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U.S. health care's widespread overbilling problem

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Re: U.S. health care's widespread overbilling problem

#151

Post by EvanAnderson »

DougWebb wrote: post #137
projectramo wrote: post #4

I know this will attract a lot of people who have suggestions for healthcare. Let me add my big one: price transparency. I had a simple test the other day. I could not get a price. I could not get a price with my insurance, or without it. I called at least 9 times. I got 5 call backs from people who asked me to schedule the procedure but no price. On the 10th call, I finally got someone to tell me what the out-of-poc…

Price transparency is probably not feasible, most of the time. For the software developers, here's an analogy: asking your doctor how much it will cost to treat you is akin to a product manager asking you how long it will take to implement a feature. You might have a rough idea, but until you get into the requirements, do some design work, and dig into the details you can't even come up with a precise estimate. And y…

I agree that the pricing model is wrong. Fee for service creates perverse incentives.

Having said that, though, unlike developing a new piece of software we have vast stores of data about procedures, complications, and outcomes from other patients who have already undergone the procedure. Surely there's a pricing model, if we are bound to fee for service, that could use this trove of existing data to provide more transparency.

I'd be happy with knowing pricing within half an order of magnitude.

Re: U.S. health care's widespread overbilling problem

#152

Post by dragon_greens »

DougWebb wrote: post #137
projectramo wrote: post #4

I know this will attract a lot of people who have suggestions for healthcare. Let me add my big one: price transparency. I had a simple test the other day. I could not get a price. I could not get a price with my insurance, or without it. I called at least 9 times. I got 5 call backs from people who asked me to schedule the procedure but no price. On the 10th call, I finally got someone to tell me what the out-of-poc…

Price transparency is probably not feasible, most of the time. For the software developers, here's an analogy: asking your doctor how much it will cost to treat you is akin to a product manager asking you how long it will take to implement a feature. You might have a rough idea, but until you get into the requirements, do some design work, and dig into the details you can't even come up with a precise estimate. And y…

That sounds fine on paper but does tends to cause overuse of the resource. People don’t value what they get cheaply or free. I belive NHS from UK is facing a similar problem.

Re: U.S. health care's widespread overbilling problem

#153

Post by DougWebb »

EvanAnderson wrote: post #151
DougWebb wrote: post #137

Earlier quoted context omitted.

Price transparency is probably not feasible, most of the time. For the software developers, here's an analogy: asking your doctor how much it will cost to treat you is akin to a product manager asking you how long it will take to implement a feature. You might have a rough idea, but until you get into the requirements, do some design work, and dig into the details you can't even come up with a precise estimate. And y…

I agree that the pricing model is wrong. Fee for service creates perverse incentives. Having said that, though, unlike developing a new piece of software we have vast stores of data about procedures, complications, and outcomes from other patients who have already undergone the procedure. Surely there's a pricing model, if we are bound to fee for service, that could use this trove of existing data to provide more tra…

A lot of that trove of existing data is locked up behind privacy law barriers, and there's no incentive for doing the work to strip out the PII and make it available for aggregate analysis. And since we're talking about the costs for performing medical treatments, the details that would need to be stripped out could be significant.

For example, if Procedure A tends to be more costly when the patient also needs Procedure B, that's significant. But if the aggregate information includes the fact that the same patient needed both A and B, that might be usable to identify the patient, and so the relationship can't be shared in the data.

Re: U.S. health care's widespread overbilling problem

#154

Post by harisenbon »

beat wrote: post #149
projectramo wrote: post #4

I know this will attract a lot of people who have suggestions for healthcare. Let me add my big one: price transparency. I had a simple test the other day. I could not get a price. I could not get a price with my insurance, or without it. I called at least 9 times. I got 5 call backs from people who asked me to schedule the procedure but no price. On the 10th call, I finally got someone to tell me what the out-of-poc…

The core difference between the American health insurance model and the Japanese model (which costs half as much and has better outcomes) is fixed pricing. In Japan, a government commission sets prices for every medical product and procedure, tuning the prices to insure profitability, while preventing profiteering. In America, price negotiation is done between providers and insurance carriers. This has a few obvious…

I'm heading back from Japan today, and my family got a bunch of checkups and medical stuff done while we were here.

Even without insurance all our procedures cost total less than ~$100 apiece.

The most expensive thing I've ever had in japan was my full body workup last year for $500.

It included: stomach ultrasound, 5 blood tests, eye exam, MRI(brain) and barium scan. All without insurance.

By comparison, in the US I was charged $1200 to get my daughters arm cast changed (no xray, just a nurse changing the cast), and $800 for an ultrasound.

It is literally cheaper to fly to Japan and get treatment without insurance than to use my health insurance that I pay $1300/month for.

Also, as a bonus, because of the set prices of medical procedures in Japan, insurance is super cheap. For a family of 4 it was costing me around $500/month when I used to live here.

Re: U.S. health care's widespread overbilling problem

#155

Post by grecy »

maxxxxx wrote: post #3

To me hospitals are basically scam operations. My girlfriend has had several surgeries in the last two years. In addition to already outrageous standard prices ($40000 surgical center cost for a surgery where we spent in total five hours at the center) pretty much every bill had mistakes. Then after a few months a collection agency will try to collect for something that never got billed and never has happened. I can…

Healthcare in the USA is not a scam, it's simply a for-profit business. They have worked extremely hard to maximize those profits for decades.

They're actually good at it, and it were a startup extracting those profits they would be applauded for it.

Re: U.S. health care's widespread overbilling problem

#156

Post by ScottBurson »

jazzyk wrote: post #98
dboreham wrote: post #88

Earlier quoted context omitted.

Because Americans are selfish. Source: lived in US for 20 years.

I have lived in the US for 27+ years and I think Americans tend to be very generous, a lot of people donate their time and money to charities, churches, etc. They just don't want to give their money to a bunch of bureaucrats, who spend it mostly on themselves, and seem to multiply like rabbits.

The funny thing is, the money is still going to a bunch of bureaucrats who multiply like rabbits -- it's just that they work for the insurance companies rather than the government. They're needed because of the ongoing arms race between providers and insurance companies, of which the overbilling described by this article is a major part.

In fact, a single payer system would sharply reduce the number of jobs for health care administrators -- to the point that I've seen a blog post somewhere pointing out that these people would need income support and retraining. The economies of several small cities depend heavily on these jobs.

Re: U.S. health care's widespread overbilling problem

#157

Post by EvanAnderson »

DougWebb wrote: post #153
EvanAnderson wrote: post #151

Earlier quoted context omitted.

I agree that the pricing model is wrong. Fee for service creates perverse incentives. Having said that, though, unlike developing a new piece of software we have vast stores of data about procedures, complications, and outcomes from other patients who have already undergone the procedure. Surely there's a pricing model, if we are bound to fee for service, that could use this trove of existing data to provide more tra…

A lot of that trove of existing data is locked up behind privacy law barriers, and there's no incentive for doing the work to strip out the PII and make it available for aggregate analysis. And since we're talking about the costs for performing medical treatments, the details that would need to be stripped out could be significant. For example, if Procedure A tends to be more costly when the patient also needs Proced…

The software development number is, arguably, almost completely unknowable. The healthcare pricing number is knowable (for some fuzzy value of knowable) if our society cared enough to do something about it. We don't, though.

Re: U.S. health care's widespread overbilling problem

#158

Post by DougWebb »

dragon_greens wrote: post #152
DougWebb wrote: post #137

Earlier quoted context omitted.

Price transparency is probably not feasible, most of the time. For the software developers, here's an analogy: asking your doctor how much it will cost to treat you is akin to a product manager asking you how long it will take to implement a feature. You might have a rough idea, but until you get into the requirements, do some design work, and dig into the details you can't even come up with a precise estimate. And y…

That sounds fine on paper but does tends to cause overuse of the resource. People don’t value what they get cheaply or free. I belive NHS from UK is facing a similar problem.

"overuse" is a tricky word to use here. Are we concerned about patients getting too much "good healthcare" without being adequately grateful for it? Should we give them "adequate healthcare" instead? Or maybe "barely adequate", so that they know what they're missing?

You're probably thinking more along the lines of unnecessary tests being performed, or prescribing drugs "just in case". I have a dermatologist near me who I like and who is widely known, but every time I see her if she prescribes one drug for me, she prescribes 1 or 2 others as well for the exact same thing.

I believe that this sort of waste comes partly from a financial incentive (line items on insurance claims, or justification for them, and in my dermatologist's case kickbacks from drug companies), and partly from as a defense against being accused of malpractice. It could also be simple laziness too: order a test and let the lab try to figure out a diagnosis.

Any major overhaul of the healthcare system along the lines I proposed would need to deal with these issues as well. The financial and malpractice incentives could probably be eliminated. Maybe laziness too, assuming doctors had to get annual reviews for salary adjustments, just like everyone else.

Re: U.S. health care's widespread overbilling problem

#159

Post by skummetmaelk »

makecheck wrote: post #139

Generally it is really hard to negotiate fair pricing if one side knows the other side has tons of money. "Oh gee, government contract? That'll be $15,000 more for no good reason." Perhaps anonymizing all billing would help so that negotiations simply cannot know what the other side can afford.

Whereas it's really hard to negotiate pricing with people who are going to die or be physically impaired for the rest of their lives if they don't pay whatever you ask?

Re: U.S. health care's widespread overbilling problem

#160

Post by romuloab42 »

camiller wrote: post #63
mfoy_ wrote: post #46

"The United States remains one of the only advanced industrialized democracies in the world without universal coverage. While this in and of itself is not a problem, the United States also spends more on health care as a percentage of GDP than any other advanced country in the world and has worse health outcomes – with lower life expectancy, higher infant mortality and higher obesity rates than comparable countries l…

I think this is because we choose to live less healthy lifestyles rather than the quality of medical care. Super size that...

Not just that, but remember not everybody can afford health care in US, so it's not unfathomable to think some of those bad statistics is due to people not being able to afford proper care, not just that they don't live a healthy life (which can certainly contribute to that).
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