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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

#111

Post by azalemeth »

11thEarlOfMar wrote: post #85

Even I am surprised: Appendectomy: MSDRG 343: at Kaiser in Santa Clara: $56,000 Appendectomy: MSDRG 343: at Holston Valley Medical Center, TN: $4,700 Our healthcare system is even more broken than I ever imagined.

For a contrast [1] from the other side of the pond, you could get by on about $3k USD (most British people have no idea about this! [2]):

> RESULTS

> Fifty laparoscopic appendicectomies were performed. Median operative time was 60 min. The median total operative cost of laparoscopic appendicectomy was £906. Median equipment cost for laparoscopically completed cases was £254. Median total in-patient cost was £1617 (range, £880–£3360). This compared with a mean re-imbursement of £1981 representing a [hospital] cost benefit of £233 per case (P = 0.0009).

> CONCLUSIONS

> Despite a liberal use of disposable equipment, laparoscopic appendicectomy can still be performed within the confines of the national tariffs. There is a considerable variation in the cost of this procedure, and it may be possible to reduce costs by more stringent use of disposable equipment and standardising recovery protocols.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2966171/ [2] https://www.theguardian.com/society/ng-interactive/2016/feb/...

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

#112

Post by electriclove »

eldavido wrote: post #84
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 realized over the past few years that there is no "natural" price for anything. It's 100% set by competition. Economic research confirms this. Mergers result in higher prices due to less competition. What we need is way, way, WAY more competition in healthcare. 10x as many providers, 10x as many clinics, with prices posted on the wall. When they start losing business, they'll notice.

There will never be 10x as many providers due to the AMA and lobbying. Existing interests don't want to see lower prices and competition.

If this was possible, I'd agree with you. But the reality is that the best we can hope for is single payer.

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

#114

Post by mindslight »

dheera wrote: post #79
dr_faustus wrote: post #44

It's always fascinating to see that even compared to prices you pay as a self-paying patient in Germany (which are already 1.5x - 2x higher than what the "public" insurances, ie. 85% of the population, pay for the same procedures), the prices in the US are about 5x to 10x higher. The standard of care seems to be quite comparable if you look at outcomes, so there must be huge inefficiences in the American system (doct…

Everything is inflated the whole way in the American system. Universities overcharge in the US. The medical education costs upwards of $800K if you include the cost of lost opportunity had you gone into a different field and worked those years instead. So doctors need higher salaries. That, combined with idiotic market dynamics around medical supplies, means that all medical costs are higher. That in turn means every…

You can't waste money on the scale of the US system by simply paying doctors too much. Rather, you need to hire entire departments of nonproductive people - eg billing and administration. When you zoom in, most of these positions look like a necessary function, but systematically they don't need to exist. Take for instance a "nurse navigator", whose entire job is to deal with insurance company rigmaroles - as a patient you're extremely thankful to have them, but their position is actually only necessary due to a corresponding insurance company department (that you're also paying for!) trying to deny you care.

The ultimate problem is this planned economy mandate of "full employment". It is in no individual's interest to declare that their own job is counterproductive, otherwise they'll starve. So they hang on performing in their own little niche, sucking resources out of the system so they personally can continue living a dignified life. We're stuck in a paperclip maximizer, and the healthcare industry is one of the best small-scale illustrations of this.

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

#115

Post by dante_dev »

persedes wrote: post #77
dante_dev wrote: post #66

Earlier quoted context omitted.

Just throwing some data, average general practice doctor is 150k$ in US vs 61k$ in germany. https://www.payscale.com/research/DE/Job=Physician_%2F_Docto... https://www.payscale.com/research/US/Job=Physician_%2F_Docto...

I believe that doctors in the US get paid more than in germany, but 60k seems very very low. Teachers have an income in that range.... Edit: Looking at some german articles, maybe they did not convert from eur to usd, ~80,000-100,000$ (depending on expertise etc) seems more likely for a dr working at a hospital (which is still low imho compared to US salaries...). https://www.arzt-wirtschaft.de/wie-hoch-ist-das-gehal…

I think the difference in wages narrows down with specializations. I linked just the "general practitioner" because I couldn't find an average including all the specializations.

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

#116

Post by aaronblohowiak »

bhupy wrote: post #94
btbuildem wrote: post #54

Earlier quoted context omitted.

I imagine it's on account of all the administration and intermediaries.

It's not. There's a good breakdown that compares what drives healthcare spending between the US vs Germany (and others). https://www.healthsystemtracker.org/brief/what-drives-health... The vast majority of the difference comes from just the raw cost of inpatient and outpatient care. Even if you were to completely zero out the administrative costs per capita, you'd hardly make a dent in bridging the gap.

>raw cost of inpatient and outpatient care

I am interested to understand what makes the "raw" costs so wildly different.

When my son had an infection in germany, we went to the equivalent of pediatric urgent care and after seeing the nurse, having bloodwork done and a few different 15 minute sessions with the physician we came to the end of the visit with the doctor, they apologized that we had to be charged the full uninsured rate and that a bill would be given to us later that we could use to have our insurance (they could not bill our insurance internationally.) We paid the 50 euros and asked what the total amount would be, assuming that was the co-pay. There was a lot of confusion because the 50 euro wasn't the copay -- it was the full-freight amount. Getting a single 15 minutes with a doctor, let alone the prep with the nurses and bloodwork being rushed would be far more than that in USA.

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

#117

Post by echelon »

How do we disrupt the fucking debacle that is US healthcare?

Would it be possible to create a subscription-based health network that was vertically integrated and provided just basic outpatient needs? Charge $9/mo or something ridiculously low and encourage everyone to check their health often and maintain healthy lifestyles?

Use automation to reduce costs. Then gradually increase the scope of care.

That won't help with surgery, cancer, childbirth, etc. right away, but it might create a gravitational shift that puts swaths of expensive general practitioners out of business, creating excess supply and lowering the range of what insurance covers. That might greatly reduce costs.

We have to eat away at this bloated, inaccessible system somehow.

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

#118

Post by mrnickel001 »

11thEarlOfMar wrote: post #85

Even I am surprised: Appendectomy: MSDRG 343: at Kaiser in Santa Clara: $56,000 Appendectomy: MSDRG 343: at Holston Valley Medical Center, TN: $4,700 Our healthcare system is even more broken than I ever imagined.

Yeah that's a generally interesting one because Kaiser's pricing is inflated assuming that all their patient's also have Kaiser insurance. But appendectomies do range quite a bit.

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

#119

Post by mrnickel001 »

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…

Thanks for the feedback! We'll be improving our filter/sort here in the coming days and we'll take this feedback into our plan.

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

#120

Post by ageitgey »

smueller1234 wrote: post #74

Suggestion: I hope I didn't completely miss something, but the site seems to put average prices for procedures all over the place when the median price would actually be much more informative to somebody searching for a provider. Looking at a few procedures, the prices seem to have significant outliers, which exacerbates this.

Thanks, we're working on figuring out the best way to represent those and maybe making them more location-specific. Even with median prices, it doesn't always make sense to show a country-wide median since there is a huge difference in price ranges between markets. A super high price in Nashville might be a super low price in Los Angeles, for example.
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