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Health insurers just published close to a trillion hospital prices

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Re: Health insurers just published close to a trillion hospital prices

#61

Post by Judgmentality »

ChrisLomont wrote: post #41
suoduandao2 wrote: post #26

Earlier quoted context omitted.

Judging by the US's price/outcome ratio compared to other developed nations, a little over half[1]. [1] https://www.pgpf.org/blog/2022/07/how-does-the-us-healthcare...

Why that article points out the US spends $12k/capita on healthcare the singles out administrative costs at $1k/capita while ignoring all the other relevant factors is beyond me. They then use the misleading infant mortality stat, ignoring that the US considers vastly more babies viable than any other country, meaning we try to save infants that other countries write off, thus they count against the US when it fails,…

> So, to get prices like most other developed nations, we would be forced to cut nurse and doctor salaries, which would likely lower quality of workers as future workers went to more lucrative fields, which would likely lower outcomes.

Why are you ignoring all of the costs that go to people besides nurses and doctors? I know very rich people whose entire careers are built around selling overpriced products to hospitals. These people are leeches that provide no value other than profiting off of dumb compliance laws. If you can buy the same product at any store for 1/10 the price, there is no benefit to requiring it be gatekept by people whose sole incentive is squeezing blood from a stone.

Get rid of graft. The problem is the system and the incentives it creates. US healthcare is dictated primarily by insurance companies who care more about maximizing profit than providing healthcare.

To fix the system you start with increased transparency, then you focus on accountability. Why do we allow such blatant corruption? Let's get rid of all the leeches first, since they provide no actual value while jacking up prices. There are so many areas we can improve results and cut costs before we address the salaries of doctors and nurses.

Re: Health insurers just published close to a trillion hospital prices

#62

Post by imoverclocked »

acchow wrote: post #45
thechao wrote: post #36

Earlier quoted context omitted.

Any time you can convert a problem from an `N x K` problem to an `N + K` problem, there's some asshole administrator trying to turn an `N + K` problem into an `N x K` problem. It wouldn't surprise me if there's huge amounts of redundant information in there.

> In the newly-released data, each "negotiated rate" (or simply "price") is associated with a lot of metadata, but it boils down to: who's paying, who's getting paid, what they're getting paid for, plus some extra fluff to keep track of versioning. The hundreds of billions of prices in the dataset (probably over a trillion) result from all the possible combinations of these things. They basically denormalized all the…

> You could give me the source code and let me run this function

If I understand correctly, in this case, that function's source is highly distributed in wetware. It's about as closed-source as it gets; nobody has anywhere near the full source. Each hospital is its own fiefdom!

Re: Health insurers just published close to a trillion hospital prices

#63

Post by mskar »

riskable wrote: post #49
mskar wrote: post #43

I work in data at https://www.carrumhealth.com/ , and I've been parsing this data for weeks. The transparency prices allow us to meaningfully negotiate with providers, and make tangible, incremental progress toward cheaper health care. Providers and existing insurance carriers leverage information asymmetry to control the market otherwise. For context, we bundle the 100's of itemized costs into a single, static bill…

How much do you think it costs to maintain all these negotiated contracts VS just having a single payer system with the same price for all procedures?

It's very expensive, carriers have an economic incentive to simplify it and this is still where they end up. There are a long tail of provider circumstances that the single-payer model will need to figure out. Some examples:

* Small hospitals in low-density, underserved areas have to make up for underutilized equipment and personnel costs. They raise prices on unrelated, common procedures to break even (This is very common)

* CMS (medicare/medicaid) sets a low price for a procedure that's overly common in a particular facility, now that facility loses money for each occurrence. They choose other procedures to raise the price to try to break even.

* Larger hospitals have higher administrative and operations costs (for things like training and research) that benefit society, but need to be averaged out across all procedure costs. This differs from hospital to hospital.

* Smaller professional facilities or physicians groups (like Ambulatory Surgery Centers) have much lower administrative costs and a smaller staff, so they have lower overhead per procedure. They are designed to be efficient, and can handle lower prices. However if there are any major complications, they won't be able to service the patient, and have to send to a hospital. This then pushes all the highest-cost, ICU-type procedures into hospitals, where there is already a higher overhead, causing hospitals to need separate pricing to cover more complex patients.

A large single payer price set will probably force efficiencies into the healthcare system. It'll be great for folk's costs, but we may see many facilities close, and lines of care will be consolidated into specialty centers. (more travel to get imaging, procedures, or to see a specialist)

Re: Health insurers just published close to a trillion hospital prices

#64

Post by acchow »

imoverclocked wrote: post #62
acchow wrote: post #45

Earlier quoted context omitted.

> In the newly-released data, each "negotiated rate" (or simply "price") is associated with a lot of metadata, but it boils down to: who's paying, who's getting paid, what they're getting paid for, plus some extra fluff to keep track of versioning. The hundreds of billions of prices in the dataset (probably over a trillion) result from all the possible combinations of these things. They basically denormalized all the…

> You could give me the source code and let me run this function If I understand correctly, in this case, that function's source is highly distributed in wetware. It's about as closed-source as it gets; nobody has anywhere near the full source. Each hospital is its own fiefdom!

Yeah this is part of the problem.

But even if you had like 10M rows of pricing and then gave a 2% discount to entity A, 3% discount to entity B, 4% discount to C, etc.

You could publish these discount rules.

Or you could just multiply the 10M rows by the number of different entities giving 10*n M rows.

And then let the consumer of the data try to figure out the rules from the output...?

Re: Health insurers just published close to a trillion hospital prices

#65

Post by kaesar14 »

ChrisLomont wrote: post #41
suoduandao2 wrote: post #26

Earlier quoted context omitted.

Judging by the US's price/outcome ratio compared to other developed nations, a little over half[1]. [1] https://www.pgpf.org/blog/2022/07/how-does-the-us-healthcare...

Why that article points out the US spends $12k/capita on healthcare the singles out administrative costs at $1k/capita while ignoring all the other relevant factors is beyond me. They then use the misleading infant mortality stat, ignoring that the US considers vastly more babies viable than any other country, meaning we try to save infants that other countries write off, thus they count against the US when it fails,…

Which part of this equation is contributing to hospitals charging 50 dollars for a bag of IV fluid? I'd cut that part out. Whatever it is.

Re: Health insurers just published close to a trillion hospital prices

#66

Post by Victerius »

A4ET8a8uTh0 wrote: post #50
axus wrote: post #7

Earlier quoted context omitted.

The article mentioned CSV files, it seems more like a reflection of what a huge bureaucracy the US healthcare system is. I liked their suggestion that the government should have created the database as part of the law, done the processing on the raw data, and made it more accessible.

In their defense, if it was anything but CSV files, they would be accused of making it too complicated/locking into proprietary formats and so on. I can't say CSV would be my first choice, but I don't really want to think what the alternative would be.

Millions of .xlsx files

Re: Health insurers just published close to a trillion hospital prices

#67

Post by inetknght »

Titan2189 wrote: post #44

Someone with the right connections should call up Google Cloud and ask them to ingest the data into BigQuery as an example dataset like the NY taxi trips. It would be a great way for them to show off the capabilities of the engine and helpful for everyone wanting to do analysis on it. https://cloud.google.com/bigquery/public-data

No post body was provided.

Re: Health insurers just published close to a trillion hospital prices

#69

Post by [deleted] »

axus wrote: post #7
RhodesianHunter wrote: post #6

Anyone else get the feeling this is malicious compliance on behalf of the insurance companies? "Oh, they're going to force us to publish our prices are they? Well we'll publish so much data it'll take a herculean effort to make it readable to anyone that doesn't work in data engineering"

The article mentioned CSV files, it seems more like a reflection of what a huge bureaucracy the US healthcare system is. I liked their suggestion that the government should have created the database as part of the law, done the processing on the raw data, and made it more accessible.

[deleted]

Re: Health insurers just published close to a trillion hospital prices

#70

Post by duffpkg »

I'm author of Hacking Healthcare for O'Reilly, 20 year health system executive, blah, blah.

It's very easy for people to forget the scale of the US "health system", we are talking 1/5, maybe more, of the entire US economy. If US healthcare spending were a country, it would have the third largest GDP in the world. Accidents of history and the massive federal beauracracy created the crazy monster of ICD/CPT codes that results in the very clumsy way of pricing healthcare services that results in this massive matrix of data.

As pointed out elsewhere there is a tremendous amount of cost distribution that goes into the code matrix and this plays a large role in negotiations with health insurers as well. Ground is given in one set of procedures and lost in others.

This is a big step in shining light into areas that need it to improve the system overall.

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