Hospital prices are about to go public in the U.S. • Hacker News Board

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

#181

Post by nicoburns » Thu, Dec 27, 2018, 1:04 PM UTC

QuantumGood wrote: post #129

arethuza wrote: post #122

Earlier quoted context omitted.

"With insurance, was hospitalized for a heart condition. ~$45,000" Please tell me you didn't have to pay the ~$45,000 personally?

We had to pay our ~$8,000 deductible, everything above that was covered. We paid by negotiating a one lump sum payment and got 25% off. Had a relative with more cash flow make the payment all at once then paid them in installments. Was told by a doctor later that they only get paid 75% of what they bill by the insurance company, and that considering that, the 25% discount made sense. Tried for a 30% discount but 25%…

> We were able to pursue some things we probably wouldn't have otherwise. Simple things like having more cough syrup on hand became a no-brainer as cost of visit and prescription was guaranteed to be $0

This is one of the big upsides of always free at the point of access healthcare like we have in the UK. Although there is some inefficiency, in practice I beleive it actually lowers the total cost of healthcare as people seek treatment/diagnosis earlier and avoid getting as sick in the first place.

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

#182

Post by justaguyhere » Thu, Dec 27, 2018, 1:04 PM UTC

bookofjoe wrote: post #172

Pro tip: I was a neurosurgical anesthesiologist at the University of Virginia Health Sciences Center for twelve years (1983-1995). Every now and then I'd get a call from our billing office that they'd received a letter from a patient I'd cared for who was too poor to pay what our department had billed (usually many thousands of dollars: I had NO IDEA what our charges were, BTW, nor did any of my colleagues in the dep…

by my initialing a form we had, their balance due us was 0

That is very nice of you. I hope others like you in positions of power do the same!

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

#183

Post by zentiggr » Thu, Dec 27, 2018, 1:14 PM UTC

kristopolous wrote: post #150

tertius wrote: post #143

Earlier quoted context omitted.

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 la…

Good goals, but we know the current market structure is light years away from perfect.

Definitely a situation where any partial progress toward clarity and openness is a big step in the right direction. The potential for cascading changes in business practices and further reveals of all the private deals and hidden costs makes it an even better value in the future.

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

#184

Post by bookofjoe » Thu, Dec 27, 2018, 1:14 PM UTC

justaguyhere wrote: post #182

bookofjoe wrote: post #172

Pro tip: I was a neurosurgical anesthesiologist at the University of Virginia Health Sciences Center for twelve years (1983-1995). Every now and then I'd get a call from our billing office that they'd received a letter from a patient I'd cared for who was too poor to pay what our department had billed (usually many thousands of dollars: I had NO IDEA what our charges were, BTW, nor did any of my colleagues in the dep…

by my initialing a form we had, their balance due us was 0 That is very nice of you. I hope others like you in positions of power do the same!

As I recall, every fellow attending did exactly what I did whenever they received a letter like that. It happened so infrequently, and our department billed so many tens of millions of dollars/year, it wasn't even a ripple in the pond.

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

#185

Post by sturgill » Thu, Dec 27, 2018, 1:20 PM UTC

codingdave wrote: post #176

I'd be happier to see regulated business practices. While I agree that the prices are a problem, I've felt more pain from bills that keep coming in for more than a year after a major event. And when I go to complain, they say that someone made a mistake, the insurance took a long time to respond, or some other excuse. Give me a final bill with all charges within 30 days, then 30 more days to resolve any issues with t…

I currently use hospital billing as an example when explaining the halting problem. You’re never sure if you’ve paid off an incident or if another bill will show up in a few months...

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

#186

Post by justaguyhere » Thu, Dec 27, 2018, 1:20 PM UTC

bookofjoe wrote: post #184

justaguyhere wrote: post #182

Earlier quoted context omitted.

by my initialing a form we had, their balance due us was 0 That is very nice of you. I hope others like you in positions of power do the same!

As I recall, every fellow attending did exactly what I did whenever they received a letter like that. It happened so infrequently, and our department billed so many tens of millions of dollars/year, it wasn't even a ripple in the pond.

it wasn't even a ripple in the pond.

True, but it did make a difference to those people you helped! so yeah, kudos to you.

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

#187

Post by 10122018 » Thu, Dec 27, 2018, 1:22 PM UTC

bookofjoe wrote: post #172

Pro tip: I was a neurosurgical anesthesiologist at the University of Virginia Health Sciences Center for twelve years (1983-1995). Every now and then I'd get a call from our billing office that they'd received a letter from a patient I'd cared for who was too poor to pay what our department had billed (usually many thousands of dollars: I had NO IDEA what our charges were, BTW, nor did any of my colleagues in the dep…

Thank you for doing that. As somebody who has recently received a discount from their dentist on an emergency procedure, I can't begin to tell you how much we as patients appreciate these acts of consideration and kindness. Even if we can't fix the larger, systemic problems in healthcare right now, these individual acts of kindness can really make a big difference in somebody's life.

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

#188

Post by bbddg » Thu, Dec 27, 2018, 1:24 PM UTC

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.

People on Medicare are over 65 and people in the VA have been in the military. Both of those groups of people are going to have much higher medical needs than the general population.

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

#189

Post by assblaster » Thu, Dec 27, 2018, 1:30 PM UTC

___alt wrote: post #102

I'm so glad I live in a country with single-payer healthcare.

I'm so glad I live in the United States, arguably the greatest country in the history of the world.

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

#190

Post by sturgill » Thu, Dec 27, 2018, 1:31 PM UTC

mwerd wrote: 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…

I shared this experience before on HN, but I once cut my leg quite severely playing ice hockey. Ended up at the ER dripping blood everywhere. I went to the desk and asked if they took my insurance. Said I was only interested in treatment if my insurance would cover it. I was assured it was fine.

Naturally the doctor assigned to me did not take my insurance...

I got out of the out-of-network billing after hours of phone calls and lots of unkind words. But man was it just a terrible experience. And with insurance coming from work, it’s not like I could change providers. And with one hospital close to my house I didn’t have lots of options in an emergency. Nor would I expect any other hospital to treat me differently.

My dad is a nurse and I grew up wandering hospitals. He complained as far back as the 80s that insurance was killing medicine. I didn’t understand it as a kid, but I see more what he was getting at as an adult.