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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

#251

Post by LatteLazy »

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.

I think you're right. The issue with these services is that they're extremely local. Really, only cities will likely really have much competition. That relies on there being separately owned facilities. And even then there is the issue that 2-3 providers never really compete even if they're not colluding...

I honestly think that free market healthcare is doomed to failure. The information a-symmetry, the size of hospitals compared to populations, localization, the degree of specialization, strategic nature of services, and the social externalities are just too great to ever really have a market. But that's just me on my soap box.

Hopefully transparent pricing will do some good at least. I wonder if requiring insurers to share savings in cash would further encourage people to shop around (eg going to the place 4h away to get a 2k MRI instead of a 4k MRI means you get say half the saving [1k] back from your insurer)...

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

#252

Post by eldavido »

jimmaswell wrote: post #105
eldavido wrote: post #58

Earlier quoted context omitted.

Also a fiscal conservative, I completely agree single-payer would be much better than what we have now. What I think would be best though, is to eliminate medicare/medicaid, hand people cash, and get out of the way. The high-order problem with medicine isn't coverage or insurance. It's price. There are only two ways to get price under control: meaningful competition, or government price controls (e.g. single payer).…

Patients would still decide where to be treated based on those factors, the only difference is the insurance is standardized. Nobody in countries with socialized health insurance seems to complain about lack of choices or any of that, and rich people in those places can still get private insurance to get their nose job done right away from a private practice. For everyone else I get the impression it works just fine.

I'm less convinced. The NHS, Britain's version of this, is constantly underfunded, and has long wait times for a variety of procedures. The Economist writes about this frequently.

https://www.economist.com/britain/2018/06/28/the-three-myths...

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

#254

Post by egillie »

zachmu wrote: post #245

We're running a $10,000 bounty to assemble this information into a queryable database: https://www.dolthub.com/repositories/dolthub/hospital-price-... You get paid based on the percentage of rows you contribute to the dataset. So if you fill in 20% of the rows, you get $2,000. More details here: https://dolthub.awsdev.ld-corp.com/blog/2021-01-14-hopsital-...

This is amazing! Will the data be public after it's assembled?

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

#255

Post by coredog64 »

analog31 wrote: post #223
lotsofpulp wrote: post #195

Earlier quoted context omitted.

Increasing supply of doctors by increasing residency funding, decreasing education costs, and decreasing the sacrifice that needs to be made to become a registered doctor. I have no idea why doctors need to sacrifice their entire 22 to 30 year old lives constantly slaving away, working on call, sometimes 24 hours at a time. Relax some of the draconian, outdated hazing rules. Attract more smart people, make it so youn…

Indeed, bringing down the cost of med school might also have the effect of attracting people with a working class background, who see it as a form of labor, not as a return on an investment. I'm not sure what the impact of tort reform would be. It's possible to look up how much is paid in premiums, but we don't know who owns the malpractice insurance industry, and I've read that it's doctors.

There’s two costs to the US legal environment: Insurance premiums and defensive medicine. It’s in the doctor’s interest to run every test because it’s free to him, but failure to do so raises his risks. So you wind up spending money non-productively and you have a non-zero rate of false positives, unnecessary treatment, etc.

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

#256

Post by DanBC »

mancerayder wrote: post #247
kwhitefoot wrote: post #179

Earlier quoted context omitted.

> (the latter two have long waits for essential surgeries compared to the U.S.) References?

"Wait times for cancer treatment -- where timeliness can be a matter of life and death -- are also far too lengthy. According to January NHS England data, almost 25% of cancer patients didn't start treatment on time despite an urgent referral by their primary care doctor. That's the worst performance since records began in 2009. And keep in mind that "on time" for the NHS is already 62 days after referral. Unsurprisi…

> live at least five years after diagnosis,

Five year survival rates don't give you much information, because the US engages in massive over testing. You need to know all cause mortality, and the US does worse here than the UK.

The US over tests people and over treats cancer; that costs a lot of money and isn't pleasant for people but it doesn't make them live longer.

If hypothetical Beth dies age 82 does it matter if she is told she has cancer at age 75 or age 79?

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

#257

Post by snakeboy »

alisonkisk wrote: post #147
snakeboy wrote: post #90

Earlier quoted context omitted.

That's why I don't let black people into my restaurant. Statistically, they're more likely to commit a crime once inside, so I don't want to take the risk. All the black people in town end up going to the restaurant down the street, who had their register robbed one time by a dark-skinned fellow that I turned away because he sure looked suspicious! I sure hope they've learned their lesson by now. You can bet that as…

It's a poor response. Nationality is tied to legal system. For example, if a product injures me as an USAn, I need to sue to get my bills paid. As a European, I can simply get public healthcare.

If I'm a USAn doing business with a private company in a foreign country, that's not relevant. OP is using population-level trends to influence develop his bias towards individuals.

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

#258

Post by [deleted] »

mancerayder wrote: post #247
kwhitefoot wrote: post #179

Earlier quoted context omitted.

> (the latter two have long waits for essential surgeries compared to the U.S.) References?

"Wait times for cancer treatment -- where timeliness can be a matter of life and death -- are also far too lengthy. According to January NHS England data, almost 25% of cancer patients didn't start treatment on time despite an urgent referral by their primary care doctor. That's the worst performance since records began in 2009. And keep in mind that "on time" for the NHS is already 62 days after referral. Unsurprisi…

[deleted]

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

#259

Post by JohnCohorn »

chaboud wrote: post #186
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…

Chargemaster prices (the non-negotiated price) are ridiculously high in the US. They’re so high that some hospitals will give uninsured patients a break of “half off” without even negotiating. The reason for this is that chargemaster price is a fake dollar price resulting from a broken incentive structure and process. Here’s a setup: A hospital is working out a negotiated rate for aggregate services with an insurance…

I wonder how much truth there is in the theory that insurers are incentivized to let costs go way up and may be complicit in it. Basically the theory I’ve heard is that Obamacare limited by law the percentage margin that insurers can make as their piece of the pie. So then one of the only easy ways left for them to grow their profits in an absolute sense is to increase the amount of money flowing through the system.

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

#260

Post by huitzitziltzin »

dcolkitt wrote: post #178
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…

Before coming to any conclusions on this topic, I highly suggest reading this extremely in-depth analysis on cross-country healthcare spending.[1] The simple answer is that Americans really do consume significantly more healthcare than Europeans. The most straightforward signature of this is the fact that a much higher proportion of Americans work in the healthcare industry than any other large country. The US also t…

> The simple answer is that Americans really do consume significantly more healthcare than Europeans.

I do not believe this is correct.

From the OECD, average length of hospital stay across rich countries:

https://data.oecd.org/healthcare/length-of-hospital-stay.htm

We pay more but we generally consume less. EDIT: let me add this comparison of health prices across countries from the Health Care Cost Institute. See Table 1:

https://healthcostinstitute.org/hcci-research/international-...

Our prices are higher.

The US is an obese country, but you will find if you look that obesity rates are similar or worse in (e.g.) Mexico and some Gulf States (I think the UAE though I don't have a source for you).

We are not a wild outlier in terms of measured unhealthiness. Life expectancies here are lower though, despite vastly higher expenditure than other rich countries.

There are important failures on the supply side of the market:

From the OECD, we have fewer hospital beds per capita than most rich countries:

https://data.oecd.org/healtheqt/hospital-beds.htm

We have fewer doctors per capita than most countries:

https://data.oecd.org/healthres/doctors.htm

Failures of competition throughout the market (including hospital consolidation) keep prices high. We do basically zero evaluation of cost effectiveness.

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