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

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

#311

Post by technics256 »

egillie wrote: post #288
SteveCoast wrote: post #219

A number of people, including me, have been building similar things, see http://price.hospital The problem seems to be figuring out a revenue model, and translating all the medical terms in to human.

Same, I've been mapping out CA average prices at http://hospitalprices-env.eba-r2yhwdcw.us-west-1.elasticbean... Comparing just the price of a hip replacement is difficult, because there are so many other services that will bundled in with a hip replacement (anesthesia etc) that may not be represented in the service price alone. The "average cost by diagnosis code a patient comes in with" transparency requirement is…

Are you scraping this or just visiting each site manually and getting the machine readable data? Cool stuff!!

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

#312

Post by ageitgey »

dubcanada wrote: post #232

How accurate is this? Some of the threads point out extremes between different hospitals, is that because X hospital does more stuff then Y, and Y charges you the same as X it's just a bunch of hidden/extra stuff that isn't billed as "MSDRG 343"? Or is it because the hospital like any business can charge you what ever you want and may charge more or less depending on the neighbourhood, rent, etc?

I think part of it is that there is a huge difference in cost between some facilities. But another part of it is that a lot of hospitals don't really know what they charge. They had to scramble and hire consultants to come up with these numbers to meet the deadline and the numbers will probably get more accurate and vary less over time as hospitals get better used to working with prices out in the public.

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

#313

Post by spaetzleesser »

4ec0755f5522 wrote: post #265

I just read an article about quiet / dream jobs (park ranger etc.) In it, every single person has a side gig(s) or is otherwise making decisions on their careers based on medical coverage. Every one of them! One of the people says most people leave when they turn 26 because they can't stay on their parents' health insurance. What?! > And like other dream jobs I learned about, it’s not enough to survive on: During > o…

Employer based health insurance should be abolished. There should be one risk pool either nation or state wide and within that everybody can get insurance for the same price. It would reduce a lot of administrative effort in companies (why does my employer have to worry about my health insurance but not my car insurance?) and allow people to change jobs without worrying about health care. Religious employers also couldn't control things like birth control because health insurance would be none of their business.

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

#314

Post by ska »

eldavido wrote: post #250
ska wrote: post #155

Earlier quoted context omitted.

aside: Singapore is a weird case and probably not a good comparitor for most healthcare systems. > If people can't pay as much, the only thing for them to do is drop prices. Or not offer the product at all. One problem with this entire area is that "healthcare" is really not one service/product area, and it is probably a mistake to treat it as such. To be transparent, I don't share your optimism about market solution…

The main thing I take on faith is that people are different and one-size fits all solutions don't produce good outcomes. We have different car brands, grocery stores, non-health insurance companies, package delivery companies, retailers, and housing options. Some people want fast and cheap. Others want to drive an hour to save a few bucks. This isn't some technical academic point. Without a range of choices, you actu…

> I don't get this at all.

I think this is why I suggested looking it as two markets. Your examples (estate lawyers, auto repair, dental care) look a bit like a visit to your GP's office. None of it looks much like some of the other things healthcare provides for us (e.g. many major and emergency procedures). And it's not like all of those markets are working particularly well currently (auto /house sales/ opticians/ etc. suck)

I don't think anyone would disagree that one-size-fits-all is the right approach, which is why nobody really tries that. What you are essentially saying is that you think is that you will get more flexibility if you open that market further, and that it will be both a better solution for more people, and not a horribly worse for any significant number of them (which is probably not acceptable here).

I'd agree with the first part, but the second requires faith - that in practice the signalling that you are talking about is clear enough (in both directions) and the response time short enough that you arrive at a better solution and in a reasonable amount of time. This is not at all clear. This isn't about treating doctors as "gods" either, they aren't able to make the systemic decisions well either, individually.

> What actually bothers me most about this whole thing is that nobody is willing to get serious about the tradeoffs their system entails.

This I agree with entirely. Two big ones come to mind - we need to have a conversation about appropriate end-of-life care and costs, and we have to be very transparent that our current level of medical capability means that there is an appreciable risk that (to a first approximation) anyone may end up with a medical condition that (a) we know how to cure or mitigate and (b) that person will never be able to afford. To me paying for these (or choosing not to) is quite different than making sure you can get antibiotics when you get strep throat.

You point out some symptoms of the problem currently, but I'm a bit curious about why you are resistant to pursue know solutions that look more like, say France (or Canada, etc.) , than Singapore. Is it just ideological? I'd rather take some known improvements and then iterate to improve rather than NIH syndrome.

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

#315

Post by egillie »

technics256 wrote: post #311
egillie wrote: post #288

Earlier quoted context omitted.

Same, I've been mapping out CA average prices at http://hospitalprices-env.eba-r2yhwdcw.us-west-1.elasticbean... Comparing just the price of a hip replacement is difficult, because there are so many other services that will bundled in with a hip replacement (anesthesia etc) that may not be represented in the service price alone. The "average cost by diagnosis code a patient comes in with" transparency requirement is…

Are you scraping this or just visiting each site manually and getting the machine readable data? Cool stuff!!

California collected all of their hospitals' data at https://oshpd.ca.gov/data-and-reports/cost-transparency/hosp...

The average prices for common procedures is on the 1045 sheet

I have my gripes with California but I love that they did this

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

#316

Post by marcinzm »

jgeada wrote: post #264
marcinzm wrote: post #67

Earlier quoted context omitted.

Probably some of it but I suspect the lack of limitations on services rendered plays into it as well. If someone in the US wants to see specialists 50 times in a month due to munchausens then they'll just be charged their co-pay each time (in most insurance plans). In Germany I suspect they'd not be allowed to book appointments anymore or would require a gatekeeping referral. Same with expensive drugs that don't help…

> In Germany I suspect they'd not be allowed to book appointments anymore or would require a gatekeeping referral. This is the kind of comment that immediately classifies the commenter as never having lived outside the US and/or not reading anything but US news sources. And with the wilful blindness to how exactly those gatekeeping referrals are present in most every single healthcare plan in the US.

>And with the wilful blindness to how exactly those gatekeeping referrals are present in most every single healthcare plan in the US.

This is only required by HMO plans which cover around 40% of the US population. PPO plans don't have such a requirement.

So please don't call other people willfully blind when you yourself make broad factually incorrect statements. Pot please meet kettle.

edit: Also my statements about Germany are based on comments Germans have made on hacker news regarding their own health plans. So you should really go yell at those Germans for not knowing how their own health system works.

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

#317

Post by marcinzm »

moooo99 wrote: post #103
marcinzm wrote: post #67

Earlier quoted context omitted.

Probably some of it but I suspect the lack of limitations on services rendered plays into it as well. If someone in the US wants to see specialists 50 times in a month due to munchausens then they'll just be charged their co-pay each time (in most insurance plans). In Germany I suspect they'd not be allowed to book appointments anymore or would require a gatekeeping referral. Same with expensive drugs that don't help…

Thats not right. You can easily get an appointment in Germany, even multiple times. If you have a referral, you usually get an appointment earlier than people who directly went to the specialist. However, if you have acute pain you will quickly get an appointment on the same or the next day. Source: Me. just made the second appointment with a specialist within a week thanks to pain, appointment is tomorrow

In the US on self-referral plans (60% of health plans) you can get an appointment without any acute symptoms and with no delay versus a referral. I'd say that's a fairly large difference in ease of access without probably any impact on patient outcomes.

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

#318

Post by ilaksh »

mrnickel001 wrote: post #119
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.

My searches so far show insane differences between insurance rates and cash rates. The cash can be 5-10x higher than what the insurance company pays.

It seems like a clear case of systemic fraud to me. Am I missing something?

Also I am not able to find any fundoplication or LINX (43284).

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

#319

Post by 11thEarlOfMar »

analog31 wrote: post #304
11thEarlOfMar wrote: post #191

Earlier quoted context omitted.

For example, an appendectomy (MSDRG 343) in my area will cost $56,000. With my insurance plan, that will max out my $8,000 deductible, + another $8,000 co-insurance to hit my out of pocket maximum of $16,000. That's what I'd pay, $16,000. Or, I can go to Tennessee and get the appendectomy (MSDRG 343) for $4,700 and pay that directly. Many people will make that choice Kaiser gets less business putting downward pressur…

How many appendectomies are elective? I was immobilized by pain and possibly close to death when I had mine. The economic impact depends on actually realizing the cost savings, which could be compounded by a variety of factors.

True, appendectomy was not a good choice. Perhaps hip replacement would have been better.

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

#320

Post by stjohnswarts »

spaetzleesser wrote: post #313
4ec0755f5522 wrote: post #265

I just read an article about quiet / dream jobs (park ranger etc.) In it, every single person has a side gig(s) or is otherwise making decisions on their careers based on medical coverage. Every one of them! One of the people says most people leave when they turn 26 because they can't stay on their parents' health insurance. What?! > And like other dream jobs I learned about, it’s not enough to survive on: During > o…

Employer based health insurance should be abolished. There should be one risk pool either nation or state wide and within that everybody can get insurance for the same price. It would reduce a lot of administrative effort in companies (why does my employer have to worry about my health insurance but not my car insurance?) and allow people to change jobs without worrying about health care. Religious employers also cou…

I like this idea, especially nation wide. I think the US should set one up along side private policies though as a stepping stone so people can see/envy it. You will never ever get rid of private insurance in one fell swoop it will take steps.
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