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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.

#281

Post by setr »

cm2187 wrote: post #162
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…

I'd be curious to know how much of that is caused by malpractice insurance. I mean if hospitals were overcharging so much, then surely we should see lines of rolls royce in the hospital parking lot. Doctors are well paid in the US but they are typically not rich.

As I said, I don’t think they’re actually charging that much — negotiation with insurance is expected, with like 80% reductiond to initial price. They’re still paid very well ofc, but I think complaining about the high initial bills itself is a red herring, because no one involved expects that amount to actually materialize

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

#282

Post by Amezarak »

setr wrote: post #98
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.

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…

HDHPs are becoming extremely common. A $500 deductible would be amazing. Deductibles in the thousands of dollars are more common - mine is on the higher end, $6600, while still costing more than 20k a year.

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

#283

Post by conanbatt »

beagle3 wrote: post #81
lostlogin wrote: post #58

Earlier quoted context omitted.

What’s the logic in that? If the cost is socialised surely you’d expect more people to seek care than if they were paying?

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”…

Utilization increases with decrease in cost.

In argentina I remember calling a doctor home to check up on a cold. This would be unreasonably expensive in the US for very little healthservice in exchange.

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

#284

Post by miketery »

Holybeds wrote: post #210
karmelapple wrote: post #195

I was in a hospital in Singapore recently, and the prices for doctor consultation fees, staying in a room, and even certain tests were listed right at the front of the emergency room desk. After the patient I was with was stabilized, the nurse confirmed with us verbally what the rough cost should be for the rest of what the doctor prescribed, and asked if we wished to proceed. We could have said no and gone elsewhere…

Where I live you know the cost before you go to the doctor since you will only pay a symbolic sum of 30 USD even if the visit ends up with something like a life long cancer treatment. If you need medicine you will pay at most 120 USD per year regardless of the costs. The idea that your access to healthcare should be linked to your own or your parents financial is crazy.

I agree in principal to an extent - however economics need to be tied to the end product somewhat. Otherwise many people would opt for $100k healthcare cost (at the expense of the public) to extend their life for a few more months, this is not reasonable. Resources are finite - therefore we need appropriate allocation.

In the end I agree that a basic safety net is necessary and serves a greater good - providing things like normal checkups, preventative services, and acute trauma care is reasonable. However $200k for a second heart surgery for someone who hasn't taken heed of earlier exercise or diet advice by a practitioner should not be supported.

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

#285

Post by tobib »

coredog64 wrote: post #249
thefringthing wrote: post #227

Earlier quoted context omitted.

Would you prefer the Singaporean norm (clearly posted prices) to the Canadian/European one (free at the point of use)?

There is no single "European" model.

Neither is it "free", at least not in Germany. It gets charged to your insurer.

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

#286

Post by seanmcdirmid »

tachudda wrote: post #240
epmaybe wrote: post #211

Earlier quoted context omitted.

Something I worry about, and that maybe you can help shed some light on, is what the ramifications of such a move would be. You mentioned the grading of schools leading to higher quality. Do we know if any metric suffered as a result? One guess I have is that teachers started teaching for the test rather than for the foundation. Take that same question and apply it back to the issue of hospital cost. If there's more…

I suspect that with teachers teaching to a test, it improves bad teachers and holds good teachers back a little.

Either way, the result is that the students learn to take the test well and might not learn much if anything else.

...and Florida still is a bad place to get a public education.

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

#287

Post by madengr »

cmiles74 wrote: post #214
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…

This was my experience when my partner received treatment and the insurance company refused to cover the anesthesia charges (they claimed anesthesia was optional for the procedure and thus wasn't covered). The anesthesiologist's office was surprised that it wasn't covered and waived the charges. It was the only bright spot in a prolonged battle with the insurance company and the hospital.

Optional anesthesia may be a new trend. Restraints and a bite belt are cheaper, but the hospital would figure out a way to milk that too.

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

#288

Post by raven105x »

thefringthing wrote: post #227
karmelapple wrote: post #195

I was in a hospital in Singapore recently, and the prices for doctor consultation fees, staying in a room, and even certain tests were listed right at the front of the emergency room desk. After the patient I was with was stabilized, the nurse confirmed with us verbally what the rough cost should be for the rest of what the doctor prescribed, and asked if we wished to proceed. We could have said no and gone elsewhere…

Would you prefer the Singaporean norm (clearly posted prices) to the Canadian/European one (free at the point of use)?

Personally, yes. Like many posters here I am an Engineer not in the medical field, so take my opinion with a grain (read: mound) of salt.

Most "free" healthcare systems have either (1) horrible quality of service or (2) impossibly long waits unless your life is in danger or close to it. The latter is a systemic issue I've noticed in that healthcare, regardless of pricing or structure, does not aim to foster optimal health, but merely to prevent mortality - so if you go with a 'minor' issue such as recurring headaches or chronic fatigue, it will be dismissed entirely.

I don't have the right answer here and am all for people having affordable options from 'free, wait 3 months' to '20K, full service now', but once again, personally speaking, I'm not rich enough for 'free' things. I'd rather pay and know exactly what (and in this case, much more importantly, when) I'm getting. And from what I've noticed, my personal beliefs that people should strive for optimal health rather than mere preservation of life, is a popular opinion deemed 'unrealistic' by experts.

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

#289

Post by conanbatt »

huac wrote: post #63
refurb wrote: post #9

My guess is that eventually the govt will step in and start regulating prices if providers don’t. One interesting idea (not well thought out at all) would say that all prices need to be +\- 50% of what Medicare pays. Medicare pays $20,000 for stent placement? Great! You can charge whatever you want up to $30,000. A lot of effort goes into setting Medicare rates (and they are based on self reported costs across the co…

> 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…

So if you eliminated medicare and put all those patients into private insurance, they would all lower prices?

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

#290

Post by stickfigure »

mikestew wrote: post #233
stickfigure wrote: post #23

The next logical step is to require written estimates in advance, just like the auto repair industry.

The reason you can get a written estimate is because there’s a big book the service writer flips to, “hmm, front swing arm bushings on a ‘12 Corolla: 2 hours. Front end alignment: 0.75 hours...” Worst case is, I get the acetylene torch out for those rusted-to-hell front end bolts, but it’ll take me about what the book says, usually less. Well, worst case is a bunch more front end parts are shot, waste of money to do…

Doctoring really isn't all that different in principle. The actuaries have these books and already do estimate these costs. And the overwhelming vast number of procedures are consistently predictable.

There's a couple ways of managing unforeseen issues, the simplest of which is to pad the total with a comfortable risk margin. Or allow extra billing for emergencies, but publish rates on how often they "miss" their estimates like restaurant health codes.

Right now they're not even trying.

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