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Hospital prices are about to go public in the U.S.

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Re: Hospital prices are about to go public in the U.S.

#111

Post by conductr »

StudentStuff wrote: post #103
setr wrote: post #98

Earlier quoted context omitted.

I've discussed this before, but I think there's quite a bit of funny money in hospital bills -- a 10k bill rarely actually materializes in 10k transferred across all parties involved. Doctors bill $10k to your insurance, the insurance decides its too much, lawyers are on-hire to negotiate and take a 30% cut of the outcome, and finally 2k is paid out; the absurd bill naturally accounts for the absurd process, and I do…

This type of billing practice causes a mess of winners and losers, essentially unless your insurer has good pricing with wherever you end up getting treatment (often not a choice you get to make in an emergency), you can end up holding the bag for the cash price, usually half of the $10k number you mention. Quite ridiculous when other insurers are paying less than half that price, smells of a scam.

My conspiracy theory is it was designed this way over time so that people “needed” insurance (before it was required).

Re: Hospital prices are about to go public in the U.S.

#112

Post by TwoHeadedBeast »

peteretep wrote: post #73
feanaro wrote: post #71

Earlier quoted context omitted.

That still doesn't explain how prices of medical services in many other countries turn out several order of magnitudes smaller than commonly encountered prices in the US.

Are the prices that Medicare pay orders of magnitude different? ISTR that Medicare and the VA both pay about $10k per patient per year, which I think is comparable with the NHS. No sources as this is half-remembered.

NHS spending is £2892 per person/year, that's quite a bit lower.

Re: Hospital prices are about to go public in the U.S.

#114

Post by mastef »

QuantumGood wrote: post #110
mikedilger wrote: post #21

I actually stiffed a doctor once because he refused to give a price up front and when I got the bill it was outlandish. I also made a huge scene in the intake/waiting room about this. I was leaving the United States at the time so I didn't really care about my credit record. To be slightly more honest: he wasn't the doctor assigned to me on intake, he was another doctor from another hospital across the street as a co…

Had new insurance and a sore shoulder. Was billed ~$1,400 for a physical therapist to examine it ("evaluation"). No treatment. Very little covered by insurance. The next day had a chiropractor treat it and shoulder was fine. $25 with coupon. Funny part is, as it was new insurance, I spent over 30 minutes with insurance rep in advance on phone going over options and trying to get an idea of likely costs. When I had a…

The differences in the prices you mentioned are astronomical...

I'm already getting angry here to be charged $50 instead of $25 when the doctor "touches" you during some basic evaluation. But at least they tell you about any massive amounts coming up before any treatment happens.

Re: Hospital prices are about to go public in the U.S.

#115

Post by namdnay »

telotortium wrote: post #45
pkaye wrote: post #10

Earlier quoted context omitted.

If you look at healthcare vs GDP, the US is way above the line compared to comparable countries. https://www.healthsystemtracker.org/chart-collection/health-... I think scaling the average costs from other countries accounting for GDP would be a good way to set the rates.

If you look at the actual household income in various countries, as opposed to the GDP, which doesn't always track household income as well for many OECD countries, it turns out that the US has pretty much the healthcare consumption expected for its average household income: https://randomcriticalanalysis.com/2018/11/19/why-everything... . Based on this analysis, I think the primary issue with US healthcare is the fa…

That's an interesting measure - wouldn't it be biased by the fact that household income in the US is "artificially" inflated compared to other countries, because healthcare costs need to be paid from income?

Re: Hospital prices are about to go public in the U.S.

#116

Post by yodsanklai »

Some anecdotes related in the comments are scary. I'm wondering, how is the situation for a software engineer working in a big company (say GAFA in silicon valley). Suppose you broke a leg skiing, and need surgery and various medical exams. How much are you expected to pay? what's the administrative overhead? same question for dental care.

Re: Hospital prices are about to go public in the U.S.

#117

Post by arethuza »

QuantumGood wrote: post #110
mikedilger wrote: post #21

I actually stiffed a doctor once because he refused to give a price up front and when I got the bill it was outlandish. I also made a huge scene in the intake/waiting room about this. I was leaving the United States at the time so I didn't really care about my credit record. To be slightly more honest: he wasn't the doctor assigned to me on intake, he was another doctor from another hospital across the street as a co…

Had new insurance and a sore shoulder. Was billed ~$1,400 for a physical therapist to examine it ("evaluation"). No treatment. Very little covered by insurance. The next day had a chiropractor treat it and shoulder was fine. $25 with coupon. Funny part is, as it was new insurance, I spent over 30 minutes with insurance rep in advance on phone going over options and trying to get an idea of likely costs. When I had a…

So you have insurance but it doesn't cover stuff when you are actually ill? Does your insurance policy actually spell stuff out so that you can predict what will or won't be covered?

Note: I'm from the UK and find the stories about US healthcare insurance grimly fascinating....

Re: Hospital prices are about to go public in the U.S.

#118

Post by cheschire »

lostlogin wrote: post #66
Scoundreller wrote: post #31

Earlier quoted context omitted.

That only works for non-urgent care and when estimates are cheap enough to encourage shopping around. Although even free estimates cost you time.

Could you explain a little further? Most industries are able to provide quotes, why shouldn’t healthcare facilities?

Those industries probably bake the cost of estimating quotes into the manpower cost already. Hospital bills would ostensibly be even higher simply to provide quotes.

But I believe his core point was up front. When your arm is off, you're not going to ask for, or even reject, a quote.

I would anticipate though that once quotes are known, and posted to glassdoor-like services, one could develop an app where you point to your arm, select "it's fallen off" and then you are provided the cheapest hospitals for your issue and their ratings.

Re: Hospital prices are about to go public in the U.S.

#119

Post by alkonaut »

conductr wrote: post #109
huac wrote: post #63

Earlier quoted context omitted.

> all prices need to be +\- 50% of what Medicare pays. This is actually close to what happens with private insurers- they negotiate with a hospital to pay n-times what Medicare pays for some set of treatments. So why does Medicare pay the least? Because they have the most patients covered of any insurance network in the US. That's a hell of a bargaining factor. More patients = cheaper prices. The logical conclusion i…

No. Medicare pays the least because the don’t negotiate. They just set prices. As a hospital/doctor you can choose to accept Medicare patients or not. Most providers lose money on Medicare patients, or so the like to say.

Wouldn’t it make more sense to properly separate private and public? If hospitals can be either Medicare-only or no-Medicare (using Medicare as the name of a future broad/universal system much larger than Medicare/aid is today) then hospitals would chose to be Medicare in proportion to how many are covered. If everyone (including those who chose a private insurance) pays a full insurance premium for the public system on their taxes, the private insurers’ patient lists would shrink very quickly, and so would the number of hospitals that could survive by providing treatment to those patients. So looking from outside it looks like “hospital prices” is just another one of the problems that would be solved by a tax funded public universal healthcare insurance?

Example (Sweden): I pay a full public insurance through taxes, and I have a private insurance via my employer that lets me cut some waiting times for certain procedures from 90 to 14 days. It’s an expensive way for my employer to make sure I’d be back to work quicker than I would otherwise be. Obviously, this is a luxury few use or need so the number of hospitals that provide this care is extremely limited (a few percent).

Re: Hospital prices are about to go public in the U.S.

#120

Post by QuantumGood »

mastef wrote: post #114
QuantumGood wrote: post #110

Earlier quoted context omitted.

Had new insurance and a sore shoulder. Was billed ~$1,400 for a physical therapist to examine it ("evaluation"). No treatment. Very little covered by insurance. The next day had a chiropractor treat it and shoulder was fine. $25 with coupon. Funny part is, as it was new insurance, I spent over 30 minutes with insurance rep in advance on phone going over options and trying to get an idea of likely costs. When I had a…

The differences in the prices you mentioned are astronomical... I'm already getting angry here to be charged $50 instead of $25 when the doctor "touches" you during some basic evaluation. But at least they tell you about any massive amounts coming up before any treatment happens.

It's not sane. With insurance, was hospitalized for a heart condition. ~$45,000. Found no problem in testing, so they kept ordering more tests, sending in more cardiologists. Kept hearing "I know you've said this several times already, but please repeat for me...". Each time I repeated the story to a different doctor there was a large bill. Clearly the hospital new how to pad the bill.

I eventually left "against doctor's advice" though there was a doctor there that agreed with me leaving. Pursued lower cost versions of remaining tests recommended on outpatient basis.

The funny part that time was there was a "patient billing advocate" in the hospital, who was magically never available over the three days I was there despite repeated efforts by us each day.

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