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I analyzed hospital price lists so you didn't have to

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Re: I analyzed hospital price lists so you didn't have to

#341

Post by fukepik »

duffpkg wrote: post #65

Wrote Hacking Healthcare for O'Reilly, created ClearHealth/HealthCloud open source EMR, managed health systems for 15+ years, blah, blah, blah. It is very good there is are the transparency regulations. It is worth briefly explaining some of the reasons why many facitilities are having a hard time complying. There are some bad actors, absolutely true. However "Hanlons Razor" -- never attribute to malice that which is…

If ever there was a need for an antitrust litigation and investigation such as United States vs. Microsoft (see below), then "Epic Systems" (see below) would seem like a corporation that needs to be investigated, penalized and broken into tiny pieces to prevent its predatory practises.

https://en.wikipedia.org/wiki/United_States_v._Microsoft_Cor.... https://en.wikipedia.org/wiki/Epic_Systems

Re: I analyzed hospital price lists so you didn't have to

#342

Post by nosianu »

Joeri wrote: post #276
nosianu wrote: post #255

Earlier quoted context omitted.

> the purchaser does not know the price of something at the point of purchase. This is only solvable for the cases where what needs to be done is completely known and certain in advance. Which for very complex human biological systems would not be the majority of cases, unless providers decide to only deal with health issues that fit that criteria and send everybody else to someone else. I think the problem of not be…

When you take your car in for repair, you also can’t know for sure what the cost will be, because cars are complex systems and every car is unique in its own way. But if the garage overcharges you then you will figure this out and you will not go there again. In the US healthcare system because of the lack of price transparency it seems to be impossible to know which hospital or doctor overcharges, and so a free mark…

I'm not sure cars as an example work for health care. Each model has orders of magnitude less complexity, it's not living tissue, and variability within a model is very small. And it's all logically engineered instead of the mess that is biological systems (I have a small bit of background in life sciences - only studies, not work). But that's only an aside that I don't want to concentrate on.

> a free market cannot arise

A free market is not the best model I think, because even if you had perfect price transparency, people don't have nearly enough knowledge to evaluate the suggestions of doctors. Sure, they will select one the like more, but base don superficial information, not based on actual medical knowledge. For some truly "free market" you really want easily comparable and quite equal things to shop for. Medicine is too individual. Yes I know the desired model is you go in with your list of symptoms, get a few tests based on it, then an algorithm, right now in an MDs head, selects the appropriate treatment - time for the next patient in the overcrowded waiting area. It seems to me, and I had personal experiences with this model's limitations too, that there is a lot of dissatisfaction with this model not least with burned out medical professionals. But it sure is something the business-minds like, you can optimize processes and manage the heck out of such a system beautifully.

I - German (but I lived in the US for a decade and also had a bit of regular contact with various health providers, such as Stanford hospital or a Berkeley orthodontist for minor - and predictable, as you say - stuff like straightening teeth and hypo-sensitization) - am certainly not against a free-market component. I grew up in the GDR and we had a small bit of it even there! As a child my parents and grand parents actually did shop around for some specialists for some very reasonable amount of money, for my eyes for example (it worked out great, I stopped needing glasses as a late teenager, I ran around with one side of the glasses covered for a few years very early in childhood, for example, to strengthen one eye).

I think a little bit of that helps to reward those who care a bit more about their health and go about looking for solutions to problems more diligently and intelligently than others who just go with the flow. But I think this works best in small doses, not with the entire system set up this way.

Re: I analyzed hospital price lists so you didn't have to

#343

Post by nosianu »

lelanthran wrote: post #266
nosianu wrote: post #255

Earlier quoted context omitted.

> the purchaser does not know the price of something at the point of purchase. This is only solvable for the cases where what needs to be done is completely known and certain in advance. Which for very complex human biological systems would not be the majority of cases, unless providers decide to only deal with health issues that fit that criteria and send everybody else to someone else. I think the problem of not be…

The majority of healthcare is for routine and known in advance procedures, not for emergency or exploratory procedures. Sure, the GP might want to order tests, but the cost of the test will be known in advance, the cost of the consultation was already known by the patient. The patient can tdecide which radiologist they want, using price as a criteria if they want to. The existing method is basically "you can only kno…

> The majority of healthcare is for routine and known in advance procedures

Yes what kind of procedure is needed often is known in advance. The details often only emerge after it's been started though. Just because it's routine does not at all mean it's all predictably-in-advance the same throughout, except for really basic stuff, which in turn is unlikely to be the big cost driver.

Re: I analyzed hospital price lists so you didn't have to

#344

Post by mushbino »

symlinkk wrote: post #296
mushbino wrote: post #195

Earlier quoted context omitted.

Longer story, but the timing of the emergency and recovery period fell within an ineligibility window for COBRA. My previous insurance company wouldn't have covered it anyway. It was the worst Blue Shield plan that I didn't even know could be legal. Also, I got the first few bills, was like okay, I'll just pay these off and move on and not even bother. These were the only bills I could find in their patient portal at…

What ineligibility window are you talking about?

You have 60 days to file (in writing by mail, in my case) once you leave your previous job, I didn't have enough time between jobs to really need it, emergency happens + a few weeks of recovery time where I'm incapable of basically doing anything, I get a few bills, I pay them, start working at my new job, get more and much larger bills, now I'm ineligible for Cobra. Not that it would have mattered with that insurer anyway in my case.

Re: I analyzed hospital price lists so you didn't have to

#345

Post by buscoquadnary »

duffpkg wrote: post #65

Wrote Hacking Healthcare for O'Reilly, created ClearHealth/HealthCloud open source EMR, managed health systems for 15+ years, blah, blah, blah. It is very good there is are the transparency regulations. It is worth briefly explaining some of the reasons why many facitilities are having a hard time complying. There are some bad actors, absolutely true. However "Hanlons Razor" -- never attribute to malice that which is…

For those unaware of the travesty that is MUMPS please consult the following article.

https://thedailywtf.com/articles/A_Case_of_the_MUMPS

Re: I analyzed hospital price lists so you didn't have to

#346

Post by InitialLastName »

refurb wrote: post #228
JumpCrisscross wrote: post #51

Earlier quoted context omitted.

> the solution to most social ills in America is to simply not be poor American healthcare works well if you have money and better than anywhere else in the world if you have money and a chronic condition. If you get in an accident, however, particularly while away from your posh neighbourhood, you’re getting the same overworked, hyper-indebted surgeon as the homeless man. (If you’re a billionaire or head of state, t…

Disagree. A friend who had dual citizenship moved from Canada to the US because Medicaid covered her kids rare disease drug but Canada didn’t. Medicaid is actually very good coverage.

> Medicaid is actually very good coverage.

As the saying goes, "it's the best insurance money can't buy".

Re: I analyzed hospital price lists so you didn't have to

#347

Post by PaulDavisThe1st »

nosianu wrote: post #342
Joeri wrote: post #276

Earlier quoted context omitted.

When you take your car in for repair, you also can’t know for sure what the cost will be, because cars are complex systems and every car is unique in its own way. But if the garage overcharges you then you will figure this out and you will not go there again. In the US healthcare system because of the lack of price transparency it seems to be impossible to know which hospital or doctor overcharges, and so a free mark…

I'm not sure cars as an example work for health care. Each model has orders of magnitude less complexity, it's not living tissue, and variability within a model is very small. And it's all logically engineered instead of the mess that is biological systems (I have a small bit of background in life sciences - only studies, not work). But that's only an aside that I don't want to concentrate on. > a free market cannot…

> I think a little bit of that helps to reward those who care a bit more about their health and go about looking for solutions to problems more diligently and intelligently than others who just go with the flow

But caring about pricing is entirely different than caring about the right solutions

Re: I analyzed hospital price lists so you didn't have to

#348

Post by beeboop »

hunterb123 wrote: post #178
beeboop wrote: post #150

Earlier quoted context omitted.

Pretty sure he's just writing commentary on the US not having a single payer healthcare system

I posed my question to warrant a discussion from either the commentary or faithful statement regardless of their intent. Mainly to understand the expectations, values, and reasoning.

I don't think the concept is lost on any half intelligent adult that running a hospital has expenses and has to be paid by someone. The commentary is accurate that's is messed up to have a "price", like something is being sold. Having hospitals run off funding by taxpayers isn't a price any more than the military buying an F35 having a per-American price (and no one thinks of it that way)

Re: I analyzed hospital price lists so you didn't have to

#349

Post by patwolf »

sp332 wrote: post #91
stevage wrote: post #82

>Require a standard format. Pick JSON or CSV in some standard encoding. We don't need hospitals publishing XML files and Excel spreadsheets. Definitely CSV. Always CSV. It's easy to produce, easy to parse, and kind of human readable. And easy to do some basic analysis with tools that everyone has access to - Excel, Google Sheets etc.

I didn't like CSV because too much actual data has commas in it, so commas aren't a good delimiter.

From the perspective of reading/writing CSVs programmatically, I actually prefer that it's a common character. You'll discover very quickly whether the parser handles escapes correctly. With a more exotic delimiter it might be a long time to discover the problem, and by then it will be harder to fix.

From the perspective of writing CSVs by hand in a text editor, commas suck.

Re: I analyzed hospital price lists so you didn't have to

#350

Post by lelanthran »

nosianu wrote: post #343
lelanthran wrote: post #266

Earlier quoted context omitted.

The majority of healthcare is for routine and known in advance procedures, not for emergency or exploratory procedures. Sure, the GP might want to order tests, but the cost of the test will be known in advance, the cost of the consultation was already known by the patient. The patient can tdecide which radiologist they want, using price as a criteria if they want to. The existing method is basically "you can only kno…

> The majority of healthcare is for routine and known in advance procedures Yes what kind of procedure is needed often is known in advance. The details often only emerge after it's been started though. Just because it's routine does not at all mean it's all predictably-in-advance the same throughout, except for really basic stuff, which in turn is unlikely to be the big cost driver.

> Yes what kind of procedure is needed often is known in advance. The details often only emerge after it's been started though. Just because it's routine does not at all mean it's all predictably-in-advance the same throughout, except for really basic stuff, which in turn is unlikely to be the big cost driver.

I dunno that I'd call a broken leg "really basic stuff".

This is what I responded to and what I quoted in my original post:

> "Here is the cash price. We won't know your HDHP insurance price until after we bill them, which could be good for you or could be bad."

So, yeah, the supplier currently knows in advance what it costs to fix a broken leg. There is no reason for the price of more mundane medical care to be opaque at all.

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