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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.

#251

Post by MrMorden »

phkahler wrote: post #218

One thing I advocate is fixed pricing. It's great to put prices online, but as long as insurance companies and such get to make deals there will be no real transparency or competition. The one downside I see to enforcing the prices is that it would ruin this ability to offer a break to people who need it. On the other hand, with enforce posted prices those prices would come down to levels similar to what insurance co…

That's the way it works in Maryland; medical providers are only allowed to have one rate card.

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

#252

Post by PenguinCoder »

alehul wrote: post #200
sturgill wrote: post #190

Earlier quoted context omitted.

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 pho…

Just out of curiosity: have you tried calling your insurance to ask them where you should go? I haven't either, and have generally gone by your route of asking the hospital whether it will be insured, but I'd imagine calling insurance (if a feasible option?) would provide a lower rate of error.

The patient shouldn't have to call the insurance provider to see where it is accepted. This is adding to the problem. Do you have insurance, yes or no? Should be a good he only question not add-ons like, what provider, etc. It's stupid as hell that certain doctors are in network at a hospital while others are out of network, at the same damn facility. Ask me how I know this. American Healthcare insurance and billing is beyond messed up and needs to be fixed.

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

#253

Post by ethbro »

pavel_lishin wrote: post #246
ethbro wrote: post #243

Earlier quoted context omitted.

It's a good goal, but this is a very complex system. For example, if published prices were brought down to slightly-above-insurance rates, fewer people would buy insurance. Consequently, insurers would have less bargaining power, further erroding their price advantage (and financial solvency). As an end result, absent regulatory mandate, non-high deductible plans would cease to be market viable. Providers, insurers,…

> For example, if published prices were brought down to slightly-above-insurance rates, fewer people would buy insurance. Would they? I don't buy insurance so my doctor visits are only $20 - I buy insurance so that if something catastrophic happens to me, I'm not on the hook for hundreds of thousands of dollars. Even if the cost of (e.g., brain surgery, emergency appendectomy, resetting shattered bones) was the same…

I would hazard to say that both of us aren't in the demographic where $20 matters.

But for a lot of people, $20 vs $250 is the difference between going to a doctor and not.

Separate from that there's the catastrophic vs no coverage argument. If you're struggling to make rent at the end of the month, it's probably a smarter personal bet not to buy insurance.

But patients without at least catastrophic are corrosive to our medical system, and what the ACA mandate was targeting.

Personally, I think the ACA mandate for a catastrophic policy, with preventative care included, and direct cash subsidies to people at the poverty line (to cover routine care) is the best solution.

I'd expect the ACA designers considered this, and only broadened the mandate requirements as a horse trade to insurers for assuming the risk of offering marketplace plans.

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

#254

Post by dmoy »

pavel_lishin wrote: post #246
ethbro wrote: post #243

Earlier quoted context omitted.

It's a good goal, but this is a very complex system. For example, if published prices were brought down to slightly-above-insurance rates, fewer people would buy insurance. Consequently, insurers would have less bargaining power, further erroding their price advantage (and financial solvency). As an end result, absent regulatory mandate, non-high deductible plans would cease to be market viable. Providers, insurers,…

> For example, if published prices were brought down to slightly-above-insurance rates, fewer people would buy insurance. Would they? I don't buy insurance so my doctor visits are only $20 - I buy insurance so that if something catastrophic happens to me, I'm not on the hook for hundreds of thousands of dollars. Even if the cost of (e.g., brain surgery, emergency appendectomy, resetting shattered bones) was the same…

Yea this is exactly why I only ever get high deductible insurance.

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

#255

Post by beagle3 »

lostlogin wrote: post #91
beagle3 wrote: post #81

Earlier quoted context omitted.

What’s the logic in that? Am I going to get a quad bypass just because it is cheaper? People seek care because they need it. The kind of care that people use more because it is cheaper/available is maintenance care (which reduces overall costs because things are often treated before they become critical). The first time I heard “I am feeling sick / cut my hand / need stitches but I cannot afford to go to the doctor”…

I think I didn’t make my point clearly. The post I replied to was suggesting that Americans seek care more than others and that’s why costs are higher. I didn’t think that likely, and argue that direct exposure to the cost would lead to people seeking care less often.

That's not true in my experience - it seemed like Americans seek less care, because it was expensive; but when they do, they seem to want to medicate everything away and go back to work ASAP (even if it's something that heals on its own, and even if it means taking painkillers for a while and risking complications), whereas in other places, it is acceptable to let many things run their course, and mild discomfort is considered acceptable.

E.g., in the netherlands (and IIRC also in Germany), it is considered rude to come to work when you are sick - you expose everyone else to risk, for a work day that's likely less-than-effective (because, you are sick) -- whereas in the US, you're expected to just pop an advil and show up (and .. if you are visibly suffering, you'd be considered a hero).

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

#256

Post by pcarolan »

ethbro wrote: post #244
pcarolan wrote: post #238

Earlier quoted context omitted.

My experience is that hospitals have switched to a zero tolerance policy around this in the last few years. They'd rather make no concessions and sell bad debt for pennies on the dollar than set a precedent that there are alternative channels of payment. The one lifeline they give you is an interest free loan. From an economic standpoint, I'm sure this optimizes revenue. From a humanitarian standpoint, it's disturbin…

Caveat: All hospitals not managed identically. I'm sure there's a lot of varying billing policy, hospital to hospital. And varying ability to financially write off care. As a gut guess, I'd expect rural hospitals to be the worst about this and suburban the best.

I'm sure this is true. We've (unfortunately) now experienced this at 4 different hospital systems. The customer service is alarmingly similar.

Hospital: "Call your insurance company and ask for a break" Insurance Company: "Call the hospital and ask for a break"

Also, 2/4 of these hospitals had outsourced their billing which means they can't even make decisions on behalf of the hospital (and have a disincentive to write anything off). Seems like a structural way of avoiding writedowns.

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

#257

Post by blitmap »

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…

After we establish transparent pricing across the board, we're going to have to deal with the reality that some folks seek care without having any ability to pay for services.

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

#258

Post by beagle3 »

namdnay wrote: post #121
beagle3 wrote: post #81

Earlier quoted context omitted.

What’s the logic in that? Am I going to get a quad bypass just because it is cheaper? People seek care because they need it. The kind of care that people use more because it is cheaper/available is maintenance care (which reduces overall costs because things are often treated before they become critical). The first time I heard “I am feeling sick / cut my hand / need stitches but I cannot afford to go to the doctor”…

I think there's a balance to be found. Here in France people will go to the doctor for a common cold, and immediately load up on unnecessary medicine at the pharmacy. I'm sure that if they were asked to pay even 5E out of their pocket it would significantly reduce the shortage of GPs and the lower costs.

Israel tried this a decade or so ago - something like 10EUR/Qtr if you've used any services, and additionally 1EUR/visit -- both of which would be waived if you were in really bad financial shape.

IIRC, it made zero measurable difference on the number of visits, but the bureaucracy involved with charging this was costing more than than the money collected, so it was eventually scrapped.

(I might be mistaken, an Israeli versed in how the system works / worked is welcome to correct me)

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

#260

Post by SlowRobotAhead »

It’s funny how long it took me to figure out the rule, is being pushed through by Trump’s HHS appointee.

Some of the only info I could find on him by name is how much of “a distaster” he would be published around the time he was appointed.

I’m getting real sick of what constitutes professional journalism. I don’t like Trump, but when accomplishments are effectively hidden, and all speculation is unabashedly negative - there is a problem.

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