I am not sure if patients will see any of the savings though. I view hospitals as fundamentally dishonest organizations after a few experiences. Their medical treatment is fine but their financial practices are borderline fraudulent.
62% of bankruptcies in the US are caused by medical debt.
The only saving grace in this all is that you can save enough for retirement in creditor-protected retirement accounts, and can otherwise secure yourself financially while telling your creditors to pound sand if they're being ridiculous.
The hospital can try to be as evil as they want, but their ability to do so in a market that has actual price and service competition will make it very difficult to do so.
I mean this nicely but sincerely, are you high?
The problem with our healthcare system is that too much money goes to drug companies, medical device makers, and insurance companies and not enough makes it to the people actually providing the care. Its a bit more complicated than that, I'd admit, but that's the TLDR version.
To clarify: Medicare reimburses rates that are below COGS, so hospitals have to increase the amount they charge private insurers in order to make up the loss.
One of the reasons hospitals accept discounted rates for insured patients in general is ease of reimbursement vs trying to chase the patient for money.
That's not an incentive for hospitals to serve Medicare patients; it's compensation for the fact that the hospital sees so many Medicare patients (and therefore so few privately-insured patients, by portion) that it can't make up the difference solely from overcharging private insurers.
Insurers negotiate reimbursement rates with hospitals, with both parties being able to leverage their size/social cachet to extract favorable terms. This contributes to the availability of certain hospital chains in the preferred networks vs. the non-preferred networks of particular insurers.
The hospitals negotiate those rates. If they're not happy with them, they need better negotiators.
It's like taking your car to a mechanic, and once it's fixed, refusing to pay, claiming car didn't need THAT repair in the first place. Then getting away with it because you have an arbitration agreement in place with the shop. So the shop needs to employ an entire separate department of ASE certified mechanics that are dedicated to documenting that the repairs performed on customer cars were necessary. But the kicker is, YOU GET TO DECIDE IF YOU'RE CONVINCED THE REPAIR WAS NECESSARY.
Hospitals used to have small (1 person per 10k beds) claims denial departments and use outsourcing firms if case loads increased. Now they are acquiring all the outsourcing firms and increasing their staff to like 100 people per 10k beds. It's insane.
I like to retell a particularly awful denial my partner had to deal with, which was a patient had their open heart surgery claim denied by the insurance company because they determined that the patient's condition only warranted observational care (that's right, the insurance company determines what care you need/get). The hospital eventually won that claim, but they routinely lose $100k+ claims and have to eat the cost.
Your body is. A routine surgery can absolutely turn into a hundred-thousand-dollar nightmare.
Never mind that a mechanic has a much better understanding of a car, then a doctor does of a human body.
When things go bad in medicine, your bill grows really, really, really fast.
Also, unlike a mechanic with a car, your doctor can't stop working on you after they blow through their quoted budget and ask if you still want to pay for treating the complications. I mean, they can, but unless you've got a death wish, you're not going to say 'no.'
Even if nobody had insurance and shopped around, the US style of billing would lead to very little downward pressure on prices, as it's impossible to have a clue of what you are going to pay.
Many businesses, including freelance developers, will not charge per hour, but by job. You jack up the price to end up ahead in the case of typical complications, but there are cases where you lose money, and that's on you being bad at estimates and billing. Billing by procedure in the medical system is just setting the wrong incentives, and a recipe for maximum waste, if not downright fraud.
If an actuary can quote me the price of a life insurance premium 40 years before a person is expected to die, such that the company doesn't lose money, a hospital can figure out how to price its services such that it doesn't go bankrupt. Those wailing about too many uncontrolled variables are just trying to suck the last available penny out of the patients. How can they possibly nickel-and-dime people to death on their itemized bills if they don't know exactly how many cm of plastic tubing will be needed for the surgery?! How can they charge $25 per 500mg analgesic pill if that is already included in the published price of the procedure?! It's really only a problem if your mission is to suck out all the consumer benefit of trade via price discrimination.
If my auto mechanic blows past their original quote, they don't stop work and ask for more money. They fix the danged problem, charge what they said they would, and try to estimate better on the next job. And they certainly don't plow ahead, replace the engine and transmission and exhaust system, laser-scour the rusted body panels, put on new tires, repaint the exterior, reupholster the interior, clean all the crap out of the trunk, fill up the gas tank, and then try to charge me $120k to get my 2001 Civic back. The doctor can't stop working, but they can stop charging extra for it. If I knew ahead of time that it would have cost that much, I probably would not have consented to the procedure in the first place.
If you bring your car in for repair and tell them that you need to have the car's brake rotors and pads replaced, the shop can tell you that the parts will cost X and the labor will be Y hours at Z cost per hour and give you a relatively accurate estimate. They may later tell you that there were some bolts that had to be drilled out before they could remove some parts and that may increase the labor cost somewhat.
Why can't that be the same case if I go to get a chest X-ray with posterior-antierior and lateral views? If you have the CPT code(s) and the insurance information, it should not be difficult or time consuming to get the cost estimate.
It is both difficult and time consuming [0], and, moreover, often distant from the provider, because medical billing is quite often outsourced.
[0] Perhaps not in the median case, but there are plenty of complex cases, which is one of the reasons this is outsourced.
Emergency care is a different matter, I imagine, insurance-coverage-wise, but pre-approval seems to be fairly widespread for planned stuff these days.
She came home one day feeling pretty good about overturning a $180k denial. She checked back a few weeks later, and found the paid in full amount to be in the neighborhood of $10k after "negotiated discounts."
The system is fucked. Had the denial gone through, that person would have been on the hook for the full 180k. (Or, to be more accurate, the hospital would have negotiated for $10k from the patient and written the remaining 170k off of their taxes)
The surgeons I see through work have very nice houses and 100k+ cars so they are part of this.
Median surgeon salary in CA is $400K. In UK, a surgeon gets about $100K.
It also is almost impossible to have a real discussion about this fact because it makes people uncomfortable.
Without that... the costs will always be unevenly distributed due to the nature of illness, that's why the only sane first-step health policy is mandated universal insurance coverage, public or private, since the main question is who is going to get the bad news that they've got the unlucky genes/mutated cells/whatever. Everyone pays in, everyone gets covered if/when they need it.
And if you pay in your whole life and never get seriously ill? That's not a reason to complain, that's a reason to thank your lucky stars you didn't have to deal with being seriously ill or injured! It's not fucking fun, like sick people are trying to get a free ride here.
"The real root problems with the system are that a tiny minority of very sick patients account for an overwhelming majority of treatment costs"
It's impossible to tell exactly what the parent comment meant any more precisely without clarification, whether they were talking about unnecessary over-consumption of resources (Americans have been over-healthcare'd for decades), or that eg cancer patients or elderly consume vast resources (as one would expect). However, it is of course the case that a tiny percentage of the population produces a very large share of the cost. The bottom 50% of healthcare consumers, are a mere 3% of the cost in the system. I don't know what the point of any of that is however, there are only ultimately two choices: go back to the old system that was far less expensive for the majority, but didn't properly cover about 1/3 of the population; or continue to shift toward universal healthcare with a fully distributed cost (which means significantly raising taxes on the middle class, as in every universal healthcare system).
"When it comes to America's spiraling health care costs, the country's problems begin with the 5%. In 2008 and 2009, 5% of Americans were responsible for nearly half of the country's medical spending. ... In 2009, the top 1% of patients accounted for 21.8% of expenditures."
https://www.theatlantic.com/business/archive/2012/01/5-of-am...
Can't find data right now, but a generally healthy person will spend most of it's lifetime healthcare expenses on its last 2 years.
NHS adopts this measures in the so called death panels. So it can have money to fund preventive care and promote healthy lifestyles.
Please cite which of these procedures are forbidden.
> NHS adopts this measures in the so called death panels
The US has these too, in the form of insurance companies.
I think if you're going to have them it's better to ahve them be publically owned not for profit organisations under intense government regulation, rather than profit making companies.
http://www.telegraph.co.uk/news/health/news/6127514/Sentence...
Also, it had a policy of not funding what they call "procedures of limited clinical value"
http://www.miltonkeynesccg.nhs.uk/referrals-and-priorities-p...
https://www.compassionindying.org.uk/wp-content/uploads/2015...
https://www.theguardian.com/society/2013/jul/15/liverpool-ca...
Your second link is even weirder. Firstly you've linked to a local organisation that covers a population of 250,000 people. Milton Keynes CCG is not a national organisaton. Secondly, you've said this is about not funding some treatments, but you've linked to the page where people can request funding for those treatments. Thirdly, You think US insurance companies fund anything and everything?
Some treatments are very expensive and also do not work. We see this most commonly with cancer drugs. To ease the burden for CCGs there's a national "Cancer Drugs Fund", set up to provide access to the latest cancer drugs.
They do not work. They do not work, and they cause harm, and they are very expensive.
https://www.theguardian.com/science/2017/apr/28/cancer-drugs...
> The Cancer Drugs Fund, set up by the government to pay for expensive medicines that the NHS would not normally finance, failed to benefit patients and may have resulted in some of them suffering unnecessarily from toxic side-effects, experts say.
> An analysis in a leading cancer journal has found that the fund paid out £1.27bn from 2010 to 2016 – an amount that would have paid for an entire year of mainstream cancer drugs for the NHS.
> But medicine it paid for was not worth the money, the report concluded. The analysis in the Annals of Oncology journal looked at 29 cancer drugs approved for 47 different types of treatment (known as indications), some of which were approved to treat more than one cancer. They found that only 18 of the 47 treatments prolonged the patient’s life, and then only by an average of three months.
But assuming someone still wants it, and they apply for individual funding and don't get it, they're now in the same position as many Americans: they can crowd-fund and go private.
In general: If you ask the insurance companies who the problem is, they point at hospitals and drug companies. If you ask hospitals who the problem is, they point at insurance companies and drug companies. If you ask drug companies who the problem is, they point at insurance companies and hospitals.
If you look at patient costs in the three sectors compared to other countries, you see a remarkably even division of the spoils between the three heads of the beast.
Erm no, actually you pay a lot more for pure hospital services all things considered than whatever is paid for the price of drugs. I totally agree that drugs should be cheaper for patients, but pretending drug manufacturers are the only/main problem is just far from the reality of the market. Every intermediate is inflating their prices as well.
Doctor associations all across the country create enormous barriers to the opening of new medical schools to avoid competition.
Don't get me wrong, medical doctors are generally good hard working people. But we need to acknowledge they're part of the problem.
A surgeon in CA earns on average about $400k while its peer in UK makes $100.
4x the cost of labor should partially explain why a surgery can easily cost 6 figures.
similar to how nursing unions band together and squash efforts for community paramedicine (many of the same services at a way lower cost) to expand. "they'll be taking our jobs!" is what it boils down to.
not yet...
Disclaimer: None. I don't work in the medical industry.
The other services you listed are less dependent on innovation.
But reality is more complicated.
See https://www.pharmaceutical-journal.com/news-and-analysis/fea...
Fading away used to mean dying in the streets. Sometimes it still does, but much more rarely. It's a dearly paid price for the innovation that brought us the world as it is today.
It's a big mess and I don't see billing practices improving significantly until the reimbursement system changes. Single payer could really simplify things for the end user.
We tried price shopping an hsg test because we had to out of pocket it. Hospitals took hours on the phone and multiple call backs. Other places could give us a quote in minutes.
We chose a hospital based on price. The morning of the procedure they told us it doesn't include everything. But they said we were wrong and our insurance covered it, so we didn't worry. But it got denied, and then we had to pay their shitty insurance inflated price.
I think private healthcare in the UK would have very clear pricing. They have to compete with "free" (in this case, "free but not urgent, so your appointment is in six weeks") and deceiving patients is not going to attract further custom.
Is that the case even if I give you the exact CPT code (or possible set of codes) for a given imaging or lab procedure? That is, could you not provide the out-of-pocket and insurance covered rate if I provide my health insurance information?
For what it's worth, the last time I tried this, I still had to wait for several days to get an estimate of cost. But I don't really see why it should be the case provided that the information I mentioned above is available.
I don't think people are complaining about the doctors and nurses. They're complaining about the institutional billing & pricing practices -- and not just the exorbitant prices. Americans have trouble even getting price quotes for routine procedures [1]... a problem that, as I understand, many other countries simply don't have. How can you completely miss these fundamental problems and then claim "people truly just don't get it"?
[1] https://www.reuters.com/article/us-hospitals-prices/hospital...
The entire market for drugs like Ramelteon—drugs that only exist because doctors can't prescribe the generic, because hospital and pharmacy suppliers don't carry the generic, because no drug lab finds it profitable to sell the generic, despite FDA approval—would collapse overnight.