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The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

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Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#51

Post by refurb »

causi wrote: post #2

Somehow everybody in this system claims they're not the ones making bank on this swindling. The doctors say they're underpaid. The hospital admin says they're underpaid. The insurance companies say they're barely covering their payouts. So who is lying?

Well UCSF charged my brother in law $20,000 for an MRI a private standalone MRI clinic charges $3,000 for.

Insurance paid UCSF $16,000 after discount.

So I’d say the hospitals definitely are a part of the problem.

You can imagine what he did with a fund raising letter he got from UCSF asking for a donation so they could continue to help the community…

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#52

Post by pydry »

causi wrote: post #2

Somehow everybody in this system claims they're not the ones making bank on this swindling. The doctors say they're underpaid. The hospital admin says they're underpaid. The insurance companies say they're barely covering their payouts. So who is lying?

Probably a lot of actors. You know that the hospitals who claimed that their prices were trade secrets when being forced to reveal them were telling porkies.

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#53

Post by jonplackett »

Why is the discussion in America always private VS nationalised healthcare instead of just making private healthcare value for money / less insane.

Here in the UK we have the NHS which is great. But we ALSO have private insurance / hospitals / healthcare that is reasonably priced.

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#54

Post by namdnay »

tasubotadas wrote: post #25
HPsquared wrote: post #13

Earlier quoted context omitted.

The stitches are expensive mostly because of many regulatory factors that restrict the supply of medical services and drive costs up, with the "free market" component being in how much they can charge the patients. It's the worst of both worlds in the US.

Exactly. What the US lacks is actually more liberal market in health. Less regulations and more competition. When talking about regulations people usually mean regulating pricing and/or service quality but what actually needs to be tackled are the factors that limit competition, like: - process for opening new clinics/hospitals should have little to none restrictions - requirements for doctors (no doctors from outsid…

None of the other countries being discussed have any of that, and yet their systems work fine. So I don’t think the solution is there

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#55

Post by refurb »

nine_zeros wrote: post #21
causi wrote: post #2

Somehow everybody in this system claims they're not the ones making bank on this swindling. The doctors say they're underpaid. The hospital admin says they're underpaid. The insurance companies say they're barely covering their payouts. So who is lying?

The American insurance system has inherent efficiency problems. Hospitals are for profit corporations. Doctors are reviewed on how much revenue they generate per patient - usually by asking for more diagnosis and treatments - which is what patients want too. Too much admin, too little doctors. Someone should get the admin to doctor ratios at hospitals, it is nuts. A lot of admin is there to handle the insane document…

Most hospitals in the US are non-profit entities.

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#56

Post by jiggawatts »

smcleod wrote: post #27

I'm in my mid 30s and have left fixing up some damaged teeth and my large wisdom teeth impacted for 17 years too long, this Monday I'm going to get them removed under general anaesthetic at a private hospital. The Australian government covers hardly any dental unless your teeth have completely rotted through and are chasing other issues. So far my costs are: - $4500 in fillings and general dental. - $1800 for a crown…

It's not all roses and butterflies down under.

My missus needed highly specialised but relatively quick and low-risk surgery. Maybe 3 surgeons in the whole country do this particular procedure. Think 30 minutes in the OR, a couple of hours to wake up from the anaesthesia, and then you go home.

$4,000.

And then the anaesthetist sent a separate bill.

What does Medicare + Private Hospital cover out of this? A grand total of $130.

It turns out that this particular procedure has no specific "code", so it's lumped in with a routine day surgery billing code. Which is something like $270, with $130 covered by Medicare.

Now, if you ask me, $270 is too low, $4K is a tad high, and 100% of both should be covered by Medicare.

I looked into it, and it turned out that the Medicare refunds are based on "fixed prices" determined by the government decades ago, and haven't changed since then. Private insurance "goes by the government pricing" because it lets them get away with paying you pennies on the dollar.

Realistically, you're not getting any kind of surgery with general anaesthesia for under $1K. Don't worry though, the government and your insurance company will give you maybe a bit over 10% of that back! They have you "covered".

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#57

Post by gitfan86 »

addicted wrote: post #34
causi wrote: post #2

Somehow everybody in this system claims they're not the ones making bank on this swindling. The doctors say they're underpaid. The hospital admin says they're underpaid. The insurance companies say they're barely covering their payouts. So who is lying?

No one is lying. The system is filled with massive inefficiencies. 1) Insurance companies don’t pay sticker prices. They pay negotiated rates. At the same time, hospitals have to pick up a lot of ER costs that are never covered. They might be making money but reasonable amounts at best (also that’s probably not true either considering how many hospitals are shutting down in the US). 2) The negotiated rates insurance…

Another big inefficiency is the margin of error allowed due to malpractice lawsuits. If a patient is at a 1 in a 10,000 risk for a problem, the Doctor will order a test to rule that problem out. Because if the Doctor doesn't order the test and the person ends up having the problem, the Doctor could be sued for malpractice. In other countries the Doctor would say this is very unlikely so I'm not going to run the test.

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#58

Post by helloguillecl »

refurb wrote: post #46
helloguillecl wrote: post #8

This is absurd. Even in a country with liberal economics and "free choice" health system (however with universal care, and state regulation), the same stitches in a world-class private clinic in Santiago, Chile would cost 400 USD, before insurance . The clinics there are not the ones Americans imagine from a middle-income country, most of them have better infrastructure and doctors than the ones I know in Europe. And…

The plastic surgery and vision correction industries work pretty well in the US. You see price competition and patients have the ability to shop around and make choices that are important to them (references from other patients, doctor personality, etc). Now contrast that with going to a hospital for a procedure where you have time to shop around. Can you get a price? No. Can you easily get appointments with doctors…

The United States leads the way in treatments and medical tech, but this gives me the impression that the US society is not benefiting as it could from that.

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#59

Post by chiph »

helloguillecl wrote: post #20
HPsquared wrote: post #13

Earlier quoted context omitted.

The stitches are expensive mostly because of many regulatory factors that restrict the supply of medical services and drive costs up, with the "free market" component being in how much they can charge the patients. It's the worst of both worlds in the US.

I can tell you that you cannot freely open a clinic in Chile, and Doctors have the monopoly on many treatments that are delivered by nurses or other workers in Europe. Becoming a Doctor is not easy, and foreign Doctors must go through difficult tests before working for the public system. Additionally, I remember that many supplies come from... the United States? So what regulations are you talking about? Maybe you me…

There's three areas that I'm aware of. Certificates of Need, which some states require before you can offer certain services (like MRI/CT scanning). Supply contracts, where a hospital has a pre-set price for consumables like IV solutions, scalpels, and bandages with a supplier. And advertising.

The Certificate reduces competition because they impose geographical exclusivity. If you want to buy a MRI machine for your clinic, you cannot if the state determines if your area already has enough of them. And if you file a Certificate with the state intending to buy one, your nearby competitors are likely to place objections to your purchase. This is because the machines are expensive and the other clinics want to ensure their investment gets paid for. But this process also ensures they're expensive because the machines aren't able to be built in volumes large enough to result in a cost reduction.

The supply contracts make things easier for the hospital, as they only have to deal with one supplier for an item or class of item. The price is known up front for the duration of the contract. But this also means that the hospital cannot change suppliers if another one has a lower price for the same item midway through the contract period, reducing competition. They also restrict choice by the doctors at the hospital - doctors have strong preferences for items like gloves because of sizing & fit, and the way they transmit feeling through them (thinness, texture, etc). If a hospital changes suppliers to one that doesn't carry their favorite glove, they aren't able to perform as well. And they can't bring their own into the operating room because of liability.

I don't know how many advertisements you see in Chile for medicine, but here in the US I would guess that a quarter of advertisements on TV are for them. All those ads cost a lot of money, and they're not being targeted at doctors, but patients: "Ask your doctor if {brand} is right for you"

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#60

Post by dathinab »

throwaway09223 wrote: post #16
causi wrote: post #2

Somehow everybody in this system claims they're not the ones making bank on this swindling. The doctors say they're underpaid. The hospital admin says they're underpaid. The insurance companies say they're barely covering their payouts. So who is lying?

My understanding is that the ER system is especially expensive because paying customers are subsidizing non-paying customers (homeless) who use the ER as primary care. That said, I don't think this excludes the possibility that the insurance companies and the hospitals are also not telling the full truth.

The EU also have non paying non insured ER patients, it still isn't that expensive. So this seems strange.

Except if the US is literally falling apart and had ab endless amount of non paying people?

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