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Show HN: Compare prices that US hospitals charge patients, insurance companies

turquoise.health

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Re: Show HN: Compare prices that US hospitals charge patients, insurance companies

#31

Post by annoyingnoob »

LatteLazy wrote: post #22
dnautics wrote: post #10

Earlier quoted context omitted.

- paying for services for people who don't have/can't afford insurance. - medical malpractice insurance -> legal system - big pharma/med devices industry

Plus - Gold plating everything to avoid getting sued. - Inflated medical school costs - the price of a huge bureaucracy for billing people, chasing them, disputing it, agreeing rates with insurers, renegotiating rates with insurers, applying the right discounts, billing a dozen different state and federal programs for various bits, those being disputed, managing all that etc.

-Disposable everything, priced at a premium

Re: Show HN: Compare prices that US hospitals charge patients, insurance companies

#32

Post by LatteLazy »

spaetzleesser wrote: post #19
LatteLazy wrote: post #15

Earlier quoted context omitted.

>How can there be such a large difference in price for something that, I believe, is legally & medically the same procedure? If no one publishes their prices how do you set yours? 2 dollars? 2000 dollars? 2m dollars?

I am pretty sure the providers and insurers know exactly what everyone is charging. It’s the patients that are being kept in the dark.

Like any opaque market, bigger players will have more info, but I doubt anyone will share information as its collusion (maybe illegal) and also advantages either your negotiating opponent or your competitors...

Re: Show HN: Compare prices that US hospitals charge patients, insurance companies

#33

Post by PragmaticPulp »

terse_malvolio wrote: post #9

Sometimes the cost is bigger than the cost in a different country plus the plane ticket.

The U.S. healthcare system is built around the idea that everyone has health insurance. Obviously, that's not a valid assumption at all, which is one of many reasons why it's such a problem.

Insurance companies each negotiate a rate for various services with hospitals. People pay different rates depending on the insurance they have, due to these different negotiated rates.

This creates a perverse incentive where hospitals want to list their "cash" price as being higher than the negotiated rates, otherwise insurance companies will come back to negotiate their rates down to the obviously lower cash price.

In reality, it's usually surprisingly easy to get hospitals to give significant discounts if you tell them you're without insurance and you'll be paying in cash. Patients without insurance can often negotiate their bills down to a fraction of the original list price by simply calling in and telling the billing office they don't have insurance.

It's obviously not a great system.

Re: Show HN: Compare prices that US hospitals charge patients, insurance companies

#34

Post by azalemeth »

I think something else that would be of interest would be doing this for drug prescriptions: compare the cost that my employer, the NHS, pay for a compound and those that Americans pay for the exact same compound. This is easy on my end at least -- prices and prescription guidance are released in the BNF / British National Formulary annually and are all made available in public. I have never understood the US system of "co-pays" and found the whole thing very confusing.

For a few "popular" random examples that I think HN might have heard of: one branded Epi-Pen is £26.45; Naproxen (the NSAID painkiller) is £4.29 / 56 pack; and omeprazole (PPI used to treat gastric reflux) is £0.84 / 28 pack.

A more expensive example might be the cystic fibrosis "designer drugs" lumacaftor with ivacaftor -- 112 tablets are £8000 (to be prescribed by a specialist, if the patient has the genotype to respond to it -- a total annual cost of about £26k). The US equivalent is $379,780 [1].

(NB: The price you pay as a British patient is usually £0, unless you are a working-aged and working English person -- at which point it is £9.15 per item [independent of its cost] or a fixed "all you can eat" prepayment certificate that works out at about £8.83/month -- which is what I have. Oh, and plus the taxes, of course...).

[1] https://www.jmcp.org/doi/pdf/10.18553/jmcp.2018.24.10.987

Re: Show HN: Compare prices that US hospitals charge patients, insurance companies

#36

Post by wjossey »

nugget wrote: post #5
KingMachiavelli wrote: post #2

It would be nice to be able to see the lowest & highest prices & other stats. I can manually find the lowest price by sorting by price but I can't seem to reverse it to show the highest price first... Anyway, it seems that there are orders of magnitude differences for the same service. The service 'MRI Lumbar Spine With & Without Contrast Material' has a lowest price of $210 while the closest and highest I personally…

In 2015 I did several months of due diligence in this market - price comparison for diagnostic imaging - before concluding that it wasn't feasible to build the product we wanted to build. This new law provides the data that we were unable to access (at scale) on our own. From the data we did get our hands on, I remember seeing price differences like $200 vs $4k for the exact same procedure. The low cost provider was…

For folks who don’t believe in universal medical coverage, this is part of the reason why it’s so inefficient for it not to exist.

The uninsured person going to the hospital at 1AM that requires an MRI because slipped a disc in their back still ends up getting that MRI. When they fail to pay that bill, which would be 5%-10% of their annual earnings, we all still pay for it. We just decided to layer in debt collection, anxiety, and depression onto the patient in lieu of cash.

As someone who still considers themselves a fiscal conservative, and also believes we need true universal coverage for all Americans, this seems like a no brainer to me at this point (and I say that as someone who would have not supported this in the 00s but has evolved significantly on this issue).

Re: Show HN: Compare prices that US hospitals charge patients, insurance companies

#37

Post by excannuck »

spaetzleesser wrote: post #13
dnautics wrote: post #10

Earlier quoted context omitted.

- paying for services for people who don't have/can't afford insurance. - medical malpractice insurance -> legal system - big pharma/med devices industry

You should add - doctors are paid higher in the US than in another countries - billing staff overhead because of the insane insurance system - highly paid hospital administration - lots of middlemen that stay invisible because there is no price transparency - shiny new buildings that are built by friends of the hospital administration

"billing staff overhead because of the insane insurance system"

While true, I would generalize to "insane bureaucratic system" unless you want to include public "insurance" into the mix. Medicaid and Medicare aren't simple!

Re: Show HN: Compare prices that US hospitals charge patients, insurance companies

#38

Post by TameAntelope »

jasonpeacock wrote: post #21
dominotw wrote: post #12

Earlier quoted context omitted.

I guess you could roll the dice and hope the for best but you will lose your ability to sue the hospital for malpractice if they mess up.

You're making a lot of assumptions here that an out-of-country hospital would be of questionable quality and not have medical malpractice laws. Just because other countries medical & legal systems are different than the US doesn't mean they are inferior.

Even the best hospitals make mistakes, malpractice is not just some cudgel used to beat good doctors over their heads, and America has some of the most comprehensive malpractice law in the world.

That said, if I'm wrong about that I'm interested in learning more.

Re: Show HN: Compare prices that US hospitals charge patients, insurance companies

#39

Post by citrus1330 »

forgingahead wrote: post #11

This was a big accomplishment of the Trump admin. Regardless of what your other opinions of his administration are, healthcare pricing transparency in the US is a very important step forward to improving the healthcare situation there. Source (one of many): https://www.reuters.com/article/us-usa-trump-drugs/white-hou...

How is it possible that this was not required before? I am so glad that we had Trump, even if it was just for 4 years.
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