Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Health insurers just published close to a trillion hospital prices

dolthub.com

Post reply on HN
Print view View original

91–100 of 549 posts

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

#91

Post by e_i_pi_2 »

celestialcheese wrote: post #81
e_i_pi_2 wrote: post #74

Earlier quoted context omitted.

My understanding (not an expert by any means) is that we basically have two tiers of negotiation - the fed. govt. has way more leverage but also some amount of corruption that goes into pricing, then afterwards individual hospitals and "networks" of providers will negotiate with the insurer - sometimes after the procedure has already happened - to figure out the final price. The end result is that you might end up wi…

> To make it worse we also have laws preventing healthcare providers from providing prices upfront, out of a fear that people will forego necessary care they can't afford. What are these laws? This seems so backwards - I know personally I have put off medical care in my past because I had high deductible insurance, and no guarantee that the bill I'd get wouldn't wipe me out, and no way to price shop. Paralysis of unk…

Ah thanks for making me look this up! Seems like it did change recently (Jan 1, 2021)

https://www.cms.gov/hospital-price-transparency

Now assuming the hospital is compliant the information should be available. To be fair my understanding of the argument for the old law was that you didn't want a hospital with a big sign out front saying "Broken arm repair: $10k" and having people not go in for it when there might be some financial aid they could get afterwards

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

#92

Post by bawana »

sl-dolt wrote: post #32

I'm the author. A question I have is: how did so many prices ever get negotiated in the first place? What kind of systems are in place to do this kind of micro-negotiation?

Today in Massachusetts, physicians cannot get paid unless they belong to an organization that negotiates their rates with the insurers. These negotiating entities are like unions but not really. If the insurer and the organization disagree, the insurer simply goes to a different organization to make a contract. Prices were not publicly available so each negotiation resulted in a different fee schedule. On top of that, insurers invent different 'products' with different amounts of 'coverage' for different premiums. Each of these 'products' had their own negotiation, their contracts, and their own subset of physicians who chose to participate. So what do these organizations do for the cut that they take? They reduce the burden of the insurers so they dont have to negotiate with each individual provider.

Hospitals are an entirely different system. They have much more negotiating power and if an insurer has a customer that goes to a hospital emergency room outside of their contract, the insurer has to pay outlandish rates. So it is in the insurer's interest to make a deal. They achieve this by inventing different 'products' with different amounts of 'coverage' for different premiums. Each of these 'products' had their own negotiation and their contracts.

Price transparency is the first good thing that has been mandated. However, this misses the mark. The focus is the patient, not the insurer, the hospital or the physician. Accordingly, patients should be allowed to submit their explanation of benefits and their bills-this is the data that reflects the true cost of healthcare. All of the numbers provided by hospitals, insurers and physicians has been massaged and buried in a forest of minutiae.

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

#93

Post by hayst4ck »

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?

PBS put out a documentary ages ago comparing America to other countries. At the time our administrative overhead was 25% while Taiwan's overhead was 2%.

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

#94

Post by simonw »

coredog64 wrote: post #84
e_i_pi_2 wrote: post #80

My current assumption is that private healthcare/insurance is to blame, because countries without that or with less generally have better outcomes at less cost. Looking for evidence to the contrary

As two quick examples, both Switzerland and France have private healthcare providers and insurers. I think that’s enough to falsify your assumption :)

Those countries both have "less generally" than the USA.

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

#95

Post by teeray »

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"

Just be glad the lawyers didn’t make the prices exclusively available via the traditional UHaul full of Banker’s Boxes.

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

#96

Post by jjulius »

daniel-cussen wrote: post #73
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.

Quoted post unavailable.

... what in the blue hell...?

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

#97

Post by jahewson »

paulmd wrote: post #76
ChrisLomont wrote: post #41

Earlier quoted context omitted.

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,…

> The US pays about twice per nurse or doctor in the system, and part of that is because the US pays nearly twice for most skilled work. which is in turn because in the US an average GP comes out of medical school with $200k-300k of student debt that has to have interest serviced and paid off within some 10-20 year timespan. That cost ultimately ends up being borne by the patient and their insurance. unfortunately th…

A debt of 1 to 1.5 years salary does not go very far to explain why US doctors are paid double what they would be in other countries.

The US brought this problem upon itself by cutting medical school funding in the 1980s to reduce the number of doctors and keep salaries high. That situation remained until 2005. Now we have too few doctors, too few schools, and a generation that grabbed all the money for themselves and is now retiring.

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

#98

Post by e_i_pi_2 »

coredog64 wrote: post #84
e_i_pi_2 wrote: post #80

My current assumption is that private healthcare/insurance is to blame, because countries without that or with less generally have better outcomes at less cost. Looking for evidence to the contrary

As two quick examples, both Switzerland and France have private healthcare providers and insurers. I think that’s enough to falsify your assumption :)

I don't think that disproves a general trend that increased socialization in healthcare costs leads to better outcomes and less per-capita spending.

Also FWIW France and Switzerland both have universal healthcare, under different systems where France splits payments 3 ways and covers more with the govt[1], and Switzerland seems to have a system like the ACA in the US where it's compulsory, but they also set caps on the deductibles and maximum price.

[1]: https://en.wikipedia.org/wiki/Health_care_in_France

[2]: https://en.wikipedia.org/wiki/Healthcare_in_Switzerland

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

#99

Post by duffpkg »

linkdink wrote: post #77
duffpkg wrote: post #70

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…

In your opinion, what would be the lowest hanging fruit that could be changed to have the largest positive impact?

People are rarely satisfied with this answer but its demonstrably true and was proven time and time again at the facilities ClearHealth managed.

1) Feverent, almost religious, adherence to hand washing. 2) No neck ties or dangly sleves whatsoever in buildings that house patients. 3) Change from stainless steel hardware for doors and travel touch surfaces back to "brass/copper".

Those are simple, virtually free, things that have a very meaningful impact on outcomes. Some of the most viscous fights I've had with hospital boards were over what amounted to the "uglier look" of copper/brass.

It is an extremely unpopular topic in healthcare but the area that takes a lot of effort to solve but also has a tremendously out-weighted benefit is reducing preventable medical errors. My opinion after being in healthcare ~20 years is that preventable medical error is absolutely in the top 3 causes of death in the US. The easiest subset of it to resolve is prescription related errors, we have all the tools to resolve those but not the will.

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

#100

Post by watwut »

carabiner wrote: post #55
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"

lol, have you ever worked with data from a non-tech company? This is probably the best they have, even inside the company.

Can confirm. Also, it is not better in tech companies, they just have the same data in higher variety of formats and storage systems.
Post reply on HN