Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Fed Up with Drug Companies, Hospitals Decide to Start Their Own

nytimes.com

Post reply on HN
Print view View original

101–110 of 244 posts

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#101

Post by u801e »

telchar wrote: post #56
maxxxxx wrote: post #46

Earlier quoted context omitted.

All you are saying is correct but you can't excuse their billing practices.

I work for a hospital and I agree with you that the billing practices are shitty, but I couldn't tell you what a procedure will cost you even if ordered to. At best I could give you an average for a procedure but if you're in for a few days you may see dozens of doctors and have hundreds of procedures including an operating room procedure or two and a whole lot of blood tests, imaging, poking and prodding (e.g. asses…

> I couldn't tell you what a procedure will cost you even if ordered to.

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.

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#102

Post by mirimir »

notatoad wrote: post #52
maxxxxx wrote: post #46

Earlier quoted context omitted.

All you are saying is correct but you can't excuse their billing practices.

Blaming one specific part of a profit-centric health care system for being profit-centric seems a little silly

Well, some of us blame the whole thing. Why shouldn't healthcare be a government service? Why is that less appropriate than police and military? Or roads?

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#103

Post by tacon »

For a fantastic discussion about the Byzantine process for generic drug approval, I recommend a recent episode of EconTalk[0]. The guest wrote a book called "Drug Wars: How Big Pharma Raises Prices and Keeps Generics off the Market"[1]. When up to half a billion dollars of revenue is at stake, the drug companies have incredible incentives to delay or prevent generics coming to market. Believe or not, they often simply refuse to give a sample of the old drug to the generic company. No sample to compare, no FDA approval. It is illegal to dispense a drug without a prescription, and the sample is not for a patient, so it can take some maneuvers to get a legal sample. Or the drug company can change a tiny feature of the drug, re-patent the new drug, and then destroy/withhold all the old drug. No old drug sample, no FDA approval of an "identical" generic. The drug companies will contract with a generic company that never, actually gets to production (wink, wink). Those contracts are finally being understood by judges, so now they are going to a second level of contract obfuscation that is even harder to notice, but still keeps the generic off the market.

[0]http://www.econtalk.org/archives/2017/06/robin_feldman_o.htm...

[1]https://www.amazon.com/Drug-Wars-Pharma-Raises-Generics/dp/1...

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#104

Post by aa111111111 »

TillE wrote: post #32
fludlight wrote: post #27

Let's say they succeed in launching a new generics company. Ten years down the line they will divest in order to build each hospital a shiny new geriatrics wing. Within six months the spun-off drug company will jack up prices and the cycle will continue.

From that perspective, does any country have their own publicly owned pharmaceutical manufacturer? It's the kind of thing the NHS should do, since they control most other aspects of health care, but I don't think they do. There's so little benefit to competition with generics, you may as well have that vertical integration to at least provide what hospitals need.

www.spc.lk

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#105

Post by u801e »

vkou wrote: post #35
garmaine wrote: post #28

Earlier quoted context omitted.

On the other hand, when I bring my car to an auto shop they give an estimate of cost before actually doing any work.

Your car is unlikely to experience life-threatening complications with a nearly unbounded upper cost while it's being fixed. 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.

> Your car is unlikely to experience life-threatening complications with a nearly unbounded upper cost while it's being fixed.

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.

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#106

Post by brucephillips »

mirimir wrote: post #102
notatoad wrote: post #52

Earlier quoted context omitted.

Blaming one specific part of a profit-centric health care system for being profit-centric seems a little silly

Well, some of us blame the whole thing. Why shouldn't healthcare be a government service? Why is that less appropriate than police and military? Or roads?

The same reason any industry benefits from being privatized: to incentive innovation. The antibiotics revolution would never have happened, at least not in America, had there not been a profit incentive.

The other services you listed are less dependent on innovation.

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#107

Post by telchar »

u801e wrote: post #101
telchar wrote: post #56

Earlier quoted context omitted.

I work for a hospital and I agree with you that the billing practices are shitty, but I couldn't tell you what a procedure will cost you even if ordered to. At best I could give you an average for a procedure but if you're in for a few days you may see dozens of doctors and have hundreds of procedures including an operating room procedure or two and a whole lot of blood tests, imaging, poking and prodding (e.g. asses…

> I couldn't tell you what a procedure will cost you even if ordered to. 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…

In that case I may be able to look it up. Granted this isn't the area I work in but in theory I have access to the necessary data. The people who do work in this area should be able to tell you, at least for some outpatient procedures. But more to the point if you have an inpatient stay or show up in the ER it's pretty uncertain what procedures you'll actually wind up having, which is where the price opacity really comes in.

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#108

Post by telchar »

sbov wrote: post #68
telchar wrote: post #56

Earlier quoted context omitted.

I work for a hospital and I agree with you that the billing practices are shitty, but I couldn't tell you what a procedure will cost you even if ordered to. At best I could give you an average for a procedure but if you're in for a few days you may see dozens of doctors and have hundreds of procedures including an operating room procedure or two and a whole lot of blood tests, imaging, poking and prodding (e.g. asses…

It's not only that. Our local hospitals can't give us prices for procedures that other places can. 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 ou…

It's frustrating. Neither the hospital nor the insurer typically has sufficient information to give you an answer. It's even worse when your information like age or diagnosis history factors into it.

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#109

Post by thatcat »

QuarterReptile wrote: post #99
mojomark wrote: post #49

Earlier quoted context omitted.

Concur with maj maj maj maj... additionally, the the cynisism ignores the introduction of new competitive forces with a different moral vector in a largley unchecked market, the repurcussions of which are certainly uncertain, for certain.

Unchecked? What about the FDA check on new entrants to the market?

Unchecked by market forces, since the market has been consolidated and lacks competition.

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#110

Post by thatcat »

toomanybeersies wrote: post #77
TillE wrote: post #32

Earlier quoted context omitted.

From that perspective, does any country have their own publicly owned pharmaceutical manufacturer? It's the kind of thing the NHS should do, since they control most other aspects of health care, but I don't think they do. There's so little benefit to competition with generics, you may as well have that vertical integration to at least provide what hospitals need.

In New Zealand, Pharmac [1] is a government run entity that bulk negotiates bulk contracts for supplying the entire country with prescription drugs. It's not quite the same as manufacturing it themselves, but the bulk buying does bring the price down quite substantially. [1] https://en.wikipedia.org/wiki/Pharmac

This is common, the US is alone in its legislation against negotiating as a group for prescription prices.
Post reply on HN