Health Savings Account (the one where the unused balance is not taken at the end of the year) and many consider themselves lucky to have the option of paying hundreds a month for employer insurance.
1
When I tried to find out if a procedure I needed was covered by Medicare, the doctor's office referred me to a different provider. My doctor's office said they did not perform the procedure (a lie) and said that if I wanted to know how much it cost, the other doctor's office could tell me that. Eventually I had the procedure, at my original doctor's office, and told the doctor what their front desk had said. She apologized and got me the information, but this experience certainly eliminated my trust in the medical system.
3
I have had a fairly manageable (but still life changing) chronic illness for decades but in the past 16 years it became much worse, forcing me to see more doctors about it then ever before.
I have also shopped around for decades.
The problem is not all the doctors or labs take the same currency. What do I mean? Insurance. Insurance is how you choose, use, and pay doctors and labs. I have had great doctors I wanted to stay with, but they dropped my insurance (or my insurance or "buying power" of that insurance—low or high deductible, etc.—changed out of no choice of my own). Equally, I have had to go to horrible doctors as they were the only option near me that would take my insurance.
A free market depends on a common currency. Heath care is a hodgepodge of bizarre "currencies" that depend on your age, where you live, who you work for, etc.
Single payer is going to be the solution. Then we have one currency that all of medical care accepts. If you suck as a doctor, you are going to struggle as patients move on to better practices.
Ironically, single payer is the best injections of capitalism and cost reduction we could hope for!
6
I needed a minor surgical procedure. My doctor gave me a short list of possible locations, both hospitals and surgical centers. I called the providers, my insurance company, and my doctor and no one could tell me the cost in advance.
9
The “skin n the game” model using higher deductibles and copays does not work: no one wants a deductible that is more than 5% of their income, for example $5000 for a family earning $100,000 a year. But even the simplest medical encounter can cost thousands. I went for a skin biopsy on my leg, it was a superficial non-malignant thing that they burned off with dry ice in a couple of seconds.
The price: $4000.
So, am I supposed to shop around for a skin biopsy now?
No, I willl ride it out, and if anything else happens this year, I won’t owe more than $1000.
But whatever your deductible might be, you are almost always going to pay it, no matter what.
So, forget high deductible plans, you end up paying more.
2
In the study/research, was Medicare and Medicaid business included? As I doubt, they have any incentive to worry about price. It would be interesting to have a cut just looking at employer sponsored health plans, or even a smaller cut of employer health plans with full replacement HDHP’s.
I have an HSA/high deductible plan. Many times I have called in-network providers in NYC to ask them how much I would pay out-of-pocket for a particular procedure or office visit. Basically: I know I haven't met my deductible yet. I just want to know what the negotiated in-network rate is that I will have to pay.
No provider (hospitals, independent doctor's offices, labs) has ever been able to tell me. Ever.
I once decided to spend a few hours on the phone solving this for a particularly expensive and important medical situation (non-emergency). After several calls to my insurance carrier and various hospital departments I still had no answer. (the hospital said "call your carrier, here's the billing code", the carrier said "we need to know the specific hospital department's tax ID since the hospital is large and we cover different things for different departments", the hospital billing department had to refer me to several other people in the hospital to get that number, then my insurance carrier said "oh, that's a New York tax ID/provider, you have to call our affiliate carrier in NY who will handle this claim on our behalf, but unfortunately they won't take your call... they only deal directly with providers. I [phone rep] can't even call them.", the hospital said "we can't do that, we only process claims after the procedure".
It's exasperating. Not to mention the opaque bills one receives from several billing agencies after a hospital stay/procedure.
24
This assumes all MRIs are the same. Older machines may have less resolution and weaker magnetic fields. Also the radiologist reading the MRI is important
4
@Matthew Hong Couldn't agree more. Lack of repeated MRIs is the weakest form of evidence for quality. Sure, all services returned something that looked like an MRI so what? What was the false positive or false negative rate? I interviewed once with one of these health comparison shopping startupus, I asked "How do you avoid a race to the bottom if you provide only price transparency without quality transparency?" The answer was "Doh?"
2
Oh right. I'm sure you are getting a better MRI for $3000 rather than $600. LOL. Further, you are better served to think very carefully before you submit to an MRI that is not absolutely positively necessary. Many of the referrals to clinics come from docs with vested monetary interests. Don't trust before you verify. And make sure you really, really need it.
The world as we know it changed when we ceased to be "patients" and instead became "health care consumers."
I don't want to make these kinds of decisions. If I did, I would have become a doctor.
16
A problem that insurers have never had with the medical community. They make your medical decisions daily.
1
My dog required complicated plastic surgery at a highly specialized veterinary practice. Prior to surgery, we were given a quote with all costs - imaging vet, tests prior to surgery, hospital stay, medications, surgeon, post-op costs, etc. The total price was a range that was predictive rather than definitive, but the end costs were right in the middle of the range. This surgery required the same services that a human surgery does. So, why is it impossible to secure a quote such as this in human medicine for which we pay so much more?
I work at a medical school and spend 100% of my time working within a medical environment. I once attempted to obtain costs in advance of my son's elective surgery in order to make a wise decision regarding my high-deductible insurance. It was IMPOSSIBLE. I could only finalize the cost of the operating suite and nothing else. Impossible, even considering that I am friends with the physicians who would perform the surgery. They even attempted to help me as they were curious if it was possible to estimate costs. It was not.
If a veterinary hospital is able to provide a budget, then so should a sophisticated human medicine hospital. Geez!
28
Your comments are appreciated. Asking a patient to decide 'when and if' a given diagnosis warrants treatment, is foolish; that is a physician's prerogative, provided we can removed the implicit conflicts of interest...if the recommendation is attached directly to financial gain. I always appreciated the Mayo Clinic approach (in my periodic visits, as a guest physician), as their doctors are salaried, unchanged, no matter the quantity of services provided...while expecting the highest quality, and always having patient's interests at heart. The cost of healthcare in these United States is far too high, compared to other nations, and not necessarily with better outcomes (some being far worse, as documented elsewhere). A single payer universal healthcare system may be the answer, however difficult to implement, ever since the II WW, where an employer-dependent system was deemed convenient. Time to change for the better is overdue.
7
Why do doctors send patients to expensive MRI centers? In some cases there is a personal profit motive, but for hospital based network employee doctors, there is pressure to use "in network" facilities.
One benefit is that the results are usually input into the same medical records system and thus become part of the patient's permanent online record . A less expensive, but out of network, facility might fax the results only to the prescribing doctor.
When my wife was undergoing cancer treatment, I was sent to another hospital to demand, pick up, and deliver an imaging scan from a hospital in a different network. Without my personal service, the data would not have been available to her oncologist. The free market at work.
8
The model for America’s health care system is called “racketeering” — the dishonest seeking of money by any means. Once you correctly identify it, you will know what you’re dealing with.
7
a story that could only appear in American among developed countries.
thank sky fairy for that.
2
You read policy analysis claiming an "evidence-based" perspective, you're being lied to.
Here's one: "The theory goes like this: The more of your own money that you have to spend on health care, the more careful you will be — buying only necessary care, purging waste from the system."
Nobody believes that. Especially not people who say it publicly.
Its the medical equivalent of "We're worried about poor people, desperate to give them a leg up on the ladder to American success. So we're taking away their healthcare, housing, food, day care. You're welcome."
Everything confirms it, from the claim "On the way to their M.R.I.s, patients drive by an average of six other places where the procedure could have been done more cheaply, a study suggests" to the main point: patients are so lazy and spoiled by massive medical benefits they don't bother to shop, even on the one-in-a-trillion occasion when cost is spelled out, quality is evident, and they have some clue where to go and who to trust.
When I get pizza, I surely pass six better pizza places on the way. And they advertise...
So let's have doctors do it. Because malfeasance by doctors is not the single largest source of fraud in the system.
Lets ignore that the one way our medical insurance industry can justify its $1,000,000,000,000,000 a year drain on health care would be to guide patients safely, quickly, reliably to the best, most cost-effective care. The one thing it will never do.
This article is stupid.
7
Uh, doctors and hospitals do in fact advertise. All the time. And the drug ads stretch from sea to shining sea.
@Robert
Uh, yeah, I know.
I'm trying to recall the last "Cheap! Fast! MRI!" sign I drove by on the way to my doc.
To cite a study about people driving by MRIs that might be cheaper (no mention of timeliness, quality, or insurance relationships) makes an interesting point but it is, ultimately, meaningless.
Like much of the argument in the article, or this one.
@oogada
Yes. "Lets ignore that the one way our medical insurance industry can justify its $1,000,000,000,000,000 a year drain on health care would be to guide patients safely, quickly, reliably to the best, most cost-effective care." The one group that has the time, and data, to direct patients to the most cost effective places, with the best records of success are the insurance companies. It should be a matter of law that all such organizations are non-profit.
If all you "health care is a market" freaks out there were serious, you would do away with controls on beasts like Shkreli, you'd loose opioid manufacturers to do their worst, you'd lie on the floor with your dislocated shoulder phoning up for quotes.
You'd lobby for Purdue Pharma to get an Addy, and the Sacklers a Nobel in medicine.
But you don't.
Because it is in no way a free market.
It is a utility, like sewers. It needs to be economically structured and paid for like one.
5
The very existence of this article and its necessity and importance boggles my Euro-socialist mind. “Shopping” for healthcare? Good grief.
7
Every time I read a piece like this, I ask myself what is it that prevents the US from joining the rest of the advanced world in having universal health care, For me, an MRI does not come with a bill. I have had one in the middle of the night because the machines are used 24/7, which seems entirely reasonable. When you have a huge, predatory insurance industry and a medical profession where people want to get really rich, shopping for a cheaper MRI seems a little futile. It’s never to going to really change until there is a true public health system. If that ever happens in America, I am sure there will be a separate private system for the uber-rich, so they don’t have to have anything to do with « those people « except as care givers. There has been so much scare propaganda about universal health care in the US that many seem terrified of the very idea. But if you ever achieve it, you will be astonished by having a new freedom, which is freedom from fear of being wiped out by medical bills.
7
Join me, fellow NYT readers, in not asking so much from our health care system. I have "No Code" (do not resuscitate) tattooed on my right arm and have signed a legal notice called "Declaration of a Desire for a Natural Death."
Palliative care is always less intrusive and less expensive than intensive care, and I don't want my granddaughter's generation paying my medical bills.
I'd prefer to live with as much grace, dignity, and courage as possible, and then be like the Zen Master whose student asked, "What is the best way to die?"
"Die quietly," replied the Master.
I hope to die quietly. Think carefully about what you and your loved ones want. Then draft a Living Will or Health Care Power of Attorney that reflects those wishes.
3
There is no price transparency in healthcare. Period. To put the burden on physicians to determine costs for patients for medications/procedures, etc when there are so many variables involved which are not always easily navigable is a waste of medical expertise.
Combined with the lack of transparency, the complexity of copays, co-insurance and deductibles make figuring out the out of pocket cost an insurmountable task, even if the incentive was there.
Simple solution. End the insurance claims process and make all transactions cash for outpatient care. Then make price transparency mandatory. Make all insurance cards debit cards where a portion of your premium is applied to the card to provide the funds for transactions along with your HSA. With an end to the claims processing, charges will come down. Stop requiring a prescription for lab and radiology studies and hypochondriacs will also help bring pricing down. Start a nationwide health education system that 'gamifies' learning the basics about disease where accruing points can earn reduction in premiums.
1
So I’m supposed to shop around for an MRI? I’ve already taken time off of work, now I supposed to take more time off to make phone calls. First, I have to call my insurer and get a list of in network providers. Then I have to call them, explain what procedure I need, and try to get a price. Then I have to call the doctor back, to make the appointment- because MRIs are only done on referral. But maybe the doctor doesn’t work with that MRI provider, then I have to decide on a second provider. It’s asinine to expect people to do this.
10
Read 'An American Sickness' (Dr. Elizabeth Rosenthal) to get a picture how bad (financially corrupt?) our medical system is. She has several practical suggestions that individuals can utilize - although most of the remedy has to be found via legislation .. which, IMHO, will take another 300 years.
Only one problem......Your average medical practice is no longer private but owned by your local hospital. Because running a practice has become monetarily strenuous, most independent practitioners have sold out to the hospitals. Your doctor's office might look the same but you wouldn't know that it is now hospital owned which means they "own" the doctors. Consequently, the doctors (employees) are instructed and obligated to refer their patients to the hospital for tests as it is in the best interest of the hospital.
7
The government needs to regualte prices on healthcare. It's that simple. No one wants to bargain shop for chemo.
2
How many more articles will we see for which the obvious and only answer is Single-Payer or Medicare for All?
Thank your local Republican representative for our health care "system" which picks winners (the wealthy) and losers (everyone else).
6
It's called the Unaffordable Care Act for a reason. It was designed to enrich the business of medicine at the cost of providing medical care. End of story!
2
The tight focus on costs misses a very important factor. The quality of our healthcare is TERRIBLE. There. I said it!
The doctors are all reading off of some script; mine don't really seem to have any idea what they're doing. They TELL me about my symptoms; they're not interested in anything I say. Most of them are just pushing pharmaceuticals. The devotion to electronic records means that every bad assumption, every wrong diagnosis, follows you forever like a bad penny.
Worst of all, my well-being is never part of their plan.
"Shopping for Health Care Simply Doesn’t Work. So What Might?"
Universal Healthcare.
11
"So what might work...."
A Single Payer System....... like every other first world nation on earth has..... we are the laughing stock of the world.
Almost every American, who is not in the top .9%, is one major healthcare away from bankruptcy, losing everything they spent a lifetime building....
No other first world nation allows this, why do we?
Trump is not creating greater stability, quite the opposite, he is creating enormous, bigly, uncertainty in an area where continuity over time is necessary to ensure a healthy and growing population. That in turn is a foundation of a strong economy.
1
I feel like the author's explanation for all this -- that doctors simply lack information -- is just a tad too charitable.
2
Very timely article. My husband went to a walk-in clinic (he has no current doctor as we've moved). When he asked about the cost of the appointment, they said they could not tell him. We have a $3000 deductible/high option plan. They said they had to bill insurance who would then bill us to let us know what to pay. Is this ridiculous or not? He is now being sent for an MRI. We will TRY to find out the cost but I suspect the answer will be the same: do it and we'll bill insurance and find out.
What a way to run health care!
3
So where are these "price comparison tools" and how does one find them? Hard to use something if you have no idea it even exists.
5
"Shopping for health care may sound ludicrous on its face..."
I don't see how you can print this article with a straight face. How can you be so two-faced? "Shopping for health care" was the entire rationale for ObamaCare. Even then, its purveyors knew it was a false concept, proven by the fact that they had to threaten to fine people who wouldn't or couldn't do it.
And now here is an article saying, "Lo and Behold! People either can't or won't shop for health care?!" Who'd a thunk it?! Only those millions of people who didn't want ObamaCare and had it shoved down their throats anyway.
And then you wonder why people voted for Donald Trump? Less government, and less do-gooding which backfires, are some of the reasons. Even DJT seemed better than Leftist plans. And now they are thinking of socialism? We're doomed.
2
@Kathleen880 "Shopping for Health care was NOT the entire rationale for ACA, but instead was trying to get at UNIVERSAL COVERAGE' , to start to deal with the problem of 30 million uninsured and costing all of us with their choice to go to emergency care only. The few different plans offered by ACA were part of Obama's deal to keep as much as insurance industry happy as possible - (bad choice, IMHO, but they are huge). And as far as government plans, VA health care is rated the best, only behind what government employees got before the ACA - the ACA specifically required gov workers to go with the general populace, so senators and congresspeople hated that.
I am geussing you have never paid for health care for yourself, you don't seem to have even a rudimentary understanding of - anything really. I recommend you start reading the NYT and BBC news every day.
7
We have to make a basic choice between an HMO and a PPO, where I work, for starters, and that seems to me a no-brainer - with a PPO you pay a large percentage of everything - my $150,000 back surgery would have cost me $40,000 out of pocket, at least - and that is major debt for me. Instead, with an HMO, it cost me $0.00. Of course, my doctor siblings tell me they always treat PPO patients better, but for me this is the kind of choice that is just ridiculous. It is not really choice, going $40,000 into debt v being %100 covered.
@Grace Thorsen
"my doctor siblings tell me they always treat PPO patients better,"
Wow.
This is everything that is wrong with for-profit health care.
2
My employer is phasing out our PPO and forcing everyone onto high-deductible health plans with an HSA. This is supposedly so we are more careful with our healthcare spending.
So, I was more careful. My generic medication (Mesalamine DR), for which my insurer charges $1250/3mos, can be found at a local pharmacy with a GoodRX coupon for $552/3mos.
But I can't use that! My insurer mandates that maintenance medication be purchased through the mail, through the insurer. If I try to pay the cheaper price at the local pharmacy out of pocket, my insurer won't allow this to go towards my deductible at all.
So much for shopping around!
7
There are many better new-age options for treating UC such as your diet, fecal transplants, lifestyle. UC is autoimmune as I hope you know. Fight the inflammation. Figure out what's causing it before you bomb your body with potent expensive drugs.
Econ 101
Variable pricing is a strategy of optimize profits and US Healthcare is a for profit business.
To quote from the Harvard Business Review "Managing Price, Gaining Profit"
"The Pocket Price Band. At any given point in time, no item sells at exactly the same pocket price to all customers. Rather, items sell over a range of prices. This range, given a set unit volume of a specific product, is called the pocket price band. Pocket price bands that we examined ranged up to 60% for a lighting fixtures manufacturer, 70% for a computer peripherals supplier, 200% for a specialty chemicals company, and 500% for a fastener supplier.
Understanding the variations in pocket price bands is critical to realizing a company’s best transaction pricing opportunities.
Customers perceived by managers as very profitable often end up at the low end of the band, and those perceived as unprofitable at the high end.
If a manager can identify a wide pocket price band and comprehend the underlying causes of the band’s width, then he or she can manipulate that band to the company’s benefit. "
As long as the US Healthcare system is operated by for profit health care companies its manager will manipulate the pocket prize band and attempt to disguise pricing
https://hbr.org/1992/09/managing-price-gaining-profit
3
Yes, thank you! I entirely agree! Doctors have not been giving cost-effective advice to patients for a very good reason: we have absolutely no idea what options are out there, or what they cost. We only know what needs to be done. Lab tests? There are probably half a dozen labs in a 10 mile radius of my office. I have zero idea what each of them charge for even one blood draw. EKGs? I usually tell my patients to go to their primary care doctor's office, since they usually have one (I'm a psychiatrist and my office can't afford one).
Here's the thing: even if we did know what each location charges for each service, we have no idea what the patient's insurance will or won't cover, if they'll have to use their deductible, etc. Trust me, doctors want to have their patients spend as little money as possible. We just need to know what is out there so we can help them do that.
1
My experience when trying to shop for imaging was that no one - the doctor nor the insuror - could provide information on cost and quality and that the patient was stuck with paying the amount that was above usual customary and reasonable (how UCR is calculated is not transparent at all). Without the information, how can one even hope to make a cost/quality conscious choice?
Even if we did have consumer choice how would one assure that information could be shared to all a patient's providers (both images and informal consultations)? And, how does one stop some health systems from forcing patients to get imaging/procedures redone in their own system?
While the consumer choice makes sense in the context of a single procedure like a MRI where one has time to shop, how effectively can this model be implemented for all procedures? Think of the information that would have to be readily available to all consumers and providers - who pays for this information system (yet more administrative overhead)? Who updates this information on a daily basis as price/quality changes? While this model may be useful for some procedures, it would seem to have only marginal application at best.
So while the arguments about consumer choice make sense in the abstract it does not make sense when thinking about implementing it in the real world. A simpler solution is standardized pricing, such as Medicare does, and managing duplication in imaging.
3
Let's talk about my hearing. I wanted a cochlear implant. I went to Stanford. No one would tell me what it cost. My insurance wouldn't tell me whether they'd cover it. I went back and forth to Stanford and my insurance provider, trying to get a straight answer from either one. After two months of this, my insurance dropped Stanford as an accepted medical provider. I had to wait until I was 65, covered by Medicare, to get my cochlear implant. Where was my informed choice in this context?
5
If you anticipate running through your whole deductible, you have little incentive to shop around. Someone who's getting an MRI for a knee injury but plans on having knee surgery a month later doesn't really care if the MRI is low-cost or not, since the surgery will surely eat up the deductible anyway.
3
To me the problem starts with the focus on the doctor-patient relationship, yet the doctor's role is simply to diagnose and treat ... nursing is the function of providing care ... we need to put the nurses and similar care workers at the center of the relationship, and just use doctors as needed for diagnosis and general direction of treatment ... I've come to view doctors as about the same as auto mechanics ... if you don't stay on top of them they will load you up with tons of work that you don't need and that don't actually address the reasons you came in ...
1
What we have today is not a true test of whether consumer choice and market forces could help improve cost and quality. As pointed out, a number of barriers exist, ranging from lack of competition to inadequate incentives for both buyers and sellers to engage in competition. In the recent book by Moore, Quelch, and Boudreau, "Choice Matters: how healthcare consumers make decisions and why clinicians and managers should care," we propose a number of conditions and competencies from the buyer and seller that will be needed to truly test the role of consumerism.
2
Shopping for health care is virtually impossible. In most town, one or two hospitals have gobbled up every hospital and every practice. Just look at Cleveland: you're either Cleveland Clinic or University Hospital. Or about to be one of them.
There's too much monopolization, very little pricing information, and it's impossible for the consumer to do the risk analysis to figure out if they do or don't need a test.
We were charged a whopping $4000 for CT scan at a local ER recently. When I called the competing ER to ask about their price, they told me it was "Illegal" to give out prices.
Our system is inherently monopolistic, opaque, and designed from the ground up to reap big profits.
14
I can only find out from my insurance company’s website an “estimate” for some procedures, and the cash price various facilities will charge — which is not what I will have to pay. It is pointless.
5
My recent experience with getting an MRI and some other scans, showed that although doctors wanted the tests soon (as did I), they were willing to wait longer if the facility was affiliated with the hospital they had privileges with. This in a large metropolitan area with an abundance of facilities.
2
The last time I had a non-emergency lower limb MRI, my orthopedist gave me a sheet of places to go that his practice recommended. He circled a few and said those were the ones he liked.
I have no idea why he liked them. Could be that he was an investor in them. Could be that buddies of his worked at them. Could be that he liked the standard format their radiologists used to send in their reports. Could be that they were the ones whose electronic software worked the best with the one he used.
I ended up going to the one that had an appointment available the next day which was a Saturday because I didn't want to take another day off from work. Only one of them had an appointment available the same day and it was in an inconvenient location after 5:00 PM on a Friday.
Money? I checked to make sure they participated with my insurance which meant that the imaging was a flat $100 fee. I expect that I picked a lower cost facility for my area because it was in somewhat remote suburban office park, but that was hardly the first thing on my mind when the fee was the same no matter where I went. Taking another day off of work would have been a greater cost to ME than anything else.
6
The idea of shopping for health care is still a fairly recent one. For patients and doctors new to such an environment, it is not surprising that the shopping habit, the time required to compare choices, and the data to make that comparison meaningful are all lagging.
This does not mean such a system has failed or should be abandoned. Computers are wonderful things, and a little bit of technology and transparency paired with a lot of data will go a long way to making these comparisons both quick and accurate for both doctors and patients.
It is possible that consumer-driven medicine has arrived ahead of its time, or that it is a terrible idea, but the system and its participants are still adjusting to this change and will be for some time. It seems way too early to draw strong conclusions.
"Though patients seem to follow the advice of their doctors on where to go, their doctors don’t have all the information on hand to make the best decisions for the patient either. "
I see this as the most significant statement in the entire essay. Doctors do not have information regarding pricing of procedures in general in my experience. Whether this is by design or they just don't bother to learn this is unclear. But if you're getting your health advice from your doctor, and she does not have this basic information, how is she qualified to give you the whole story?
3
Because we physicians are agents of our patients, our ethical obligation is to ensure that their care is valuable to them. That means that we provide the care that meets patients’ goals, that we ensure the highest quality within our power, and that we do so at the lowest cost to the patient and community.
CMS continues to move to site-neutral payments, which should reduce the costs of outpatient tests at hospitals, which is a step in the right direction.
But until doctors know the price of various tests and treatments, we will not be able to fulfill our ethical duty.
4
I assume that Austin Frakt has never actually shopped to compare MRI costs. I have. And the universal response was "We won't be able to tell you until we've settled with the insurance company." Which is why people don't shop for health care costs.
Incidentally, on the few occasions where a provider has told me in advance how much a medical procedure would cost, that price has always been different from the actual price.
The problem with comparison shopping for health care is that the way the industry is currently set up makes such shopping impossible.
12
I know that ex-urban and rural people are seldom included in this type of research.... but finding "cheaper" MRIs within 30 minutes of my home is not really probable. In fact, UPMC is trying to buy up as many health centers in Western PA as possible so they can control access to affordable health care. My independent hospital is one of the lowest cost places for most work in the area. The major problem with health care is that it is a for profit business, not health care first at all.
6
Might it be possible that if electronic health records were automatically shared, some hospital-employed doctors might be more likely to recommend a non-hospital MRI site? I can understand a doctor wanting immediate access to MRI results, and I know from personal experience with other medical procedures that records are not necessarily automatically shared. We have the technology. Now we need to make it work.
3
This is easy to explain. Most of the time, you can't get the actual cost until well after the procedure is completed. I had an MRI a couple of years ago, non-emergency, lower limb. I have UHC PPO, and called 3 or 4 centers and booked the low cost covered option. Weeks after the MRI, UHC sends an EOB that's a random price variation. How is this even legal?
7
Why are we not surprised. There are no market mechanics at work because Americans don't shop for health care even if they know comparative costrs. They don't even look for different sources unless they have clear proof that it is substandard. On the other hand, they are more likely to pick one provider for elective care over another based on personal testimonials of friends or because of one is more accessible; free parking is such a draw that it is becoming standard.
1
Most doctors won't take the time to provide price comparisons to patients. And getting that price information is difficult and complex. A better approach would be an internet-based tool, available from some people's insurance companies, that calculates the out of pocket costs for these outpatient procedures. The difficulty in obtaining price transparency is the culprit here. Finally people need to separate their doctor's advice into 2 groups: one group is for a treatment regimen, but the second group is for these outpatient tests & procedures for which the doctor may simply be unaware of price differences. The patient needs to shop, just like he/she does for other services.
2
Our health care system is irretrievably broken. At this point, that it's nearly impossible to find out the price of certain services is almost irrelevant. The real problem is the lack of motivation to make things accessible and clear. The obvious reasons for this are avarice, years of neglect and political party mishandling.
By keeping the patient, or customer, in the dark, it's easier to charge outrageous amounts of money for services, while tethering the patient to perceived quality, rapidity, and ease of service.
My recent research into the Medicare system is a perfect case in point. At no time, was any of the information available to me located in one place, or with all the necessary information understandable or actionable.
Even after employing a professional to assist me with obtaining the information and finding avenues of application, I was informed that I would never fully understand the process, because the laws were fluid and constantly changing. This proved to be true and appalling.
How is any layperson supposed to understand this process, or avail themselves of all their insurance has to offer? The answer to this query is: We're not supposed to understand it. If we were, our elected officials would have made the process easier for all of us, and the intrusive and greedy insurance middlemen would have been eliminated from this process.
A complete health care insurance overhaul is needed. It's long past time and the need is great.
11
@Pamela L. Pamela--all good points. There is little, if any, price transparency. So typical market forces do not work in today's health care industry in the U.S. And since healthcare is nearly 20% of GDP now, there are MANY companies and lobbyists that are highly motivated to continue to maximize their profits using the non-transparent system. Although you criticize Medicare, at least it is a national system with simplified "rules of engagement" compared to the thousands of commercial plans that have such huge variation in coverage and pricing.
5
I had an MRI of the inner ear done recently. It was a highly specialized exam. Few radiologists in the country are qualified to read it. The bill for this non-interventional, thirty minute procedure was over THIRTEEN THOUSAND dollars. Our insurance costs us 20k a year, and even with that we had to pay 1.5k for this exam.
I know the doc is special. And I'm grateful to her for diagnosing a medical condition I have lived with for over fifty years. But, seriously, the profit margin on this type of thing is astronomical. I couldn't have shopped around because so few doctors are qualified to read it. These hospitals are being run to the ground by their MBA money managers. Free market economies are anything but free.
12
The time has come for people to take responsibility for their own health. The internet is the doorway to knowledge that people can access about their ailments. Before one can shop for price saving treatments people must become experts of their own bodies. Research recommendations of clinicians, be skeptical, be questioning. Then armed with information, one can ask the questions necessary to decide if the treatment is needed and find a reasonable cost.
@Janet, I don't know about you, but my life is already full of things that I have responsibility for and have to shop for knowledge about. Car care, house maintenance, personal relationships, tax planning, day to day financial decisions etc. I have time for only the most elementary study of all of them, including health care. I rely on my doctor for his/her years of training, and my friends for their experiences in health care. Especially if I am ill, I do not have the time or energy to do the sort of research you are suggesting.
10
There is so much misinformation on the internet! Trust is the most important issue in medical care! If you or a loved one has a life threatening condition, you want a medical provider you can trust.
1
@Janet: you mean...poor people? old people? uneducated people? simple-minded people? those who don't speak good English? new immigrants? people who are not computer literate or don't own a computer?
Or do you just mean "college-degreed white professionals with upper-middle class or wealthy incomes"?
Because that is not 100% of everyone.
4
Another thing that seems to work is universal state-paid health care. Why do we insist on trying to re-invent the wheel by making it square? The rest of the developed world has already figured out that those corners get in the way.
14
If shopping for better prices wasn't already complicated enough, doctors and insurance companies are either unwilling or unable to connect with each other to determine prices for patients. Every time I've needed medical services, my doctors can only tell me their billing rates (thousands of dollars above the contracted insurance rates), and insurance will outright refuse to give a full estimate of what the price will be asked of me through their negotiated rates, siting that they need to process the claim first. There is no other system in our society that forces consumers to accrue costs with such little information on what they are spending, and with their health and well-being on the line. There is no winning for the consumer if they are not actually able to compare genuine prices, the system simply does not work.
10
@Mia Mia, you have some good points. However, doctors don't have the information on prices either. Pricing is very complicated and varies with the insurance company. And each insurance company may have multiple different plans with different copays and deductibles. The only way you can really get price transparency is to have a completely integrated health delivery system where all health care services are available in one system and the patients get all of their care in that system.
2
"For example, we could provide physicians with price, quality and distance information for the services they recommend. Further, with financial bonuses, we could give physicians (instead of, or in addition to, patients) some incentive to identify and suggest lower-cost care. An alternative approach is for insurers to refuse to pay more than a reasonable price — like the market average — for a health care service, though patients could pay the difference if they prefer a higher-priced provider."
Living in the UK I thank God for the National Health Service where referral for an MRI is based on clinical need, and financial incentives for referring patients are not part of the mix.
I don't know how the US gets out from under this mess. Medicare for all might be a start. But it will take a very long time.
12
For elective or non-emergency procedures and medications, people are shopping; just not in the United States. Canada, Mexico, and South America are the real destinations for folks that realize that the deck is stacked against them in the US.
The medical industrial complex in the US is diametrically opposed to the Hippocratic oath, intolerable, and unsustainable in its current form.
11
as you might know most medical facilities and medical care locations are in the hands of and owned by corporations(some of them operate such facilities in several states).
Do not blame doctors and medical personnel since for the most part they do not have a say in pricing(there are very few that still are owned by physicians).
Working for such corporations doctors are not even allowed to offer professional courtesy to their colleagues!
Medical insurance in the United States is a labyrinth, needlessly complicated and opaque to the user. Shopping medical services, which you suggest is an easy thing to do, becomes ridiculously difficult when no one can/will provide you with an accurate quote on what they charge, what the insurance company’s negotiated fee is, and how much you will pay out of pocket. The entire system needs a reset, which could be really simple: Medicare for all! Just make it available as an option. Those who want to stay with the complicated and usurious system, or pay for private healthcare providers, can. And those of us who want to take advantage of Medicare’s economies of scale, will.
13
Hospitals charge insurance companies and patients more for MRIs because hospitals have higher costs than independent centers. Hospitals must staff their emergency rooms, operating rooms and hospitalized patients as well as laboratories and much more. If we cut back on reimbursement to hospitals willy nilly we will surely save money but at what real cost to those of us who depend on hospitals for necessary or critical care? There will be fewer nurses, technicians ,hospitalists etc. This matter can't be oversimplified.
1
Putting the patient on the hook for the difference sounds like an aggravation of the horrible system we have now. I've called my insurance company itself to find out the price of reimbursement and they can't tell me. No one knows what any procedure will cost--believe me--I always ask and I have yet to get a straight answer.
25
An unmentioned factor is physicians tend to refer patients for testing, therapy, etc. where they have a financial stake . Despite the Stark Law :” Stark Law is a set of United States federal laws that prohibit physician self-referral, specifically a referral by a physician of a Medicare or Medicaid patient to an entity providing designated health services ("DHS") if the physician (or an immediate family member) has a financial relationship with that entity.“, physicians easily find ways around this. We trust our physicians and we don’t ask questions, assuming the physician is considering only what is best for us.
6
@Marilyn R When I signed up to work for St. John's in Springfield, MO, (now Mercy) I was told that my compensation depended directly on how many tests and referrals I made within the St. John's system. I asked, "What about the Stark Law? Isn't that illegal?' The administrator told me , "Don't worry, we've found a way around that." I only lasted 2.5 years there. I now teach students physiology, and the realities of our health care system. It's for profit, not patients.
6
that's simply not true. the overwhelming number of physicians are employees of a hospital system. we don't own or control anything. in a 20 minute visit, I don't have time to do price shopping for you too. we hate this system as much as you do. I refer to my hospital. the end. it's close and i can see the imaging myself.
4
@gdf
It is true in Florida. Many physicians are closely aligned with hospital systems, but have ownership in surgery centers, therapists, and diagnostic testing abilities. Apparently it’s true in Missouri also.
Where I live two large hospital groups have taken over just about every primary care and specialist practice, making doctors employees of their companies. I would be astonished if those hospitals do not provide incentives to doctors referring patients to the hospital's facilities, which are invariably among the most expensive places to have tests or treatment.
3
I don't believe that the US healthcare system has actually tried "making patients spend their own money". Most people who have health insurance are focused on the amount of the deductible, and the annual out-of-pocket maximum. And in my experience those who use most of the medical services generally max both out, and select their coverage level with that probability in mind. In those cases, their mindset isn't as if they are spending their own money, at least not at the margin and on a procedure-by-procedure basis. Until our system actually adopts this approach it seems misleading to criticize its effectiveness. But, even if we get there, the real issue with healthcare delivery is the profound mismatch in market power and knowledge on the part of providers versus consumers. And the only way to fix that is by equating the power of the payer with the provider, aka universal managed care, such as Medicare for all. We'll get there, but clearly not before we waste precious time and resources, not to mention lives.
2
Something is missing from this article. For years I worked at the very high quality independent Imaging Center in Fort Wayne, IN which performed advanced imaging at a significantly lower cost than the hospitals or hospital-owned imaging centers. We were extremely busy. I would like to think that this was entirely because of the quality of our procedures, diagnoses, and the caring nature of our staff. However, we also had help from insurance company programs which steered patients towards us during the process of pre-authorization. Why is this not being done more widely? Of course, it might now be too late. For example, the Imaging Center from which I have retired was purchased by a local hospital chain and its prices were raised - a lot.
2
A huge issue is that often no one can/will tell you how much medical services cost! As a Canadian living in the US, I was not used to having to "shop around" for procedures. But having heard horror stories about people being bankrupted due to the high cost of health care here, I tried to be diligent. Insurance companies (we were with BCBS) couldn’t tell us because "it depends on the providers contract with the insurance company" and that information is apparently not available to the mere hoi polloi. The labs and doctors offices often said that they not tell me for the same reason.
Earlier this year my husband and I had to go on Medicare and then had to decide on a Part D insurer and chose to get Medicare Gap as well. So now, retired and on a more limited budget, we are once again having to practice due diligence in finding out how much each interaction with the medical profession is going to cost us. Frankly, even with the political and social situation here in the US (as bad as it is) the single worst thing about living here has been negotiating the health care system. It really is bad for one's health!
21
" patients could pay the difference if they prefer a higher-priced provider " - yea, right. The day every medical service comes with a "what you will pay" price tag, maybe. I walked into a compounding pharmacy to ask the price of a prescribed remedy. They actually got insulted, refused to tell me, and told me to buy elsewhere. Turns out they were actually the cheapest source - but I had to embarrass them with a letter to my state attorney general before they would sell to me. Pass a law to require posting out-of-pocket prices, given a simple code categorizing the patient's insurance, and the software to do it will come. The kickback will come only because the medical establishment has no culture of making and keeping price commitments.
6
The only piece of health care that I can be sure has the same quality no matter where I go is prescription medicine including vaccinations, and the pharmacies and clinics will even provide you with the price before you buy. For everything else I am more concerned about the qualifications of the provider than the price. Quality is hard for consumers to evaluate, but my gut tells me to trust an MRI center in my local hospital more than the storefront MRI center in the mall. Quality involves the equipment, calibration, training of staff, and probably other things I don't know about.
If I need a joint replacement, I want to go to the surgeon and hospital that do a lot of joint replacements with few complications and would never shop by price.
Insurance networks make the provider decisions for all but the highest income consumers. Low-income health care consumers may avoid spending when the cost comes out of pocket for the deductible, but higher income consumers will try to burn through the deductible so the insurance will kick in.
All of the incentives in the system are distorted. Medicare for All! (or some other plan that covers everyone and removes the enormous costs incurred to pay insurance companies and billing staff.)
14
No one can shop for health care. Medical providers use medical coding to determine the service that one has purchased, and they do it ex post facto, without the patient's approval. Insurers decide unilaterally whether each coded item is covered.
Claiming that a consumer shopping for an insurance policy exerts any form of control over the product is incorrect. In reality, supply and demand are being completely regulated by the whims of commercial enterprises.
15
Even when the price of the MRI is known to the patient, I don't think that tells the patient what they personally are going to pay. I can't figure out what portion of any given bill will be paid by insurance and how much I will have to pay. If the MRI places and the insurance companies made it easy for me to know how much I personally would pay (like if they told me when I made an appointment), I think it would affect my behavior.
9
Most of America does not have many choices when it comes to things like MRIs. If I draw a 1 hr radius around my home, from my home I would have 5 places that have an MRI, 3 are small regional hospitals and will be expensive. If I were to increase the radius to 2 hours I could almost get the plethora of choices described by the author. The rub, it would not necessarily be any cheaper and I will have lost a day of pay as I do not have any paid time off.
I have had to have MRIs repeated because my orthopedic doctor could not see the actual scan (Dr preferred place was not in network) and the report looked like a 5 yr old wrote it. Another time the equipment was malfunctioning and the tech and person reading the scan didn't notice.
In a consumer driven market, the consumer does not pay for faulty products. I am sure some honest medical facilities and doctors exist that would not charge for their mistakes, but that does not seem to be the norm.
5
I am a primary care physician. What many comments and this article completely missed is the complexity of coordinating care. I'd love to have access to a list of the costs of MRIs and blood tests for that matter for all procedures I refer to. It is near impossible for me to obtain that list and somehow I am called money hungry for not spending more hours researching this for patients. How do I know what's in network for a patient when that is constantly changing? I don't.
Most importantly though, if you go to an imaging facility of your own accord, good luck getting the records to be reviewed. I then need a copy of the images. I need them uploaded into my electronic medical record. If you do it at a facility affiliated with my practice, which is what I recommend, I have full access to your records, can compare them easily and share with my team of sub specialists. We do not have a single electronic medical record. If you fragment healthcare more, you will incur more waste. I see this daily.
20
@Dr D
As the person going in to the MRI, how can a patient know what questions to ask their insurance company and the MRI provider to ensure your time and the patient's money is not wasted? Is it also safe to assume that if you recommend Facility A, that you know the person reading the results knows what they are looking at and their equipment is well maintained?
I have had 2 MRIs that needed to be repeated. The damage was clear for all to see, yet the final report said everything was normal. Mistakes happen but when the in network experts are 500 miles away at a major University medical center, I would like to be sure there is a good track record before leaving home.
3
@Dr D
Please stop making excuses for a broken system.
My dog had a gimpy leg. We took her to the low-cost spay clinic to get her spayed and had her hip xrayed while she was under. The clinic doesn't have orthopedic surgeons on staff, so I had them email me the scans. I was then able to email those scans to two separate ortho surgeons for diagnosis and to recommend treatment. The surgeons were able to communicate treatment options to me by email and phone - without my having to spend a dime.
If this is possible in the veterinary world, which has a much smaller patient population, then I see no reason why we can't provide this level of service to humans.
The recommendations for reform in this article are tepid at best. We live in the greatest retail empire in the history of the world. Just advertise the prices for an MRI or any other medical service so consumers can see what they cost. I believe that’s what they do in progressive nations, such as Japan. Jeez, I can walk into my car dealer and scan a price list for an oil change, transmission service or a host of other options. But to maintain my own health, I’m in the dark.
But the U.S. medical-industrial complex has everything it wants in the form of opaque pricing and no price caps for equipment, materials or services. So why would it want to change on its own?
The best you can do as a consumer today is to find doctors who you know in your gut are not money grubbers. They are still out there, but they’re getting harder and harder to find. They order only necessary tests. They don’t tell you which facility to use unless there’s an issue of competence. They’re in it for the service they provide to other human beings and not just for the bucks.
Nothing will change in this country until we break the stranglehold of the insurance lobby on Congress. To that end, we must also elect candidates who aren’t just in it for the money. And we must enact campaign finance reform. Every single problem in America can ultimately be traced back to the pernicious effect of money in politics.
14
It's fairly clear that when doctors don't want to work on a patient, such as when the patient's insurance doesn't cover a procedure, the patient simply doesn't find out that he has the problem.
Or the patient will be treated for something else or referred to a different physician. Try investigating why doctors choose their own diagnosis over another diagnosis. And they never go back and treat the previously ignored problem.
Who's going to investigate these people. The FDA or the IRS?
3
You can't make price vs. quality decisions when you have no information about either. Period. The cost of health care is universally obfuscated, particularly by hospitals. If you want a free market to work, the consumer has to be informed.
17
A clarification on the mathematics of Taiwan's single-payer system (as I understand it). Everyone, including foreigners legally resident for over 6 months, is required to join the system. The premiums are charged on a sliding scale based on income, and payment for the premium is divided among the insured, the government, and the employer, if the insured is employed. I'm at the higher end of the salary scale, so my monthly payment is about $50. People in the US object to a "mandate" there because insurance there is so expensive, but when 23 million people are required to pay only $50 or less a month, that along with the gov't and employer contributions, is more than enough to cover each year's medical expenditures, including the fraction with expensive conditions. This, of course, is because the single-payer controls the prices. Providers can choose not to join the system, but they will then have very small practices of only wealthy patients, so most do join. The use of digital medical records and IC chipped insurance cards for payment means that the system collects a huge amount of data that allows it to monitor resource usage in great detail and make needed adjustments. The system works really well, and is definitely proof of what is possible.
18
Physicians (the ones I've used) aren't going to spend the time, even with financial incentives, telling me where to get a test done. They are going to recommend a place associated with their practice that puts additional money in their own pockets. I just left a doctor who didn't have time to remember that I was due for a mammogram, but ordered a $75 vitamin D blood test for which there was no justification at all. He was just finding another way to up his income.
7
How do you find out what something costs when they refuse to reveal the price? Even direct questions are ignored.
24
@roxana I always ask what tests cost and am told it is impossible for them to know. The medical and insurance industry does not want its patients shopping and comparing price.
3
Hilarious.
Wanted a generic prescription instead of brand name. Doc sent it in. Pharmacy called and said sorry, rejected. Called my big name prescription service,' covered.' They nicely called called pharmacy and filled that afternoon. My doctor calls next morning to say it was rejected. What do I want to do. Nothing. they filled it. Oh. fine.
Go to mail box and lo and behold there is my prescription rejection letter and how to file appeal.
If we can't fill a simple prescription without a keystone cop comedy how are we going to get even basic medical service prices?
What part of gdp do we spend on an inefficient, second rate system? As I said. hilarious, not.
27
@Alan Schleifer
Act 2 of your comedy of errors - you most likely would pay the same or less for the prescription by not using your insurance.
1
My doctor does not know or really care about the costs, fortunately under Medicare it is all the same. Insurance needs to take care of this.
9
No mention is made of the role of insurance networks in the choice/options of where patients can go for services. If the cheaper/cheapest options are not in the patient's network, it would be more costly for the patient to use them. Doctors tend to refer patients to services in their network. Also, when suggesting that if patients would merely travel an additional 20 minutes each way they would get cheaper services, does not take into account that patients may be taking time off work: not all workers can afford the extra time.
14
Maybe the solution is simpler than one would think.
If an insured person is still under their deductible, then by law their insurance company should honor any lower cost provider. And count the amount as “in network.”
This will lead to more shopping where the patient is not penalized as they approach their Out of pocket max and cause the various providers to compete for the entry level services.
4
No surprise here. Consumers don't spend time shopping for a product they really don't want to buy. Nobody fantasizes about getting that MRI the way they fantasize about a vacation. Getting any medical service is an aggravation, not a pleasure. So, unless people absolutely have to do it, they won't. They will go with the easiest option. If their doctor recommends a provider, they figure the doctor trusts that provider, and knows what he or she is doing, so let's just go with that. The only other influence will most likely be which provider their health insurance is contracted with, because they may be limited to in-network providers only.
13
Additionally, many people buy things like an MRI only a few times or just once. To be an efficient shopper you need experience with the product.
Compare frequent consumers of procedures to those who’re one-offs, all with similar health coverage and see if the efficient individual shopper theory holds.
In my experience the best way to control health costs is to avoid going whenever possible.
4
Everyone talks about empowering the consumer to 'take charge of their health care' but you see where that puts us. So, we're taking the approach of empowering physicians with the data they need to make better, more informed referrals so that they guide patients to the lowest-cost/best-outcomes providers. Health decisions are complex, and patients want to get guidance from their primary doctor but when that doctor doesn't know, they can't "refer well" unless they get the right tools... so that's what we're trying to give them.
5
I am an expat living in Germany and have full medical coverage here including dental, everyone pays a 7.4% tax on wages or retirement benefits. People belong to non-profit health care companies who compensate the providers. Office visits are 10 Euros quarterly, meds costs range from zero to 11 Euros for the exotics, hospital stays, outpatient services and specialists zilch.
German healthcare is focused on preventive care, education on lifestyles and preventing minor things becoming major ones. I have not met a single German who would rather have the American way.
Lastly don't sing the old tired song about wait times, how about the wait times for the uninsured facing a major illness and seeking treatment in an ER. Fagetaboutit!
73
@Robert Keller And you have Germans as the customers, and Germans as the providers. Massive difference.
4
This piece dances around the issue central to our health care “system” and its structure. That issue isn’t price shopping, consumer-patient behavior, or good ol’ American marketplace competition, truly a myth. No, the central issue in America is a crazy-quilt, purposefully confusing, profit-driven big business called “health care.” The consumer has no power, no means to influence or change the cost reality. Just the example of MRI costs demonstrates the fraud of every provider arrangement. And need an MRI? Just try getting your provider or restrictive insurance plan to help you or accept an alternative provider.
30
I find this article deeply disturbing. 63% of Americans don’t have enough to cover a $500 healthcare emergency (Forbes). Even with insurance, Americans can’t afford their medical bills (The Atlantic). Observing “an average deductible of $300 for an MRI” with sleight of hand smacks of indifference. Having a conversation around Free Enterprise in the healthcare system is the problem, not the solution. Hanging a sign with list prices — caveat emptor! — and placing the patient in the drivers seat underscores the moral vacuity of our present system. Healthcare is a moral good, not a for-profit commodity. There is a solution and in New York it’s called the New York Health Act. Vetted by world class healthcare economists and ready to implement — NYHealth brings Universal, Comprehensive, Cost Effective and Cost Savings healthcare to all New Yorkers, regardless of immigration status. And saves $45B for infrastructure, schools, and business growth. No co-pays, no deductibles, unfettered access to Improved Medicare for All. Get smart — Take Action — Register to Vote —And Vote. To learn more, nyhcampaign.org
20
@Hadrian Sure take action, stop spending and save for your emergency fund. After all your car might break down more than your body. Voting is just making you dependent on the government, which does not work too well.
3
@vulcanalex. Thanks. I’m all set for my emergency fund — I’m thinking about the vast majority of Americans who are not as fortunate. That’s part of the absence of moral acuity I mentioned — a concept you snarkily overlook. Or, rather, couldn’t conceive. My forebears founded this great Country. We are a nation of good people, and the positive momentum of like minded advocates cannot be deterred.
10
No one shows you how to 'shop' or compare pricing--so you go where ever you are told to go. The same with prescription medicines--they say to shop around but often my prescription is sent to the nearest pharmacy. Done deal.
4
If you are young leave the United States for a country with a health care system.
32
MRI reports: Are there strict regulations for what is included? With multiple back issues over my 65 years, I have had many MRIs. Reports can vary from three pages of detailed information to two paragraphs mentioning basic problems only. How do we choose where to have imaging if we care about what will be reported?
4
@Mary
You hit the nail squarely on the head. Imaging technicians and the people maintaining the equipment matter as well. And how is the consumer supposed to know this ahead of time? The quality of the expert interpreting the results is not known to the consumer but usually IS known to the doctor.
You should have the wherewithal to ask your doctor about the quality of the facility. Sadly, there is no guarantee that you will get the truth but it is still worth asking.
4
When shopping for a rare (for the individual) and important procedure, higher price might seem preferable as it confers higher quality. So aside from expecting consumers to pick the cheaper option it seems like you'd need good quality metrics and expect people (who apparently aren't even taking time to shop) to understand these quality metrics.
2
I'm a physician in an executive level position. The example of shopping for healthcare is penny-wise and pound foolish. If a patient picks a cheaper freestanding MRI, the report and the scan itself probably won't be available for review by the doctor (or the scan is much less functional) than if performed at the hospital. surgeon is and the surgery will take place. The ordering physician may not trust the results. The scan isn't available for surgery or is much less functional. So, often such tests get repeated (no savings to anyone). Patients who stay within one system use fewer resources than patients who get care from several systems.
And even doctors have trouble interpreting the very limited and often poor quality "quality" data. A cheaper MRI isn't any good when the diagnosis is wrong. Trending doesn't work when labs are performed using different methods. The most important question to ask is whether the tests themselves are necessary and how the data will be used. A significant proportion of imaging and lab studies are unnecessary and even worse, false-positives add to unnecessary and sometimes harmful additional care. Of course, how can patients determine that? Capitation and population health management will solve some of that but create new issues.
Another option is a totally interoperable electronic health record (doubt that is coming in the near future).
18
@db where you get the mri is not necessarily where it gets read. https://www.nytimes.com/2003/11/16/business/who-s-reading-your-x-ray.html
Why must the imaging & the interpretation be the same choice?
1
@db
"The most important question to ask is whether the tests themselves are necessary and how the data will be used. A significant proportion of imaging and lab studies are unnecessary and even worse, false-positives add to unnecessary and sometimes harmful additional care."
As a physician, I hope this is the message you consistently provide to your patients. My favorite question when a particular test is recommended is "how will my treatment change based on the results of that test?"
Forget about incentivizing doctors to refer to lower cost facilities--they are already incentivized, via their affiliated or employer-hospital, to send to hospital owned imaging. Sad though it is, the financial dependence of surgeons, like orthopods, on hospitals for their very livelihoods has taken precedence over the traditional ethical standards of doctors putting their patients' interests first. In fact, although it is illegal, often they are penalized for "leakage" of patients going outside the hospital system for any services or specialists. SO THE ONLY HOPE IS FOR EDUCATION OF PATIENTS ABOUT THE UNNECESSARILY HIGH COST OF HOSPITAL BASED IMAGING, AND THE AVAILABILITY OF LOWER COSTS FACILITIES. This can be greatly enhanced by regulations and public pressure for price transparency. Those free standing lower cost imaging centers should advertise and publish their prices!!
6
A better approach is to get individuals' health service surrogates (e.g., insurers, employers, Medicare, Medicaid, etc.) to identify and offer attractive coverage for the health care system in each market with the best multi-year record of controlling cost and quality.
8
Another reason why shopping for lower-cost MRIs is impossible - most states have certificate of need (CON) stipulations that prevent non-hospital providers from offering lower cost services. For more information see https://www.vox.com/policy-and-politics/2018/7/31/17629526/mri-cost-cert...
Health care in most areas is a monopoly that prevents free-market lower cost providers from offering services.
7
Shop for care outside of the system you are already using? Do these folks even realize how LONG IT CAN TAKE to get results sent from one facility to another; to get CT scans, MRI's etc. uploaded into your medical records when they come from another facility? Do these folks not realize that there are good reasons to get some of these things done at the "better" places such as the quality of radiologist to read the report? A radiologist who can specialize and sees many scans of similar problems generally does a better job at noticing subtle issues than a generalist. AND insurance does NOT pay to have the scans read twice.
Do these people not realize if I am going to get a strep throat swab done at the cheapest place I might have to wait 6 weeks for a new patient appointment; that there is an advantage to having someone familiar with all your health issues see you rather than a stranger?
I have a complex medical history. Recently I was out of town and went to a pharmacy run walk in clinic for a urinary tract infection. I gave them the pertinent information about my medical history including that they can't prescribe me meds that have a high risk of neuropathy. I filled the Rx. Then read the circular in front of the pharmacy counter. Oops. Can't take this drug. Couldn't return it. Went back to get a different Rx. Wasted $29 and time.
These are important reasons why we don't shop for care too. It's not ALL about money. It is also about competence, the actual doctor, time...
24
@Liz
It seems that you haven't considered that the majority of individuals do not have unlimited funds, and that they might not be able to afford to pay top dollar.
I have complex medical issues as well. I've been quoted $750 and up for initial consultation with specialists , exclusive of any procedures that might be necessary.The follow up visits range between $450 and $650.
My former internist of twenty years dropped all insurance. He charges $1,200 for a physical. Sure. I would have liked to have continuity of care. In fact,
I haven't been able to find a decent internist since.
However, it's more important for me to have a roof over my head, than to have "the best" internist. As for specialists: I'm out of luck. I exhausted all the specialists who accept insurance, and have to accept being sick, incapacitated and undiagnosed.
I've been priced out of obtaining a diagnosis, for a condition that none of the specialists whom I've consulted can identify., while it is easily visible. I've heard :"I have never seen anything like that in my life" & "I have NO Idea what that is", from professors of medicine.
My only hope is the super-specialists whom I can't afford.
Perhaps this type of 'voluntary' MRI is shop-able in some places, if so many other medical costs are not.
Clearly, from the responses of physicians, the issues even for this are many, and varied.
In a world where patients have issues understanding HIPPA forms, and medical releases, exactly how many of them are qualified in any fashion to 'take charge' of their own health care.
I have, and feel I'm able to, research and basically understand conditions that affect my, and my loved ones medical conditions. But only after they are diagnosed by a professional, and even believe in second opinions if time allows, but when you, or a loved one is really ill all you ask is "who's the best for this, that takes my insurance" .
Any suggestion otherwise about 'shopping around' or ' making your own decisions ' is from people who never need to deal with it.
7
I guess it makes me unAmerican, but----I hate shopping, for anything. When you actually get fair treatment with no ripoff or hidden gouges in any business transaction, it's a truly rare occasion. And with a captive audience in the health care market, it's no wonder that the gougers and grifters have fastened on it, licking their chops. I pray I never ever have to come in contact with health care so-called, much less haggle over its price.
12
Why does the U.S. have the highest cost and least efficient health care system of all the industrialized countries?
Did this start when Henry Ford offered his workers free health care instead of a pay raise?
(and shackled them to a Model T because if they quit they lost their health care)
Does this create serious problems for labour mobility?
ancient Canadian economist
7
Patients have lost interest in saving since the advent of third party payment. When someone else pays one judges value by price.
For the century before insurance was common (1850 to 1950) life expectancy increases by about 3 years per decade. After 1950 the rate dropped to about 2.2 years per decade. That's what happens when the consumer is removed from the marketplace.
HSAs are the best answer, but they need federal support, and not just making them a part of the system. They need to be financed for many.
Putting people in control is a primary part of making them healthy.
1
@America's Favorite Country Doc/Common Sense Medicine
But if each consumer makes a deal for each provider for each medical service, each such consumer has zero leverage as to prices. At least with the advent of insurance - or better yet Medicare - they can push prices down somewhat because they have the leverage over doctors, hospitals and drug companies of offering millions and millions of patients.
5
Doctors often refer patients to facilities in which they may also have a financial interest, something that is rarely disclosed upfront, but is an unethical and abhorrent practice.
6
After being billed $4000 for a CT scan at a local ER, I called a competing hospital to see what they charged. They refused to say, telling me it was illegal to list their ER charges. I've also had specialists who simply refused to give charges for basic office visits on the phone. The medical field is utterly untransparent and obfuscating. But more importantly, medicine isn't a commodity: people want to trust their doctor.
It's like the difference between a guy that will change your oil, or one that will voice your Steinway piano. The first service is can be commodified, but the second can not.
18
Shopping around for elective care is an excellent idea in theory. In practice it is very difficult to accomplish. I have a high deductible and recently underwent an expensive breathing test, which I had to pay for. I live in Manhattan and tried shopping around. It was extremely hard, time consuming and ultimately fruitless. Service providers are not necessarily forthcoming with price information and it is difficult to evaluate the quality of elective care. Additionally , doctors affiliated with a particular hospital usually recommend the tests to be performed there and have no incentive to lower patients’ costs by sending them somewhere else. I tried using some of the existing medical pricing sites but I found that the information provided was often spotty or non existent, especially for Manhattan, in part because it relies on self reporting by hospitals, providers and patients. Effective price shopping for elective care will only truly work if service providers are required by law to be transparent about what they charge via a publicly available database. If the government will not intervene, at a minimum one can hope that an Amazon type company, consumer driven and technology innovative will come up with a site that will allow patients to shop around.
27
I, too, have had an aggravating experience trying to get an estimated cost for an elective test. I, too, have a high deductible insurance plan. The insurance company cannot (or refuses to) tell me what my “patient responsibility” portion will be. They claim they cannot share with me the negotiated rate they have with the provider for the procedure. Provider tells me the can only share the cash price for the procedure, not the rate they will bill my insurance. After months of aggravating, time-wasting calls with all involved, I have simply foregone the test. If I become ill as a result, the insurance company (and I) will be in the hook for much more. Paying for health care is like booking a cross-country flight and not being told the price until you arrive at your destination. Then, it is not “returnable.” Completely unacceptable!
22
The experiments have been done - "free market" health care doesn't work. The common element in the several systems that other countries use and which cost half as much as the US system, is prices being effectively set by government, often in a process of negotiation with providers. Only a central authority has the knowledge to do this.
21
My endocrinologist sent me back to the competing hospital for my second DEXA scan because she wanted a comparison from the same machine, as calibration can vary from vendor to vendor. Similarly, blood test results from the same lab are more meaningful.
6
The difficulties in shopping for health care not only apply to individual services. The same issues are evident when shopping for an insurance plan.
I am a retired physician. I find myself having to shop for part D (prescription coverage plans) almost every year, for both myself and my wife. Our medical conditions are not acute.
Even with generic meds, coverage and cost can shift from one year to the next. Prices can vary up to 10 fold (and maybe more) for the same generic between part D plans. For example, part D coverage for ezetimibe (generic form of Zetia) is about $27 for a 3 month supply under one major insurer, and about $270 for 3 months under another. The higher price comes under the cheapest plan--perhaps no surprise. But the reverse is true for other medications (some generic, some not).
Hence every year it is necessary to price meds individually under each plan. Yet it is not possible to be entirely certain you have accurate medication price information during the open enrollment periods. It can shift and be a very unpleasant surprise.
The point is the same as made by Mr. Frakt: how many people have the skills or patience to do this--not only for acute care, but year after year even when their medications are stable. An aging population is most susceptible to these problems, and that is exactly what we have here. It is estimated that 10,000 baby-boomers a day are retiring from the work force. Are they now supposed to sit around and shop health care?
50
Shoppable health care must be an inside joke from those who study the health care system. There is no way in today's insurance and health care system that you can shop for any procedure or visit.
Have those who favor shopping tried to talk to a facility receptionist to try to find someone to get a price? How about the fact that getting records while must better is still a challenge today between different entities. And out of bounds insurance almost alone kills the idea.
If Charleston is like other areas there are limited health systems in town. Insurance policies I've seen use one or the other but never both. In fact our state health care policy for state and county workers only supports one and very few immediate care facilities chains.
What this leads me to think is health care for all is the only way to fix this, as we are never going to get the entire health industry to change.
42
@Charleston Yank "Inside Joke" is the perfect description of shoppable health care. Thank you for putting your finger on the crux of the matter. I've been struggling with medical pricing for the 6 years that I have been on Obamacare.
4
I want medicare for all.
This issue has become particularly important for me since I spent four days in the hospital last winter due to a cyst on a nerve that caused so much pain I couldn't move. Then, I needed surgery.
My husband and I pay out of pocket for an HMO since we have our own business. Up to last winter, I had been quite healthy but actually needing medical care will raise our premiums quite substantially and I'm worried we won't be able to afford it. As a result, I will only vote for candidates who promise to fight for medicare for all.
55
I'm a 65 year old physician. In the U.S.A. no pharmacy can tell a commercially insured person what your out of pocket cost for a drug will be before you present them with a prescription and an insurance card. You MUST purchase the insurance before you can find out. All they can tell you is the cash price for an uninsured person. Go ask your pharmacist. If you can't even find this fact out, how can you possibly sort out a complex procedure. When would anyone tolerate this in other personal expenditure? We'll tell you the price after you sign the contract. Come to think of it, this is how Congress has been operating for the last three decades so why not health care?
95
@James
I am a bit puzzled here--and maybe I am missing a point. Perhaps this is more problematic for people not covered under part D.
I frequently go to the part D sites (my wife and I have separate plans) to see what my copay would be, whether by mail order or from the local pharmacy. Most of the time that is no problem. (I am a retired physician.)
If one were uninsured, then the cash price would be applicable (but maybe still available at a discount if one looks around: https://www.consumerreports.org/cro/2012/05/can-a-phone-app-help-you-fin... ).
I can understand that it would be preferable if one could do this at the point of service, in a local pharmacy.
At a basic level, I still agree with you. The overall process is ridiculously complex.
2
@JSK I do not yet have medicare. While I can sometimes get the people behind the counter to tell me my cost of a drug - to do so they have to enter it into the system as if I am buying it while I am present. The amount of gas driving all over town to compare pharmacies may well cost more then the drug savings. Or not. You just don't know. As it is, I have the "family plan" at Walgreens because I can save on pet meds and insurance. So I have them compare prices. It is a crap shoot which is plan cheaper for human meds. Also having your meds spread all over town makes no sense for people on a lot of meds as pharmacist computer programs catch interactions and that won't work if all your drugs aren't filled in one system.
As someone with an artificial hip: calling a hip replacement "an elective joint replacement" is ludicrous. Would I have had to be in a wheelchair before it could be considered?
One small detail: I live in a country with the dreaded socialized medicine. Prices for services are defined, you do not need to shop around for deals.
The total cost of my hip replacement including pre-operational checkups, own blood donations before the operation, ten days in the hospital, and physical therapy was about CHF 5'000 - about USD 5'000. My share out of pocket: CHF 40 for my crutches. And contrary to popular belief, I could choose my date for the operation. I could have had it almost immediately if I had needed it (I delayed for reasons of work).
57
Another word for “elective” is “scheduled” or “not emergency”. Not “ludicrous”. It’s not a negative connotation.
4
@Sally
For your information, healthcare in Switzerland is NOT socialized. Get informed, please.
1
I tried and was unable to find MRI price last week. The posted cost for "Upper extremity Joint MRI without dye" - $1204 on my provider's site. My health care center poses costs for common diagnostic tools. When the bill for my MRI of a toe arrived, I expected a cost around $1200. Nope. "MRI lower extremity" billed $2247. What? I asked the insurance company-- rep did not seem to care to ask provider why a toe MRI would cost $100- more than an "upper extremity," instead closer to $2459 listed for a "Brain MRI with and without dye." I asked the provider's billing office, who could merely confirm that the billing code is for lower extremity MRI with analysis. The office did say that insurers agree on the costs for procedures, so perhaps this MRI was one for which the insurer had agreed to a higher price. Maybe. I do have a high-deductable policy. No explanation for why the "lower" extremity cost is not posted. Is it perhaps because the posted costs are only those below the mean, not those above? Anyway, my anecdote is consistent with the article's observation that even if a patient tries to assess cost in advance, it is tough to do. It would be useful for big centers to post estimates for larger number of procedures-- perhaps by the standard AMA cpt number.
14
@Charlotte But the catch is that they'd have to do so for each insurance company that they accept because they have different negotiated rated with different insurance companies.
5
We could have the government set the price as it does for Medicare and is done in most other countries. Neither patients nor doctors should spend their time shopping around for what this study shows is a standardized service.
24
@Richard Lachmann
"We could have the government set the price as it does for Medicare..."
The government can't dictate prices to private industry.
As for the government setting prices for Medicare :
The government can set prices, but can not force doctors to participate in Medicare. A set price is worthless when one has to pay out of pocket because one's physicians have opted out of Medicare due to ridiculously low compensation.
This article only makes sense if the patient is paying cash(which is unlikely) or going out of network (which is perhaps more likely than paying cash but still not often).
The insurance company only pays a certain amount regardless what is charged. It matters not what is billed or charged. The MRI location (or fill in blank for whatever service) is going to get what they get from the insurance company or socialized care such as Medicare. Period.
2
No mention in the article of the elephant in the room, the insurance companies. If I go "out of network" to a cheaper MRI or other provider I may well pay MORE than if I go to a more expensive provider who is "in network". Moreover, with my insurer most of the top ranked doctors in my area won't participate in the insurance plan because why should they? Lastly, it is disingenuous in the extreme if you don't believe that hospitals that own testing laboratories, colonoscopy practices etc don't lean on their doctors and their subsidiaries to nudge patient towards them. Otherwise why would they buy them?
30
My experience is that my doctors often insist that I go to a particular lab for MRI, echocardiogram, CAT scan, etc.
6
I think this article is missing the fundamental issue of why physicians recommend specific imaging centers (which tend to be in their own health system).
If I order an MRI from the hospital where I practice, then the radiologist read is available immediately in the electronic medical record system. I'll be alerted if there is a serious finding. I can review the images myself by looking at them using the radiology software. And, if I have a question about the radiologist's report, I can call him or her and discuss the findings.
The patient always has the option to go to another facility. If a patient goes to a standalone center, then the report will be faxed to the office. It then has to be scanned into the chart. I can't see the images without someone mailing a physical disk (or sending an expensive courier). If a clarification is needed, then tracking down the radiologist who read it is much more difficult (standalone imaging centers often use remote tele-radiologists to read the images).
These are considerations that affect the choice of facility. These issues are more than inconveniences - they lead to worse patient care because of lack of integration/coordination of testing and treatment.
Sometimes it really isn't about cost.
54
@Steven YES!!!! A thousand stars YES!!!
And there are, as you implied, delays. Sometimes a referral is needed to get something done elsewhere. And the quality of radiologist varies. What they put in reports (detail, etc.). The ability to compare scans to the previous ones would be lost (unless you get copies made and take them to the new place and even then they might not get uploaded prior to when the radiologist reads the report) and thus subtle changes might be missed. The age of machines, resolution, amount of radiation a patent gets varies. And insurance won't pay to have scans read twice.
And you can risk being fired as a patient if you refuse to get your scan done at the facility the doctor works at. This almost happened to me at a university medical center. I refused because I qualified for the poverty program at a different hospital system and not at the university system. In the end I relented because I couldn't afford to then be banned from the only neuromuscular specialists in town.
3
Sure, lets ask doctors to make cost effective recommendations to their patients, based pf course on each person's health insurace policy - why not, its not like they have too much to do already.
Alternatively, how about having a sane payment system that has uniform payments by all insurers, and tiered pricing dependibg on the type of facility. Forcing doctors to be mindful of costs will ultimately lead them to recomnend treatment based on what a patient can afford, not what they need. unless of course, that is what you want.
9
Since the potential saving are shared with insurers, why don’t they either insist on equal quality less expensive care, or at least inform their insureds that they could avail themselves of it?
1
Shopping is very difficult. The providers do not want to give the info and when they do it is highly inaccurate.
Severals years I had a problem and the Dr. made arrangements for a spinal tap at a local hospital. I didn't have insurance at the time so I called the Hospital to ask the price and after about 30 min. on hold they told me $300. When I received the bill there was a Hospital charge of $ 300 for the use of the facilities along with a bill from a Dr., another charge from an anesthesiologist, and a lab bill. All totaled, I paid about 6x the Hospitals estimate. Surprise, Surprise!
The healthcare system is full of bad incentives and moral lapses. Far too many unnecessary unneeded procedures are performed and we pay too much for ALL procedures. We could start the ball rolling by paying the system to keep us healthy instead of performing procedures.
17
This year my deductible was $6650 and my goal was to carefully monitor my medical expenses to minimize them. Unfortunately in January, I had my first kidney stone and was billed for over $2000. Then I had a breast issue and needed a MRI. I shopped for the lowest cost provider and attempted to get actual quotes from my insurance provider and several MRI providers (my insurance provider would not give me costs for imaging centers). After a month and over 20 extremely frustrating interactions with my insurance co. and MRI centers all I could obtain were estimates that I was told "could" change. When insurance companies and medical providers will not commit to a firm price it makes shopping for cost-effective medical care essentially impossible.
85
@Hopeful1 We also have a high deductible plan. I only use healthcare every other year so my average deductible is only $3000. Once I hit the deductible I cram in every exam and optional service I can. I stockpile expensive medicines to use for the next year. Only emergencies in the off year. Totally crazy.
We should all start asking for prices for everything. Perhaps embarrassment will eventually set in.
I’m curious if the study considers that referring providers might be recommending their patients to get their MRI at a particular location not because of the image quality but rather on the quality of the interpreting radiologist
In my experience, referring providers build a relationship with a radiologist/radiology group such that they have confidence in the interpretation of a diagnostic exam that might significantly alter a patients management
18
Draw a pie graph with a caption Dollar size of healthcare as a % of US GDP.
Then insert the % , Insurance companies represent, Drug companies , The AMA, and ,for profit Hospital corporation's.
What it will tell you is, the medical complex is an enormous industry, and there is no incentive to simplify the consumer interface, who of course is the patient.
Shopping around for cost is a nightmare, way too complicated.
6
Seldom will the doctor's office provide you with the cost of an upcoming procedure. They protest total ignorance ( not our problem). An exception is my gynecologist's office. I had to have an outpatient biopsy with anesthesia. They showed me my total cost, collected my co payment prior and I had no further anxieties or bills. This was all within their own partnership and associated hospital network.
But just last week I had wrist surgery for carpal tunnel , also with anesthesia. At present I have absolutely no idea of the amount that is on the line. And I asked more than once. I took my credit card to the hospital the day of. No one had the slightest interest except to scurry around worrying about locking it up. It was a free standing hospital surgery outpatient facility. My orthopedist is associated with the same hospital as is my gynecologist so I don't know why he does his outpatient surgeries miles away. However he strikes me as kind, ethical and is known to be very competent. It's just not possible to penetrate the system even for a well educated person who has only needed elective , non emergency procedures and who has quite decent employer paid coverage with a $500 deductible ( $ 750 if you smoke or live with a smoker.)
To sum it up. I am in the ideal position-big city with a number of excellent hospitals and providers, great coverage that no one ever turns down, pretty good health so far though halfway through my 60's. Still can't find out anything ahead of time !
11
It's always interesting to try to get the cost of a procedure or a series of tests. I have asked, sometimes well beforehand, at least half a dozen times, what the cost of a procedure would be for me (for instance a colonoscopy) and have not yet received an answer--even when I've tried to be persistent.
5
Where do these people live that they drive by (on average) six other places where the procedure could have been done more cheaply?
There is one place that might do MRIs and that is closer than where I have it done, but it's in Seattle Children's Medical Center and I don't think they would see me since I'm old enough to buy cannabis legally.
If there is no traffic, SCCA is about 25 minutes from my house. Other centers are even further.
Plus with consolidation, people end up going to the same MRI facilities (like SCCA) to have those kind of tests done as facilities have centralized their expensive equipment .
3
Just trying to find out the cost of a procedure or test is anything but easy. And as far as deductibles go - I've never seen them make people shop around. The reality is that you will pay your deductible each year, one way or another, at least if you have a lot of health related expenses; then after that point things are covered that year. So what difference does it make to a patient if you spend it on one overly expensive test or 2 cheaper ones? Your out of pocket for the year is the same. The real way to contain costs is single payer (like Medicare for all) with the ability to negotiate costs. It's clear that relying on patients to shop around does not work.
15
@Catherine
Please don't assume that because your insurance is paying for it that it's "free." This is one of the biggest misconceptions in the American health care system. Any additional costs that the insurance company incurs this year are going to lead to higher premiums or more cost-sharing the following year. In the end, the insured always pays.
The fact that 80% of Physical Therapy patients don't complete their already paid for treatment plan shows there's more to consider in addressing these issues. Patients are customers and need rewards, and treatment ready instant deals.
1
Do you really want to have your hip replaced by the lowest bidder? Why is he the lowest? Minimal experience? High complication rates? Low word of mouth referrals? Is he going to be "learning" on your body? Does he move from state to state when the lawsuits pile up? There's a reason quality is expensive. And this is the only body I have. Here in D.C. the Washingtonian Magazine runs a yearly list of the best doctors in each specialty ... based on polling other doctors. It may not be perfect but I don't think the members of this exclusive club are going to be taking the lowest bid.
14
You think choosing a place to get an M.R.I. is difficult? This is not an isolated problem. Information for making good choices is often hard to come by in the medical world.
For instance, try choosing a doctor. There’s really no good way to do it. Doctor recommendations ought to be the answer, but, alas, they too often are no solution. Most doctors in my experience simply recommend other doctors in their own network who recommend them back – in effect benefitting themselves over the patient looking for the best doctor for his or her problem.
So what to use – online reviews? Opinions of friends or neighbors? A Ouija board?
At least with M.R.I.s you can compare prices. With doctors what do you compare?
6
Bless your soul, Dr. Frakt, for believing, at this late date, that advocates for higher deductibles and more skin in the game were genuinely interested in potential negative repercussions of this approach. I guess hope springs eternal.
It was obvious that high deductibles don't discriminate based on essential or unessential care, and it is obvious that people who have little understanding of medical procedures or potential complications are in a position to know what costs are or should be, just as it is obvious that in a well functioning free market, you will get what you pay for, and if a particular provider has a good reputation, they WILL charge more for it, because why wouldn't they?
How about looking at what every other country does to control medical costs? How about an all-payer system?
Don't you see that the reluctance to embrace effective solutions comes not because we don't know what works, but because some of us don't want it to work? Don't you see that these studies, like the ones for global warming, will never be conclusive enough for some people?
14
Many tests maybe one third are unnecessary.
A test is supposed to effect a decision.
Especially radiology tests, mris, are expensive.
Free markets require informed buyers.
3
Physicians rarely have the data at hand or the time to help patients choose the most cost effective place to have an elective study. At best, a well organized practice might have clerical staff who can perform this function.
As the author is aware, much of the problem with the cost of health care in the US is traceable to high prices which are almost never transparent to the consumer. One way to frame a solution, is to think about the similarities between health care and a utility. Specifically, like water and power, health care needs to be available on demand; should be of uniformly high quality; and price and distribution need to be closely regulated by the government.
As alluded to in the article, health care is full of free market failures. Almost 2 decades ago, Enron was able to distort the California electricity market ultimately resulting in the state abandoning the "free market" approach to provision of electricity. Similarly, in health care, the lack of price transparency and local health care monopolies among other characteristics, means that our health care "system" is riddled with mini-Enrons leading to multiple price distortions.
As mentioned in several comments, there are multiple excellent models outside the US that have addressed the contradictions inherent in the health care marketplace. If we are not afraid to regulate the utility market, perhaps we can find the will to regulate the health care market.
15
How can I price shop when my Toledo network is limited to a single healthcare provider (Promedica)? And for those whose coverage is broader, most of the time docs don't themselves know what other docs or facilities are or aren't in a particular patient's network. And what about mentioning how so many imaging centers are owned by docs who have a financial incentive to send patients to them. This solution this column presents reads more like a Comp 1 argument than a real-world possibility.
11
These types of insights never cease to amaze me. Has Prof. Frakt ever been a patient with complex medical needs and insufficient insurance? Has he ever had to assume responsibility for such a person? No one who has ever been in such a situation would even think of "shopping around" as an incentive to get better care. If you actually need medical care and have insufficient insurance, your energy is taken up by other concerns, not by shopping expeditions.
21
This is not surprising as most of the patients are not knowledgeable about healthcare. So they follow their physicians instructions without asking too many questions. This includes a simple where to get MRI or a scan. But that is why we had managed health care, to avoid differential pricing in standardized tests. Why are MHC organizations paying or allowing facilities to charge different amounts for the same tests? Why is that left up to a patient? This clearly shows MHC are not the solution as these organisations have not been able to rein in healthcare prices. We have to experiment with another model to reduce healthcare spend. Another factor that this article did not address is the self interests of the physicians. How many physicians own the scan facilities? And therefore it is of their financial interests to send the patient to a certain facility that may be expensive but is a source of income for the physicians.
3
I haven't seen a doctor for a check up in over 10 years. That's about the time it become more complicated than ever to keep track of all the changes on my insurance plan. And I was paying out of pocket to see the psychiatrist, the optometrist, and for my glasses and other things I needed. The plan, rather than being simple, was too complex. Now I'm unemployed and I no longer care about my health. But I'd stopped caring long before I was unemployed. Here's why.
1. Insurance companies force us to appeal when the care we need isn't within their norms. We usually lose.
2. They act as if switching to their doctors is nothing when it comes to trust or the doctor's knowing us. That's wrong.
3. We have to meet high deductibles every year, have co-pays, and worry about denials. That's in addition to high premiums.
4. Doctors bill for as much as they can and then balance bill us. That should stop, period.
5. There is no communication between doctors, hospitals, patients, insurance companies, etc., except when the answer is no and patients are left paying the price.
6. I don't trust any health care provider to work for me. Not as long as it's a for profit system and the insurance company can always say no.
7. Now that I'm nearly 60, not working and unable to save, my life is worth nothing to society.
49
In agreement, except for 7. You are worthy of care! You also sound depressed, and in need of care. It is hard enough navigating the health care morass- it is not a system- without trying to do so while unwell and depressed. You have all of my best wishes. Please don’t give up.
3
@hen3ry, you sound depressed. I hope you'll reach out for help. You matter.
3
All of you are missing the point of number 7. America doesn't value anyone's life unless they are rich and donate to the right politicians. Businesses do not value their employees and despite their complaints about a lack of experienced workers, don't want to hire or pay them. So, yes, at the age of 60, my life is worthless.
1
Turning medical care into a consumer good isn’t going to happen, IMO. But informing patients (like this article) about otherwise hidden and obscured mechanisms by which our medical system does help patients be better consumers.
I do have a question about the data. The authors talk about cheaper alternatives. But I am not sure if they are referring to billed cost (which affects, unfortunately, the un-insured) or negotiated rates. Billed costs are funny money in my view. Insurers reduce the billed amount to the negotiated rate and you or your insurer pays that lower amount - depending on your deductible and co-pay. But yes, negotiated rates for the same procedure are not all the same. Then neither is quality. So in the end the patient has to understand the quality of a provider (which is possible but extremely hard) and then maximize quality for price (pretty hard too). Wow, too too complicated. No wonder people rely on the referrals of their doctors.
Then there is the problem that once a persons deductible is met they have little incentive to shop.
6
There a lot of great comments below. It is impossible to know the cost of any treatment in advance because there so many /if, then, and, but and maybe's' attached, including where the treatment is performed, who performed it, what they did, how they did it and so on.
If anyone has ever sat and read the fine print of your insurance coverage, you'll know that there are all sorts of exceptions, items that are covered while similar but slightly different items are not covered. Then there are the limits where you are allowed x number treatments and so on.
A whole industry has been built up around medical billing and their sacrosanct codes, which are documented in many books covering thousands of pages.
For all these reasons, it is unlikely that there will be any changes to our health system until it collapses upon itself. No one is willing to change anything, regardless of how much it will save the system or enhance their efficiency because doing so might impact their earnings. Or to put it another way using a famous quote:
“It is difficult to get a man to understand something, when his salary depends on his not understanding it.”
-- Upton Sinclair
18
As part of my consulting practice, I conduct consumer surveys for hospitals and health systems. One series of questions that I have used for over a decade asks people if they or someone in their household has "price shopped" a health care service in the prior year and if they have, what was that service. Over the past two years we've asked that question of well over 5,000 people in markets from Pennsylvania to California. The reported level of price shopping for health care services ranges from a low of 7-8% to a high of 18% but the average is about 10-11%. And in 9 studies out of 10 the most commonly price shopped services are non-urgent diagnostic imaging, lab tests, physician office visits and non-urgent (elective) outpatient surgery.
7
Another advantage of single payer: the cost of a particular procedure is the same no matter who provides it, and the payer has lots of data on cost effectiveness to refer to. I never had much need to use Taiwan's health insurance system until about 7 years after the new system went into effect in 1995. I knew that under the old system, one had to go to a designated public clinic or hospital. Under the new system, all licensed providers are included. A Taiwan friend who had been treated for kidney disease under both the new and old systems said that healthcare became much more patient-centered under the new system because now all providers were competing for the 23 million prospective patients with national health insurance cards.
15
@Alicia LloydAll a single-payer system does is hide the actual cost from the consumer, which inevitably leads to higher costs.
You can get the equivalent of a single-payer healthcare system by mandating that everyone must charge the lowest negotiated cost.
1
@mLannyv
The costs are not hidden. After I present my IC chipped insurance card along with the standard copay ($15 or less, depending on the level of the medical facility), I get a detailed receipt listing everything the insurance is paying for and how much for each item. It certainly has deepened my appreciation for the system. The costs are covered by the monthly premiums with an annual surplus for big medical emergencies like the 2003 SARS epidemic. Americans just don't seem to want to believe this is possible, but it is. Yes, Taiwanese do emigrate to the US, but many fly back for their medical care.
@mannyv: Why does single payer "invariably" lead to higher costs? Look at all the first world countries that have single payer - they all have lower costs thatn we do!
my company provides me with a link (Compass) that informs me with the ratings, cost and availability of services. Only issue is that Imaging companies lie about their actually costs, happen with my wife cardiogram and with an scans as well.
2
I have been an informed consumer of and purchaser of health care purchased easily and successfully in over 30 countries around the world, from basic/standard to well woman plus prescrrption renewals to (unfortunately) emergency care. There was never, ever a problem accessing what i needed AND I ALWAYS KNEW THE PRICE UP FRONT. IT WAS ALWAYS AFFORDABLE.
No out of network denials. Know byzantine, labyrinthine health care system. No toll free numbers to call to spend hours to get a refusal. It once took 8 hours to get a straight answer from my US insurer as to why they wouldn't cover a prescription renewal.
It is impossible to be an informed consumer for health care in the USA. It almost impossible to get/compare a price, scheudle a treatment or even an appointment for the basics.
What a horrible system.
127
Everybody needs a cut, and hence pricing will continue to be opaque. This is a gravy train.
I visited Penn Medicine new facility in Plainsboro, NJ. Shiny buildings all around, well landscaped pavilions. All funded by easy money.
There's so many people profiting from this wasteful spending that it will not change with "medicare for all".
There's a reason why folks says, not easy to change Status-quo.
Healthcare must be accessible,affordable and for all.
The US private system has demonstrated to lack all of this .
It is an almost complete failure.
Europe and Canada,even if not perfect,give so far the best health coverage to their citizens.
In America having medical coverage is considered a privilege by the GOP .
Most Americans prize Medicare and Medicaid ,not realizing that these two systems represent the “ socialized medicine “ so many republicans resent .
16
Mr. Frakt writes in the second-to-last paragraph:
"For example, we could provide physicians with price, quality and distance information for the services they recommend. Further, with financial bonuses, we could give physicians (instead of, or in addition to, patients) some incentive to identify and suggest lower-cost care."
My question: who, exactly, is the "we" he is referring to?
6
In every aspect, the healthcare "market" just does not work like other markets. And our system is completely broken, in my view, and must be overhauled ASAP. Obamacare was not enough, clearly.
As a self-employed person, with variable monthly income, i shopped for a high-deductible plan so that I could get an affordable monthly rate, not because I wanted to pay a huge deductible. I am 64, and this deductible is absolutely a deterrent to my getting care. Every year I have some sort of argument with one of my docs about how urgent it really is to get an expensive test or procedure. (One test has been put off for years till I get Medicare, and my doctor is always annoyed.) I delay filling prescriptions and try to "stretch them." Sometimes the results are not good.
My healthcare network (as determined by my insurance) is OK, but not fantastic. If a provider is out of network, I'm not going there. I've had particularly bad luck with needing care out of state and finding an in-network provider; if I'm sick I wait till I get home.
Why are we able to only get insurance that covers our state of residence? Is this 1818, or 2018? A nation that can give a humongous tax cut to the rich can afford to have a real healthcare system that pays for treatment in all 50 states.
36
There's a realistic health insurance system compromise. Liberals want a single payer system run by the federal government and conservatives want to privatize health insurance. There are mutual savings banks owned by their depositors and mutual insurance companies owned by their policyholders. A single payer mutual insurance company, owned by its policyholders, is a practical alternative to government insurance and health insurance offered by private companies.
4
@Sheldon Burke. Years ago, when I lived in Seattle, I belonged to the HMO Group Health Cooperative of Puget Sound. We paid by buying shares in the co-op. It was so popular we had to wait almost a year before enough shares became available for us to buy in. Broke my heart to have to sell our shares when we moved to Chicago.
2
So many arguments against consigning healthcare to the free market. But, first among them is that we rarely if ever have an urgent and life threatening need for or other furniture consumer goods. Healthcare is different. Another big consideration is that there is a reason healthcare professionals go to school for years just to enter their professions: It's complex. More complex than we would reasonably expect the average person to fully grasp (especially when ill or in pain). So let's treat healthcare as the common good that it is (like police, fore, EMS, public education, public libraries and all those other "socialist" institutions) and do the right thing.
14
Shopping around only works if you can get information about price. I'm currently paying out-of-pocket for my medical care. Recently, the best I could get from my doctor's office regarding the cost of an routine checkup was the amount of the deposit they would charge at the time of the appointment and some vague statements about how the price could change depending on what the doctor did or ordered during the visit. We intentionally kept the visit to the bare minimum of interaction & examination, hoping to keep the cost within that $150 deposit. I still got a bill afterward for another $150 remainder with no explanation as to what any of the costs were for. Until the providers are required to tell you costs up-front, shopping around by price isn't possible.
22
The point aside from most of the comments here...Choice is often almost always an economic choice, limited to providers of supplemental Medicare policies that do or do not allow the daily use of medicines and food. Or, to have to choose between the two. This is how it has been for the poor on fixed income since the passage of Medicare Part D, thanks to George Bush and the Republican congress 15 years ago. Nothing has changed. NOTHING.
1
If I want to have a procedure, the clinic will not give me any information about the doctor's stats--the results of the procedure vs the clinical outcome (i.e. the operation was a success but the patient died). So then I have to base it on what the doctor says and who the doctor says to go to--regardless of my skepticism. And, of course, I won't know if the great surgeon performs it or if the great surgeon's protege does it after the patient is unable to protest.
2
For the free market mechanism to work to control prices, consumer have to make rational, well-informed choices. Works great for apples. Health care? Not so much.
4
Health is not a consumption item.
Therefore any "market" for health is an artificial setting.
Health is just the tip of an iceberg. Under the water you have lifestyle, prevention, food, environment, education to name a few. Not a lot of commodity in them either.
And then you have health feeding back into each of the items hidden below.
The challenge is how to deal in a meaningful and decent manner with this complexity at a societal level, taking care of those of us condemned, the unlucky ones who are born with or develop chronic medical conditions.
Lucky or not, we all eventually die, of old age at best, because of passing of the time.
Defining the problem is the first successful step in solving an issue. Not much effort there.
Human beings, all patients to be at some time, insurance companies, medical workers have to be brought together to solve this.
At this time the main villain in the existing arrangement are the insurance companies, no doubt about that.
4
I have always trusted doctors and that bubble has burst.
I do not doubt their intentions started good but the majority , yes , the majority , have become too intent on adding more and more profits to a ever expanding bottom line.
We need to ask some serious questions of our medical professionals and demand a follow up answer to the oft used excuses of liability and lawyers and practice costs.
We may not have deep knowledge of business expenses but we did not fall off the turnip truck either. Something is beyond fishy and is becoming downright rank in medicine. There is a con job happening to the public on a massive scale.
I don't think a new non con job pill by big pharma will change our outlook.
6
I once shopped for an MRI - on my knee - and saved my insurance company money several hundred dollars. I was lucky, MRIs were covered by my insurance and it didn't make a difference in my out of pocket cost. I'm now scheduled for an MRI at a hospital. When I suggested the cheaper imaging center, my doctor's staff said they'd have to go through the pre-authorization process again with my insurance company. I'm not sure if that is correct but if it is, it is an example of the insurance company making it more difficult for patients to save money, whether it is their own or the insurance company's.
18
@SCL And another thing, I'm going to have a brain MRI but I may later have to go for a neck MRI. Apparently they can't or won't do both at the same time. What gives?
2
@SCL
i was told the same thing by my dr. can't do mir of brain and neck at the same time.
I needed a shoulder MRI. Dr gave me two hospitals to go to. I told him it would be paid out of my HSA so I wanted to call around. He said there probably wouldn't be much difference. Hospital A was $1200, Hospital B was $1500. Interestingly, both wanted a CPT code for the quote and both said they would need to call me back the next day. Basically having you jump through hoops because they don't want to give out the info. When I called a stand-alone imaging center, they asked me my insurance plan and provided the cost in 5 seconds, $328. Any economic system where the consumer is separated from the cost of the product is going to be problematic.
43
@Dennis: In Mexico at a state-of-the-art facility that shoulder MRI is $25.
3
I've had a high-deductible plan for the last several years, and consider my family informed medical care patients and shoppers since my wife and I both work in and around the healthcare industry.
The *only* success we've had shopping around is regarding prescriptions. I can (usually) see the best price for a drug via our insurer's web site, and then use an app to find the best available cash price. And then I choose where to shop given the practicality of the situation.
I try to get paper prescriptions whenever possible to facilitate this, but sometimes I just can't, which involves delays in transferring the prescriptions between pharmacies. For some drugs, paying cash rather than going through insurance saves hundreds of dollars per recurring prescription.
Interestingly, we just exceeded our max deductible for this year, and I needed to renew an inexpensive prescription earlier today. Because we're over our max, it now shows up at $0 on the insurer's website, and I'm quickly back to no longer shopping around.
18
So, I tried to get prices to have bilateral total knee arthroscopy at the four major university hospitals in Philadelphia. Each time I called, and I called each hospital twice, I was given a different price. Same info, different price. No written quote was given. The only time I was given a written quote which was guaranteed for 1 year from the date of the quote was for plastic surgery, some of which would be covered by insurance, some not. Hospitals have no incentive to provide accurate pricing data making price comparison impossible. Why, in the world, would the same procedure with the same surgeon with the same diagnosis code be two different prices - one given on Monday morning and the other on Thursday afternoon?
"Shopping" for healthcare, as if it were a sofa is impossible and a fiction created by the GOP and those pushing high deductible plans.
BTW - I know how to ask the right questions - I'm a lawyer who at one time represented hospitals and insurance carriers. If I can't get a consistent price out of them, how can anyone else?
320
@Knitter215 THIS.
2
@Knitter215
I think they knew you were a lawyer and were just jerking you around - hospital types have a sixth sense and go into jerk-around mode if they smell legal counsel - even on the phone. Also, hospitals and insurance companies, not unlike the Armed Services have very little real accountability - remember the VA "death lists" from our recent past? I'm a doctor who was raised by a lawyer so I have empathy for both sides - except for the idiots who were "trained" to offer painless, opioid-filled lifestyles. There are fools in every profession, counselor.
1
@Knitter215
>"Shopping" for healthcare, as if it were a sofa is impossible and a fiction created by the GOP and those pushing high deductible plans. <
Not just the GOP. "Shopping" for health care is a built-in feature of the Affordable Care Act.
1
The way the ACA is structured, the most important thing may be the deductible.
1
When inquiring about pricing of procedures, I've been told "I don't know, that's handled by our billing department," and "It depends on your insurance." Similarly, when trying to find out from my insurance company what their reimbursement schedule is for a particular procedure, I've been told a percentage of customary cost in my region, but no one can give me an actual number. In fact, on rare occasions when I was given a number, it turned out to be either higher or lower than the actual reimbursement. I think comparison shopping is pretty useless. It probably only makes sense for someone without insurance who is paying entirely out of pocket, i.e. self-pay.
32
"shopping" means there is a selection from which to choose services. This is universally limited or non-existent for most situations in health care.
4
In my experience, the extraordinary cost of basic care is what makes shopping for something like an MRI unnecessary. By the time my doctor gets around to recommending an MRI, I have made it to our $3500 deductible (some doctor and dental visits for the rest of the family thrown in). A visit to a primary care doctor, then a couple of specialists, some lab work, x-rays and by mid-year we've met our deductible. At that point, who cares? Not my money anymore.
22
@Bevita
Except it is. Each time you use the health care system, regardless of who pays, you're driving up costs. (Higher demand for a good will generally lead to higher prices.) The higher costs are then passed on to you through increases in your premium. Not understanding this is part of the problem. As economists say, there is no free lunch.
The idea that a patient can shop around for health care as if it were a car is ludicrous. The average person knows little or nothing about medical care, what tests are necessary, what treatments and procedures are available, and their outcomes, never mind the costs. A better analogy would be shopping for a car mechanic. We all know how difficult it is to find a good, honest, mechanic. Most of us throw up our hands and go to the dealer for repairs, even if it is more costly, reasoning that at least the mechanic is competent since he represents the car dealership. Shopping for medical care is absurd on its face. Anyone suggesting this as a cure for our healthcare problems is a charlatan, even if he/she has a PhD after the name.
142
@Bill Agree 100%. The only time it works is for procedures which are truly elective. If you want LASIK or a boob job, the doctor will be more than happy to tell you the price up front. But for everything else, getting a number is like, well, pulling teeth.
11
@Shea-and the reason for this is that it's cash up front, without all the insurance gobbledygook. I am a pediatrician and I would *love* to be able to quote prices, but one insurance company has a mandated charge of "x" with a 30% out of pocket cost, another has a charge of "y" with a 25% copay. Another pays nothing prior to the deductible being met...I simply can't quote anything except for cash paying patients.
2
Equally absurd is that the Health Insurer determines what the allowable medical treatment will be, and tells the Physician what they will pay for, and what they will not.
All this is done by claims people without medical degrees, and without ever seeing the patient.
7
HaHaHa............
The notion that this is even remotely possible is the first joke.
I asked my insurance company once about this and even they told me it wasn't realistic to get a "quote" in advance.
Even for commodities like a hip replacement, the final cost will vary somewhat based on the patient. You wouldn't think so , but some patients can walk out the door that afternoon, others the next day, follow ups may take extra appointments.
The bottom line, insurance companies set prices, consumers do not.
Healthcare is not like an oil change or brake job with advertisements and coupons in the local paper. Perhaps the only similarity is that some Doctors are scam artists, just like some mechanics, and will try to do a shoddy job and bill you for it.
While healthcare it moving in the direction of the chain store as more and more doctors join larger and larger groups, that's all about them, trying to negotiate with insurers, not about creating better and cheaper care.
Ask anyone in the system and they will tell you that a single payer system would simplify things greatly . No one knows if it would be cheaper, but having one answer for coverage and rules for dealing with everyone would be a step in the right direction.
Maybe then I could get a quote.
PS-even then I may not go with the lowest bidder.
15
Over the past year, my wife has done much work in trying to shop around. Many establishments she has contacted do not have a handle on the costs for our insurer which makes it very difficult to get a straight answer quickly. Even with the best intentions of shopping around the opaque nature of healthcare costs make it extremely difficult. As one recent example due to the complexity of the issue, to get the lowest cost possible, my wife would have to go to three separate facilities for exams on two breasts. Doesn't make much sense!
7
Diagnostic tools, from a "simple" blood test to an MRI, can vary enormously in quality. The person "reading" those results also makes an enormous difference in the usefulness of the information revealed. The average person has not a clue about such matters. When my veterinarian sister was dealing with a challenging diagnostic case in a beloved pet, the sweet, innocent owner asked her, "can't you just call that 800 number?" Even if everyone were medically sophisticated (and had all the time in the world to spend "on hold"), obtaining meaningful cost comparisons is impossible. The "list price" is not the price your insurance company pays. In many cases, provider institutions simply will not divulge what they are going to charge, because it depends on who you are. It is an out-of-control system. Expecting mere humans to "shop" in this conspiring environment is ludicrous and unfair. Ironically, this recalcitrance may end up pushing us into single-payer. Like democracy itself, single-payer is a terrible system; it's just that the alternatives (including our current one) are so much worse!
16
I have tried to get blood work done (cholesterol, iron, the basics). No lab will see me without a doctor's order. Ridiculous.
I wanted to get a mammogram. Ditto. I had to have a doctor's order AND have the result sent to the same doctor. Ridiculous.
Why on earth do we need to have that middleman involved for such basic services? The mammogram is being read by someone I've never met in the first place; surely their report is sufficient for me to seek follow-up from another physician...
8
@Sara - Search Life Extension Foundation. You can get blood tests through them w/o an MD's order.
@Sara Regarding routine blood work, I have a friend who swears by www.anylabtestnow.com. I haven't yet tried them for myself, but I plan to.
@Sara Try walkinlab.com - no doc required and really great pricing. All tests are done by Labcorp or Quest
1
Thanks so much for shedding light on this critical element leading to unnecessarily expensive health care!!!
Providing doctors with price lists sounds like a wonderful idea. Whether they will care to pass along that important intelligence is another story.
What if you must go to an in-network MRI place? Where's the opportunity to shop then ?
12
This should be a slam-dunk.
We have all kinds of navigation applications that can find the closest Starbucks or advise on restaurants in the area, including ratings on quality and expense.
Health insurers certainly know the prices they are paying.
The only thing that isn't well-known is outcomes, because no one wants to figure that stuff out, probably because of lawsuits.
So we are stuck with a third-world health care system costing 1% prices.
PS - doctors? Finding one is a joke. Insurers don't keep their lists current and they change them at will - but patients are locked into their plans. Pathetic.
4
I have a friend who shopped.. she is getting it done in Mexico.
19
And thus you cited the result but not the cause.
Why is there such a difference in the price for MRIs of the exact same part of the body?
Because insurance coverage is so screwed up that facilities charge outrageous rates because they know in the end that they will only received the negotiated rate from the insurance company.
They could charge a million dollars for an ankle MRI but Aetna's negotiated rate is $600. (I know because I just went thru this)
So the charges are make believe. They are fake numbers for hospitalizations, doctor visits, medications anything that they know in the end they will only get the negotiated rate. They can charge double or triple for the service but only the poor person who may not have insurance is charged a super high rate that they cannot afford. And the facilities do not let on that they would be willing to accept less.
30
@SB
This! I think the fake price is to inflate the amount of charity care the hospital does to maintain their non-profit status. As long as there are fake prices, how can you trust how much charity care or unreimbursed care the hospital gave?
1
I've tried shopping for health care, as I tend to use a lot of it on a non-emergent basis. My insurer is an HMO providing coverage at one of the two large hospital/physician groups in our area. I would say market share for each group is equal. There are a few non-affiliated facilities. I receive infusions every eight weeks and assumed my insurance would cover it at my physician's office. Instead, they have deemed them too expensive because they are now considered hospital outpatient rather than part of the physician clinic. Prices went up from $9K/infusion to $37.5K/infusion, of which they would have reimbursed about $24,000. The infusion center they referred me to charges $77,000/infusion but the insurer pays only $7K. The center is nearly an hour away.
The irony is that our local county hospital is about a mile away from me. I could get my infusions there for $7,000 each, but they are part of the other large hospital group in the area. When I had insurance that covered that group, the insurer paid them $4,000. I had to choose between my doctors and my treatment. Last year I chose my treatment; this year I chose my doctors.
A second point of irony: access to this patchwork system of doctors, hospitals, pharmacies, clinics, etc. is what I now fight for. I'm fighting for the ACA so I don't have to go back to a system where I had to force my insurer to provide the care they agreed to. A system where my premiums were twice my mortgage. This is insanity.
13
The simple fact is that patients are not purchasers of services except in the few cases of truely elective procedures like Lasik surgery, elective plastic surgery procedures and a few other items generally not included in insurance coverage. Doctors and insurance plans purchase services for patients. Most covered patient services require a doctor's order and most insurances negotiate prices with providers. The only negotiating that really takes place is in the choice of a doctor and an insurance plan and after you make that choice you are within their care structure. What about those lower cost MRI's? Forget it if they are not in your network and if they are in network then your insurance company has negotiated a price for you. It might be useful if you have to receive out of network care, but that is a last resort.
In most developed countries the government negotiates prices on behalf of their citizens. That is what happens with Medicare and Medicaid in the U.S. In the U.S. we also have private insurance that negotiates prices independently (and secretly). But, unless you have no insurance at all, patient negotiations for price is a non-existent economic fantasy!
Medicare for All would negotiate prices with providers for all U.S. residents and make their network all providers in the U.S. Then providers can compete on what is crucial for patients; quality and service.
11
@Bill T
You assume that providers will take whatever the government offers. So will--many won't.
1
@Driven - If MD's won't take what the government is paying AND they can't find sufficient number of people willing to pay their prices, then they will have to go out of business.
@Bill T
Yes there are 2 main classes of concern: in-network and out-of-network. In-network you will get your insurer’s negotiated rate and depending on your deductible that will be your cost. Out-of-network a crazy-high bill.
In-network negotiated rates are not all the same. I used to believe that for example a knee MRI had the same negotiated rate regardless of the total amount the provider billed or which in-network provider used. But that is not the case. My insurer grants hospitals a higher rate than a stand-alone provider. Same procedure same quality. If there is an imaging center next door to a hospital the hospital will be allowed a higher rate. Then there's the clout of the particular provider. A must-have provider (in my area Sutter) gets higher negotiated rates than a medical practice of a few doctors (as a near monopoly Sutter can negotiate high rates). So different in-network providers will have different negotiated rates and some can be several times higher than the lowest. This makes shopping more important-especially in high-deductible plans-but much harder. But if you have met your deductible it’s hard to see the incentive for shopping.
Turning medical care into a consumer good isn’t going to happen IMO, but on the other hand publishing info (like this article) about how things work in the medical system can help patients ask better questions and gives a basic “lay-of-the-land” so they are not so easily taken advantage of.
2
"Shopping" for medical care is not going to save money. "Price controls" like those used in all the other advanced nations on the planet will save money.
5
For the solution to such problems we only need look at the countries of Western Europe, Canada, Australia, New Zealand, Japan, Singapore, etc. etc., etc. But no -- if it is contrary to what ALWAYS has been done here in this tradition-shackled nation, it cannot be considered.
15
this study suggests that if patients went to the lower priced mri they would save 36%.i would argue it would be more, because eventually the hospitals would have to compete. IF there was real competition. But asking doctors to keep track of the process is ridiculous. Perhaps insures , as a part of their pre authorization process, should offer pricing info AND offer discounted co pays for using the cheaper ones?
4
Dr. Carroll is proposing something that many (most?) economists won't agree with: examining how people act in the real world to see whether some policy works or not.
The theory that having "skin in the game" (the most offensive euphemism ever developed) would reduce the costs of health care have been repeatedly shown to be false. It doesn't work, it makes utilizing health care unpleasant and, in many cases, financially disastrous. It's time to junk high deductibles and develop a real health care system.
15
As a health care professional, I believe that even most doctors don't understand health care economics very well. Especially in the current environment where increasing numbers of doctors are employed by hospitals or other health care organizations. Then, factor in the number of insurance plans with their various restrictions and requirements for care to be delivered. Perhaps if each us had access to the IBM "Watson" the best economic and economic decisions might be made.
The necessary decisions need to be made from top down. The Canadian model is based on regional boards of providers and the government. My understanding is that their model of Universal Care works well and is generally lookup upon more favorably than ours, with, of course, the few acceptions of patients that cannot tolerate any delay in their services.
In America, we have a system of largely unregulated capitalism that makes the decisions regarding health care for the rest of us. That is why America spends between 1/3 and 1/2 more than any other country and gets results that are far inferior.
Consumer based decision making will never solve the problem. The question is, do we want a system that makes corporations rich or one that makes as many Americans as possible healthy.
23
The advantage of a hospital based imaging study is that the doctor can pull it up on her office computer. Once the independent imaging centers can email the files (the files are now too big to email) the independent centers will be much more attractive.
2
In this era of high deductibles, we have heard from a lot of peoole that they can save money by putting away their insurance cards and paying cash.
This is not well known, and not consistently true. We urge people to ask in advance: "How much will this cost? How much will it cost me, on my insurance? What's the cash price? Will you please put that in writing?"
I myself paid cash for an MRI for a family member after shopping it around. The orthopedist gave us the name of three radiologists. I called and said "I'm a cash customer, how much will this particular MRI cost?" One place said "$900." The second place said "$600." Then the first place called back and said "If you can be here at 7 tonight, it will be $450." I said "Done!" (I knew, of course, that the insurance payment here in the NYC area could be as little as $400 and as much as $2,400 -- and we hadn't met our deductible and would probably not, as we were nearing year's end.)
It's like surge pricing on Uber -- but you have to know to ask.
11
Shopping doesn't make sense because Medicare and other insurers fix the price they'll pay, which is typically much lower than the "sticker" price. It's also often advantageous to get imaging done in the medical center where the physician/surgeon works when the imaging can be accessed online.
2
I've tried shopping for imaging services. The "tools" on my insurer's website are difficult to find and even more difficult to use -- and I'm both computer literate and healthcare literate. I've also tried calling around; it's almost impossible to get a straight answer because, as others have pointed out, they don't know until they get reimbursement from the insurance company.
In our area, the medical centers and outpatient facilities are owned or tied to the insurers, limiting options even further. It didn't used to be so -- the local outpatient facility was independent and cheaper. It took maybe three minutes to schedule a procedure directly with the facility. Now it's owned by the hospital conglomerate/insurance company and it takes 10 minutes on the phone with a central appointment center that asks you the same questions over and over.
BUT, all results are digitally available to every physician within the system, eliminating having to request copies to take with you to every appointment because more often than not they weren't sent to any offices other than the referring physician, despite specifying the others involved in your care on the form.
Then again, having to shop for insurance every year means that you might have to change hospital systems every year, making all that coordination pointless.
Single payer, single reporting system.
30
@Marcy you are quite right. My doctor joined a large group practice and now of course recommends other doctors in the same practice group. Is that really the best doctor or the best for the bottom line?
I tried getting a price on a colonoscopy and how much my HDHP would cover, and I got nothing but a run-around about well, we need to know this code, told to me by all parties.
If you don't go in-network, you're on the hook for a lot of money (of unknown amount). So say I find an MRI center a lot cheaper than the one my doctor recommended; if it's out-of-network, is the price low enough for me to pay the retail price?
If you don't have insurance because you can't afford it, then you get the retail price, which you are in the worst position to afford.
10
Many people don't know that prices vary by so much, so they don't feel the need to "shop."
Also, people don't generally expect that they are going to get their pockets picked in health care. (Though that's changing, quickly!)
But when they know prices vary by a lot, and when 1) they have good tools, and 2) they know where to find them, people will "shop" for health care.
How do I know? We talk to people doing this all day every day.
I'm the founder of a startup, ClearHealthCosts.com. We bring transparency to health care by telling people what stuff costs, both on our home site and in partnership with other newsrooms. We see a lot of "shopping," and we write about it a lot.
More details on our blog -- go there and look for our story about a woman who saved $3,786 on an MRI. Also, there's a blog post on "trust" that will let you hear the voices of many others who are using our work in New Orleans to save tons of money. There are also overviews of our New Orleans and other partnerships.
Bottom line: People do shop for health care. But you have to give them the knowledge and the tools to do so.
(I am not putting links here because I believe the Times commenting system, like many others, discourages or rejects links.)
P.S. Otherwise, Austin, nice story!
5
There is a huge flaw in this analysis. The concept of "shopping" presumes that a customer interacts with a vendor. In the current system the patient is no longer the customer. The customer that your Dr./hospital/MRI provider primarily interacts with (because they control the $$, irrespective of any high deductible) is a large third party payer. Considering how little impact you have on the financial position of the "vendor", other than just showing up at the office, it is a tribute to the professionalism and altruism of health care providers that they treat all of us as well as they still do. Returning to my original point, it is almost impossible to assess the impact of shopping on the health care system when the "shopper" is in fact largely irrelevant to that system.
54
I agree that the MRI provider's customer is the insurance company. Doctors who request that you get an MRI don't know what insurance you carry. My insurance company requires that my doctor's office phone them and request any kind of imaging procedure. After that, I will receive a phone call from the insurance company telling me which imaging center I will be allowed to use. This is a cumbersome process, but when I neglected (out of ignorance because I didn't read my insurance booklet) to follow it I was on the hook for the full cost of the MRI.
12
@Mike Z
In fact, the patient is not irrelevant. The patient has become the product.
Medicare for All.
Little to no cost sharing for patients.
Taxes in, healthcare out.
If we are able to reduce our healthcare spending by 4% of GDP - from 17.9% - 13.9% (which is still higher than all other countries), we'll save approx $700B annually.
This should be our focus.
132
@M BINGO!!! I did some shopping once for a very expensive drug. If I went to the pharmacy, paid in advance, took in a cooler to a free clinic to get it injected it cost $1800 and the $900 deductible did not go to my cap. But if I had it done in the hospital linked clinic it was a "procedure".. Cost $4500 and the $900 deductible went toward my cap. And they got a subsidy from the company so I did not even have to pay that.
4
There are a lot of folks who profit by keeping prices opaque and murky. Lots of folks are getting fat on this gravy train.
They will ensure their profits stay as-is with Medicare for all. In reality, their profits will increase as more people have access to healthcare.
Pricing flat, volume up!
@M
Golly, all this talk about "single payer."
Where's the written budget? No pencils?
I spend much of my professional time working on clinical quality improvement projects for both primary and hospital care. We have enough trouble just trying to build a system of care that does the right thing for patients based on the value-based care initiatives that we participate in. Getting a handle on cost is even more difficult, much less getting that information to doctors (who usually don't have a clue about costs). As others have noted, systems also try to capture patients: keeping them in-system regardless of cost. Although I research costs and quality for many products, since I work in healthcare I realize that there is almost no way to do the same for elective health services for me or my family. Single payer with everyone operating under value-based pay models is likely the only way to go. This would allow the market to innovate and compete for patients to make a profit without continuing to gouge us.
29
This is what happens when you shop for a low cost MRI, and pay for it at time of service, in full: total chaos. You get bills from insurance companies that were not involved for services you already paid for. You get Doctors claiming extra fees, because while the MRI center accepted the negotiated rate, the Doctor's financial billing service (Doctor's are each private corporations) claims it did not "agree" to the rate.
Expect to spend 20-30 hours on the phone trying to sort this out. Mainly in wait times of 20+ minutes on hold. Mostly you will have to first explain the situation to each call agent you reach for 10-15 minutes to get the point of being able to make progress because they don't understand what you've done...
170
@OSS Architect exactly my experience. We shopped for lower MRI costs and found it after many, many hours of effort. The doctors didn't help at all.
It is not easy to find costs. And it is easy to understand the efficacy or quality of any procedure. We are left with confusion, expensive bills and no recourse.
Thank you private health care!
1
I am just one voice. I have a good insurance. I am 60, and now approach year 10 without contact with the health care system (except eye doctor and dentist). While there were many instances over the past years a doctor consultation may have sped up recovery from an illness or minor injury, I simply do not trust the health care system looking out for me.
Since I do not have that trust, I would feel obliged to "monitor" and study any doctor recommendation first - as a health illiterate person a time consuming activity.
So my choice was simply to drop out of the system; the next time I will see a doctor or hospital is when I am unable to decide for care myself in an accident, an elective quality of live surgery (e.g. cataract), or when I am close to death.
(PS: I wear glasses so I get every two years new eye glass perscriptions).
8
@Jzuend - Has your car been seen by a mechanic in the last 10 years? Or is that in perfect condition, like yourself, also?
The problem with your approach is that you may have medical problems developing that you put off, rationalizing that the pain isn't that bad or it's just a strained muscle or that small amount of blood in your stool will go away, etc.
Then one day you discover that you have stage 3/4 cancer or something equally bad. Especially as you get older, it is important to get a check-up at least yearly.
2
@Joseph
That's assuming that the cancer will be detected at an annual check up. We seem to adhere to this belief that annual check ups somehow "prevent" illness. Explain to me how this works?
At my annual check up, the doctor asked about lifestyle and risk factors. She tested my oxygen levels and listened to my lungs and heart. Any illness that might be detected through these very simple methods would likely have other symptoms that would compel me to seek out medical care before I'm even due for an annual check up.
Annual check ups are completely overrated. They're simply job security for PCPs, nothing more.
I have several times tried to get prices on various medical services - colonoscopy, mole removal and testing, physical therapy. I have never been able to get a price beforehand. I might know my deductible and co-pay, but the answer from the provider always seems to be "we won't know until we get payment from the insurance company." Don't blame the patient for this situation.
244
@E Barrow
No one is blaming the consumer, the system is intentionally designed to obfuscate the price and cost.
In 2003, my employer offered a consumer driven health plan. For individuals, the deductible was $1500, but the employer funded the first $500. Co-pays were 20% after the deductible in-network and 40% out of network.
Although adoption of the option was low in the first year, one of the benefits was that the insurer sent out
monthly emails with tips on how to save money. Although it is true that no one is going to shop for a low cost provider while having a heart attack or stroke, it is possible to get a mammogram for $100 that is just as good as the one at the hospital imaging center that charges $350.
The other service they offered was that if you weren't satisfied with in-network providers, they would attempt to bring your targeted provider in, or would negotiate a single event price with a provider for you. My sleep studies, $1000 total, $500 paid by me. Coworker with other plan, $2200 total, $400 paid by him.
Insurers and providers treat negotiated prices as trade secrets, and intentionally conceal the information from the end users, which is why you can't find out what your oop cost is going to be for a colonoscopy, but less what your insurance plus co-pay is going to be. The CDH program was very open about pricing and also provided quality ratings for providers. It only lasted two years and then cancelled after UHC bought them.
6
@E Barrow
docs and medical facilities are anti capitalist and do not function on the free market. Why are they exempt?
@E Barrow
The writer -- who, BTW, works for a government provider -- misses the main point.
Because providers and payers worldwide -- including so-called "single payer" -- have such poor financial accounting and cost accounting systems, everyone is unsure what specifically costs what. Look it up.
And is that why Bernie Sanders, after 25 years, *still* has not provided a written budget for his "single payer" theories? Hmm ..
1
I haven't been to a doctor since I switched to a high deductible health plan nearly 5 years ago.
32
@Sharon
Studies have shown that annual check ups do little to improve outcomes. And why would they? A once a year lecture from your doctor telling you to lose weight isn't the great panacea that the health care community makes it out to be. Most people voluntarily go to the doctor when something hurts. Anything more than that is simply adding to health care inflation.
It is now well established that most of the excess in US health care costs is due to high prices and inefficient administration of insurance benefits, not increased use of health care per se. Employers and government pay for health care. The federal government refuses to use its purchasing power to bring down costs (except for the VA) due to the political power of the health care industry. In areas where employers have organized to lower prices, they have had some success (e.g. Minnesota). The insurance companies are inefficient pass through organizations that take a piece of the action, and do not have sufficient market power to force hospitals to reduce prices and compensation. If the federal government and employers used their economic power to lower health care prices, prices would come down over time, or at least not increase as rapidly as they would with the payers sitting on their hands. Expecting decisions of individual patients to reduce costs is Republican propaganda designed to preserve the status quo for the very profitable health care industry, including "non-profit" hospitals. Medicare for all won't fix this problem unless government and other payers take action to lower prices. The federal government's health care pricing policies are dictated by the health care industry. We are spending 8 to 10% more of GDP for health care than other countries due to this broken market. In comparison, defense spending is 4 to 5% of GDP).
62
@MVonKorff
It is a bogus argument that the failure to negotiate prices by the federal government results in higher prices. The government intentionally sets up the rules to benefit big medicine.
Under part D, the Republican designed drug program, drug prices declined to consumers. Insurers negotiated discounts that were passed on to consumers. When consumers with high cost drug hit the donut hole, drug companies couponed the deductibles for consumers who could not cover them and only high income retirees wound up paying them out of pocket.
When Obamacare declared that drug coverage was an essential benefit and compliant health insurance had to insure drug costs, it created a gaming opportunity that helped drug companies increase prices, put pharmacy benefit managers [with their 30% profit] between the insurer [who got to add 20% of profit and overhead to the already higher drug prices].
With the increased opacity to drug pricing, Medicaid [which is entitled to a discount off the lowest market prices] paid higher prices, in addition to everyone else.
Since 2013, the year before the Democrat crony plan took effect, prescription drugs [70% of which are generic] inflated at 2.4 time the CPI.
For all those who claim that Obamacare was derived from the Heritage Foundation proposal, this single item demonstrates the lie. And it was not an unintended consequence. It is the price Democrats paid to big med for their support. As Gruber informed the electorate.
3
@ebmem writes, "Under part D, the Republican designed drug program, drug prices declined to consumers."
Are you counting the cost to taxpayers in the cost to consumers? And the cost of Medicare part D was less than expected because fewer people signed up, not because the drug companies lowered their prices.
Although generic versions of [frequently prescribed to the elderly] drugs are now available, plans offered by three of the five [exemplar Medicare Part D] insurers currently exclude some or all of these drugs from their formularies.…Further, prices for the generic versions are not substantially lower than their brand-name equivalents. The lowest price for simvastatin (generic Zocor) 20 mg is 706 percent more expensive than the VA price for brand-name Zocor. The lowest price for sertraline HCl (generic Zoloft) is 47 percent more expensive than the VA price for brand-name Zoloft."
— Families USA 2007 "No Bargain: Medicare Drug Plans Deliver High Prices"
Also see
Stiglitz, Joseph E. (2012). The Price of Inequality. W.W. Norton & Company. p. 560
@MVonKorff
" .. It is now well established that most of the excess in US health care costs .."
No verifying Web-link provided. Where is this "proof?"
Just like Bernie Sanders' alleged "plans." All talk. No data or planning to back them up.
Spend trillions without a budget. How absurd, ridiculous, and utterly bizarre.
According to my doctor (and experience), quality of imaging is important and varies greatly or maybe it is the quality of the radiologist at the imaging center that really makes the difference. After having an MRI interpreted incorrectly which led me to endure unnecessary pain for 4 years before having surgery, I now listen to my doctor’s suggestions. All facilities are not created equal.
21
@Sally - Wasn't your MD able to read the MRI himself and see that the radiologist reading was incorrect?
I think this should be part of an MD's training, yet I have run into MD's that seem uncomfortable or even unable to read MRI's. I never visit these MD's a 2nd time.
This article makes health care sound like shopping online for a new car or laptop. Many drugs are riddled with coupons and medical procedure prices are negotiable. When you step back and look at what is happening to health care, you see that it is becoming more and more commoditized, subject to the same sleazy marketing techniques on TV and online.
A health care delivery system should not be driven by how best to save money. That will guarantee a growing range in health care quality from excellent to terrible, all based on price.
25
@Emergence
The further the delivery of health care moves from a free market, the more expensive it becomes. The opacity of quality and pricing is designed to prevent you from making informed purchasing decisions.
If the system were commoditized, when your doctor diagnosed osteoporosis and prescribed twice annual injections of Prolia, you would pull out your smartphone, look up osteoporosis and Prolia on a reliable website. You would ask your doctor why he was prescribing Prolia at $2000 times two, rather than generic Fosamax tablets at one per week at a cost of $52 per year. If he said he didn't think you were sufficiently reliable to take a pill once per week, you could take that under advisement. If he said that your insurer would pay him $200 twice per year to do the injections, and it was in his profit plan, you could also take that under advisement.
The objective of a free market is to provide the highest value at the lowest cost.
There will always be variability in quality and cost. For most interactions with medical delivery, the patient knows or can assist in figuring out a solution, and a competent provider can address the problem. When the problem is more serious or more complex, superior skills are required. An increase in visibility to price as well as quality are necessary.
Ted Kennedy went to NC for treatment of his brain cancer. The elite have access to quality data unavailable to your or me because they don't want to compete with the hoi polloi .
3
@ebmem writes, "The further the delivery of health care moves from a free market, the more expensive it becomes. "
Unfortunately the data proves just the opposite is true.
Look at the following figures:
Here are the per capita figures for health care costs in 2016 in PPP dollars:
US - 9507.2
Austria - 5227.3
Belgium - 4839.8
France - 4500.4
Germany - 5550.6
Luxembourg - 7462.8
The Netherlands - 5385.4
Switzerland - 7919.0
Sweden - 5487.5
Denmark - 5199.3
UK - 4192.5
Canada - 4643.7
Obviously, the US is closest to a "free market." Switzerland which requires everyone to have private insurance is the next closet and the next most expensive. The UK which is furthest from a free market has the lowest costs.
Let's compare some bottom line statistics between the US and the UK.
Life expectancy at birth: UK - 81.1 US - 78.8
Infant Mortality (Deaths per 1,000): UK - 3.8 US - 6.0
Maternal Mortality (WHO): UK - 9 US - 14
Except for the last figure, all of these come from the OECD.
It is just another aspect our of de facto criminal health care policy.
This should be the number one issue in the upcoming election. Most Americans want a national, affordable, quality plan like much of the rest of the civilized world has.
Stress that to voters in the majority of districts where the polls say voters want it.
54
@Paul
Who is going to work in your national healthcare system? You don't have a right to another's labor at what price you deem affordable.
1
@Driven- Thank you for your reply Driven. 90% of the time you are right but with things like SS, military, medical care etc. it does not work as evidenced by our de facto criminal health care system ie don't get sick, be rich and/or don't have a bad life event.
All of our peer countries and most of the rest of the civilized and not so civilized world has figured it out and most of them have better medical stats than us like longer life expectancy, child death rates, etc. etc.
We can do it here too if we want it. We already have a version of it now with medicare and even republicans would kill if you take it away from them.
Paragraph 6: Routine checkups are electives and potentially shoppable. Who ever came to that conclusion doesn't understand the purpose of a routine checkup nor did they do their homework and include the cost of records transfers.
30
@ARL Yes, like you would call around and see who is offering a special this month on check-ups, like shopping for an oil change! Not to mention, I have to schedule 4-6 months IN ADVANCE for a physical.
4
@ARL The also didn't include the long "new patient" waits that can happen; that your doctor is far more familiar with you and your issues and this matters... It also doesn't take into account the differing quality/skill level/competence level of different doctors...And having your records scattered all over town helps no one either.
2
Professor Frakt points out that, "As with many health care services, there is a large variation of prices across these locations, which means a tremendous opportunity to save money by selecting lower-priced ones. "
But instead of advocating for patients to "shop around," he should be advocating for the implementation of single-payer health care, which has the tremendous advantage of having a government entity set the price of drugs, surgical services, MRI's and X-rays so that patients, many of whom are in pain or severely injured don't have to try to "shop around." The government protects them from being gouged.
Professor Frakt should be reporting on the success of single-payer health care systems like that in Taiwan, Canada, Germany and elsewhere. "Shopping around" is a fool's errand. There is no rational substitute for single-payer health care.
Let's see the research reports on that.
226
@Sean
The medical establishment resists visibility because it would cut into its profit.
Medicare refused to release cost data to the public for years on the argument that the financial privacy of providers would be violated. When the WSJ was successful in its FOIA request, Menendez's eye doctor friend was exposed, along with several other multimillion dollar fraudsters.
In the private sector, pricing agreements between pharmacy benefit managers, drug companies, insurers who have contracted out prescription drug plans to PBMs are trade secrets to keep consumers in the dark. Drug prices [70% of which are generic] have increased at 2.4 times the rate of inflation since the inception of O'Care, and the inflation applies to everyone, the people with employer provided health insurance, Medicaid, Medicare as well as O'Care policies.
Reimbursement rates negotiated between insurers and providers are trade secrets. That is why you are unaware that the consolidation of hospital services prompted by Obamacare resulted in hospital billing rates increasing at 3.3 times the rate of inflation despite a decrease in uncompensated care.
Inflation of medical costs for the single payer Medicare has increased. Eliminating all of the other programs and consolidating them into Medicare-for-all does nothing to improve the quality or cost of care.
Government control of the financing of medical care guarantees that the big medicine cronies will be encouraged to gouge consumers.
2
@ebmem writes, "Eliminating all of the other programs and consolidating them into Medicare-for-all does nothing to improve the quality or cost of care."
And Canada does not exist.
@Sean
Well, gee, why doesn't Bernie Sanders provide a written budget for his "single payer" theories? He's had 25 years. What is he waiting for -- pencils and paper?
When one goal is to reach the 'maximum out of pocket' cost of the insurance plan, so future needs are covered more fully, price does not matter.
8
@Dan Weinshenker Bingo. I am scheduling my knee replacements for next year. The first will be in January and will use up my $2000 deductible and probably my $6000 OOP. The next will be September. There is no reason for me to care how much the replacement costs since they will all be more than my deductible. And I am resentful of having to deal with this pain- I have had health insurance my entire life and now that I am old enough to need it I am being forced to wait until I have the deductible available. (but my pain meds cost me $4.00 a month.). .
4
These experiments failed because the doctors and patients were not aligned. If both are in a closed network with a budget, they have a mutual interest in keeping costs down. In such organized systems of care, the patients must have their tests within the network or pay a higher price for going outside.The physicians and their delivery system have a fixed budget so running up more tests can result in losses and eventually trigger higher insurance premiums for consumers. Of course such a system requires coordination, IT and informed doctors and patients working together. Such systems exist, like Kaiser Permanente, but they are unusual and hard to organize. When that model grows, costs will come under control. Until then, health care will remain a fragmented cottage industry, highly vulnerable to profiteering.
10
Such plans can work. In the '70's, I worked for an employer who offered participation in an HMO, where all care was provided at the clinic and most employees were long term. Good outcomes, low costs. Works for a closed system where you have an employer payer for a stable population and providers who need to provide quality care in order to remain employed.
Kaiser Permanente is a huge conglomeration of providers, insurance plans, for-profit subsidiaries, and government cronyism. Their vertically integrated structure was the model for health delivery much touted by the Obama administration in the design of Obamacare because of its reputation for high quality of outcomes.
Demonstration programs were funded by Obamacare that were going to prove that the superior coordination of care, centralized records, blah blah of KP, Mayo, the Anderson Center, the Cleveland Clinic would result in lower cost and higher quality. Their business models would spread. Unfortunately, their billing consultants could glean far more profit through skilled coding than any Medicare bonus was going to produce. They were out of the demo projects shortly.
KP bought out competitors and used their bargaining position to raise prices to insurers.
Something that works for a closed society is not scalable. Even within a closed organization like KP there is no protection against profiteering when the bills are being paid by the government, employers and the public.
1
@MAK - KP doesn't have a great rep because they make too many decisions based on cost rather than need. My 84yo friend/landlord was a KP patient last year. Despite complaining for 3 years of pains in his left abdomen, KP was unable to find the problem until they finally discovered that he had colon cancer. They then removed most of his colon, place a waste bag on his hip and after a week sent him home.
But he was unable to keep food down, so had to go back into the hospital, where they operated on him again to fix whatever they had apparently screwed up during the 1st operation. After nearly a month in the hospital recovering, they shipped him to a rehab facility. About 3 weeks into that, where he continued to remain week, his heart starter acting up.
They transferred him back to a KP hospital where he died , they say, of a heart attack a week later.
I've heard too many stories of people who were misdiagnosed at KP facilities or knew of people who died to what appeared to be poor treatment.
I will never choose an HMO on my own, especially KP.
1
This notion that health care is a market commodity and that imposing high deductibles and supposed price transparency on a website will induce the public to shop for their health care has long been discredited. The only people who benefit are the private health insurers who charge high premiums and little payouts because of our confusing system.
Is there any wonder why single payer, national health insurance is winning hearts, minds and votes?
154
@macman2 Nice if I could get a rebate on premiums if I didn't "overuse" medical care in a given calendar year.
@macman2
A free market in medicine has never been discredited because it has never been tried.
If the Bush reforms had been permitted to survive, medical costs would be 10-15% lower today and would with incremental changes would stabilize at 40% of the current costs. That would put Americans at 60% of current costs and a 20% premium over what socialized medicine countries spend. The 20% premium would allow us to pay physicians and other providers at American wage levels, instead of the what they get elsewhere and still fund essentially all of the worldwide medical R & D.
1
@ebmem Please support this with data or at least what reforms you are referencing. It is easy to say "if this, then that" in theory. Who projected those results, the CBO or a partisan foundation?
How many doctors send patients to MRIs where they have an investment? Would those physicians appreciate information about lower cost options?
As long as money is made, there will be incentive, even if it's not conscious corruption, to use the more expensive services.
13
I bet doctors have plenty to do keeping up with their drumbeat of appointments and medical science. It’s unrealistic to expect them to also be experts in the purposefully arcane and opaque billing practices at other facilities. And from the patient perspective, the demand curve for good care is vertical: who’s going to go cheap in a life-threatening situation?
What we need is a really good Consumer Reports periodical that rates doctors, hospitals, drugs and pricing. But much of the data is probably secret, and the rest may be too complicated to allow any comprehensible explanation.
65
Many MRI centers are not connected digitally to hospital's systems which a doctor has access to for ready and capable review. Trying to get records transferred simply does not happen or has not on the two occasions I have requested such transfers. Perhaps records were faxed and not entered into the system but there is no way to check that either. The outcomes handed to me were assessments at detail for a patient, not a physician. Mandating full digital reporting would help access to lower cost centers.
46
@poslug Have you ever heard of digital transmissions?
It is possible that even 15 years ago the problem you describe existed, but not today.
1
@poslug, try requesting your imaging on a flash drive or other digital media.
@poslug
In the meantime, whenever you have an MRI for example, you can ask the facility for a CD with your scan on it, and they will give it to you with a short wait..you can hand carry that with you to your appointment with the doc that ordered it in the first place.
Of course, with so many physicians now working for hospital systems (over 50%), it's not surprising that patients end up at the hospital MRI. No, the referring physicians isn't compensated for his referral for the MRI (the Stark self-referral law prevents that), but the physician's compensation is indirectly affected. What people don't know is that the success in "bending the cost curve" was in large part the development of independent outpatient facilities, including imaging center. Hospitals responded by buying many of those independent facilities, and then employing or joint venturing with physicians. And because hospitals are such large providers, insurers respond by agreeing to higher reimbursement rates for hospital affiliated outpatient facilities than the rates for independent facilities; indeed, the hospital premium can exceed 50%, or in some cases even 100%. Of course, we expect, and accept, high levels of compensation for physicians and others in health care including hospital administrators. Why? Physicians have not always been so highly compensated; indeed, the modest Buick was often identified as the "physician car" when I was a child. It's easy to blame high cost diagnostic tests, such as MRI, but the profits from those high cost diagnostic tests don't disappear into space.
35
@reaylward
A physician is theoretically prohibited from referring a patient to a lab or imaging center for a commission or one in which he has an ownership interest. He is not prohibited from referring to an imaging center owned by his employer, even if he gets a bonus for doing so.
The higher reimbursement rates for hospital affiliation is unrelated to any cost justification, it is based on the improved negotiating ability of the big boys, which gets passed along to all consumers. The consolidation in the industry is the direct result of the incentives built into Obamacare and easily explain why hospital billings rates have increased at 3.3 time the CPI while unreimbursed care declined. Just in case you were wondering why the average household did not get a $2500 annual reduction in medical costs when the insured rate increased.
Obama and Gruber were well aware that the cost curve was going to bend upwards. The law was designed to increase revenue to big medicine, which is why they supported it and paid for the publicity campaigns. Hospitals got rate inflation and drug companies got to raise prices at 2.2 time the rate of inflation, even for the 70% of drugs consumed that are generics.
The profits don't disappear, they accrue to big medicine. Americans get to pay more for no incremental value.
3
@reaylwardWhen I was a kid, Buicks were not considered "modest:" those huge sedans with the iconic four holes on the front fenders were just one rung lower on the status ladder than Cadillacs or Lincolns. They conveyed a high income combined with common sense and a lack of ostentation. Ditto the hooded-nib Parker 51 fountain pen--there were far more ornate ones with flashy open gold nibs, but ballpoints were considered too downscale (most were giveaways). Shoes were conservative wingtip oxfords. All these items were signs that a doctor was competent enough to charge a high enough fee to afford them, but not so high that he saw his patients as mere dollar signs.
2
@ebmem, so do you support Canada's system of Medicare for All or the UK system of socialized medicine? Both of them do better with the problems you list. Both of them have better bottom line health care statistics (life expectancy, infant and maternal mortality, etc,) Here are what we and they paid per person for health care in 2016 in PPP dollars which take the cost of living into account:
US - 9507.2
Canada - 4643
UK - 4192.5
And EVERYONE in Canada and the UK gets good health care.
It's not just "too complicated." It's often impossible.
Ask your primary care physician during your appointment how much something is going to cost. Most of the time they will have no earthly idea.
Call up the pharmacy and ask them how much something is. Half they time they tell you they can't tell you until you come to pick it up.
Try asking how much that ambulance ride is going to be while you're unconscious.
Imagine going to a store and half the items didn't have prices on them, and sometimes someone came by and put something in your basket and told you you'd die without it, and when you asked how much it was they said you had to buy it now or else, it's an emergency. Sometimes the items buy themselves without your permission. Sometimes you buy a shirt, but after agreeing to pay for it you're told that while the fabric of the shirt is a certain price, you have to pay extra because the thread and the buttons came from a different source. Regardless of how items end up at the register with you, sometimes at checkout receipt has a line item for the store's air conditioning and a surcharge because your cashier is a temp, and sometimes it doesn't have anything on it at all but the final price.
Healthcare is not a real marketplace. It's a garage sale run by a dozen different people who don't know what they're charging, or if they do won't tell you, and who often have a gun to your head.
303
@Polly Regarding pharmacies, I don't take a lot of drugs, but I've never seen to point of paying top dollar for them. When I have a new prescription, I ask my doc for a paper prescription. I visit every pharmacy within easy driving distance and ask the price, and take notes -- where, when, what quantity, what price. If the pharmacy refuses, I scratch them off the list and the pharmacist know the store has lost my business forever. I now pay about $35 a month for seven prescriptions, plus a little for 81 mg aspirin. The highest price for the same drugs was around $250.
2
@Polly
In my area, it's not just the providers. With dozens of insurance companies and plans that each have their own "contracted" price schedules it's sometimes hard to fault the provider for saying "I don't know," to cost questions. And don't forget that the contract prices are often in continual negotiation, and can change weekly for each insurance company and plan.
That pharmacist/physician/billing clerk probably can't even find out what price they can charge, let alone the cost for the patient, until the prescription or service is complete and run through their insurance & pricing systems.
1