Live data from Hacker News

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

ajc.com

141–150 of 390 posts

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

#141
post #133

This won't help consumers. The prices (both charges and what Medicare pays) are already effectively public: https://data.cms.gov/Medicare-Physician-Supplier/Medicare-Pr... The problem, as some other comments point out, is that they're way too complicated. The link I posted, for example, is just the provider charges. A hospital visit typically has a facility claim and at least one provider claim. Depending on the type…

> It's a total mess and hopelessly complex for the average consumer. But not for insurance companies; it's in their interest to compare hospitals and get the best care for the lowest price. I for one hope this will trigger competition. On the other hand, it'll probably end up shafting the personnel instead of the ridiculous profit margins.

The idea of effective competition in emergency services has always struck me as fanciful.

The benefit that competition provides to incentivize lower prices and better services is a consumer's ability to easily deny someone their business and go elsewhere.

What would this look like here?

Would one be in the back of an ambulance doing price shopping on a tablet as they are fighting some terrible injury?

Perhaps tie in different billing departments in a conference call as they bid over who will do the critically urgent surgery as the patient slides in and out of consciousness?

Maybe decide to have a heart attack during a winter sale special or reach into their dresser to get a coupon out as they collapse to the floor?

Or would someone be placed on a transportable life support system as they get ferried across a city deal hunting by having different procedures at different institutions, expecting them to talk to each other and string together piecemeal lab results for a coherent diagnosis?

Maybe someone would do the work beforehand, search all the popular ailments and their procedures and then do price shopping in good health and prepare an execution plan if they fall ill?

Maybe there's a non-absurd example, but I honestly can't think of it. The competition mechanism seems to be a completely unrealistic application.

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

#142
post #140
post #133

This won't help consumers. The prices (both charges and what Medicare pays) are already effectively public: https://data.cms.gov/Medicare-Physician-Supplier/Medicare-Pr... The problem, as some other comments point out, is that they're way too complicated. The link I posted, for example, is just the provider charges. A hospital visit typically has a facility claim and at least one provider claim. Depending on the type…

> It's a total mess and hopelessly complex for the average consumer. Sounds like something the people on this forum can help improve.

It's not a technological problem but a political one: the obfuscatory pricing is deliberate.

Maybe you could have "fighting hospital billing as a service", but that's definitely going to need a chunk of human labour on top of whatever AI assistance you apply.

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

#143

Earlier quoted context omitted.

> It's a total mess and hopelessly complex for the average consumer. But not for insurance companies; it's in their interest to compare hospitals and get the best care for the lowest price. I for one hope this will trigger competition. On the other hand, it'll probably end up shafting the personnel instead of the ridiculous profit margins.

The idea of effective competition in emergency services has always struck me as fanciful. The benefit that competition provides to incentivize lower prices and better services is a consumer's ability to easily deny someone their business and go elsewhere. What would this look like here? Would one be in the back of an ambulance doing price shopping on a tablet as they are fighting some terrible injury? Perhaps tie in…

Ambulance staff are incentivized by pretty nurses and free food/snacks. Ask any paramedic in a city with enough choice of hospitals and they'll tell you.

What is the best answer to the "emergency care competition" that you've found?

And what proportion of medical spending is on emergency vs. not?

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

#144
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…

I'm not so sure average household income would be all that useful when income inequality is high. You would have to slice and dice those numbers a bit more to make them even vaguely representative of reality.

Besides, you have to factor in living costs.

I've looked into living cost a few times when considering working in the Bay Area and I realized that while my income would easily double, my living costs would increase a more than just a factor of two. I would have to accept a lower standard of living than I enjoy now.

I think the only way to really deal with healthcare cost is to look at whether or not we think it is a good idea that there is a huge profit margin. For patient outcomes and for society as a whole.

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

#145
post #142
post #140

Earlier quoted context omitted.

> It's a total mess and hopelessly complex for the average consumer. Sounds like something the people on this forum can help improve.

It's not a technological problem but a political one: the obfuscatory pricing is deliberate. Maybe you could have "fighting hospital billing as a service", but that's definitely going to need a chunk of human labour on top of whatever AI assistance you apply.

Is there any way this could be represented via interactive graph? We were able to tame much complex stuff than deliberate obfuscation by people not aware what tech can do.

I guess there is not enough incentive ($$) to solve this problem.

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

#146

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…

I wouldn't compare a chiropractor to a physical therapist, but $1400 for a sore shoulder? Was this in the ER?

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

#147
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.

Agreed, providers are not as willing to negotiate with you as they are with insurance companies. Probably because they've already negotiated...

Just go all cash with an HSA.

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

#148
post #140
post #133

This won't help consumers. The prices (both charges and what Medicare pays) are already effectively public: https://data.cms.gov/Medicare-Physician-Supplier/Medicare-Pr... The problem, as some other comments point out, is that they're way too complicated. The link I posted, for example, is just the provider charges. A hospital visit typically has a facility claim and at least one provider claim. Depending on the type…

> It's a total mess and hopelessly complex for the average consumer. Sounds like something the people on this forum can help improve.

So, somehow technology can help educate ~300 million people about insurance, procedure costs, payments, and also provide medical education to those 300 million people so that they can wrap their head around the necessary medical lingo?

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

#149

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…

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....

Not just health insurance, but healthcare is crazy too.

Spent a total of 36 hours on the phone with the hospital to figure out how much something would cost because I knew I had to pay out of pocket. And they weren't even right when they finally gave me a number.

Had a doctor remove a cotton ball from my ear in the hallway. Charged me 2.4k for that. Didn't have insurance either.

My wife's friend delivered her own baby in the hallway and they still sent her a bill for delivery.

My wife had her gall bladder removed, supposedly the most common surgery. Surgeon charged 25k, hospital charged 65k, anesthesiologist charged 3k, and a doctor that talked to her for 25 seconds charged 1.5k. Insurance and the hospital argued over the bill for almost a year, during which time the hospital kept sending me payment due notices.

No one in this industry has my sympathy.

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

#150

Earlier quoted context omitted.

The idea of effective competition in emergency services has always struck me as fanciful. The benefit that competition provides to incentivize lower prices and better services is a consumer's ability to easily deny someone their business and go elsewhere. What would this look like here? Would one be in the back of an ambulance doing price shopping on a tablet as they are fighting some terrible injury? Perhaps tie in…

Ambulance staff are incentivized by pretty nurses and free food/snacks. Ask any paramedic in a city with enough choice of hospitals and they'll tell you. What is the best answer to the "emergency care competition" that you've found? And what proportion of medical spending is on emergency vs. not?

Even in non-emergency care, perfect competition requires perfect knowledge (the consumer to know medical knowledge), perfect information (knowing the exact quality of care from all competitors beforehand), rational buyers (having no preexisting biases based on irrational cognition), no barriers to entry or exit (ie, being able to switch hospitals mid stream), no network effect (the previous state...eg who does the lab work, shouldn't have an outsize influence on the subsequent, eg who does the diagnosis... See dollar auction for an extreme example https://en.m.wikipedia.org/wiki/Dollar_auction) and a variety of other fairly unachievable factors which do not apply here.

It's not a good model to structure the allocation in this particular instance, too many conditions are nearly impossible to satisfy. It's not a sensible way to design this market.

Post reply on HN