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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

#101

Earlier quoted context omitted.

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 t…

> France and Switzerland both have universal healthcare

You said private healthcare/insurance were to blame. Switzerland has private health insurance.

Universal healthcare is a separate goal post. For what it’s worth, I’m unclear its comprehensive iteration is compatible with America’s immigration model. (It absolutely is for life-saving measures.)

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

#102
This is the real solution to healthcare costs and quality. Instead of the government handing hospitals a blank check for low quality services in a single payer scenario, we allow price transparency, competition and the free market to drive down costs and increase quality. Hate him if you want, but this was a huge accomplishment by Trump that has just started to take effect.

If you think the government can bring down the cost of anything please see education and NASA for great examples.

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

#103
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…

Do you consider the amount that the US spends per capita on healthcare relative to other countries for the same standard of care a "failure" of the healthcare industry? Or is there some other reason healthcare "just costs more" here? Also wondering what you think a solution is - single-payer for better and simpler price negotiations, or some other approach? My main concern is if we're spending 20% of GDP on something…

As with everything it touches, it's the intrinsic failure of capitalism (ofc success for the capitalists / bourgeoisie). It's the amount of capitalism that defines prices. In every other country the more healthcare is a public matter, the cheaper it is for the people.

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

#105

Earlier quoted context omitted.

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 t…

It's not just Switzerland and France; the Netherlands also has a private-only health insurance system. It's also very difficult to draw decisive conclusions since, across countries, there are hundreds of confounding variables — it's not just public vs private, but it's also which regulations exist in each country, whether it's employer-sponsored vs individual, general willingness to pay, etc. You're correct that Switzerland has a system like the ACA in the US, but the biggest difference is that it's not common for the Swiss to get their private insurance from their employers; it's all on the individual market. The US is actually unique in that regard, and is probably the most significant difference — the vast majority of working age adults in the US get their insurance from their employers, and as a result the ACA's individual market has been in a dire state since the program's inception.

Also "socialization" is very different from "nationalization". The general trend you're talking about is more to do with the fact that having society subsidize healthcare for the poor can lead to better outcomes. As it relates to who actually does the insuring, underwriting, and payment (public vs private), one isn't necessarily better than the other; each has its trade-offs. It's just that the US (in particular) has chosen the worst of both worlds.

I work in this industry, and from where I sit, the closest thing we have to a clean A/B test that controls for all of those confounding variables is actually being run in the US right now, with Medicare. When you turn 65, you have the option to enroll either in "Original Medicare", which is what we usually think of when we talk about "single payer healthcare in America", or you can enroll in Medicare Advantage (aka Medicare "Part C"), where the premiums that would go to the CMS instead go to private insurers like Humana, United, Oscar Health, Aetna, Clover, etc. These plans replace Original Medicare.

- 48% of Medicare beneficiaries are on private Medicare Advantage plans instead of the public "Original Medicare". Because everyone is entitled to "Original Medicare", this is purely voluntary. This number has been growing so rapidly that the CBO projects that by 2023, the majority of beneficiaries with choose the private over the public option. The CBO further projects this proportion to increase to 61%(!!) by 2032. (https://www.kff.org/medicare/issue-brief/medicare-advantage-...)

- For most beneficiaries, Medicare Advantage costs about 40% less than Original Medicare and are, on average, of higher quality than Original Medicare (https://healthpayerintelligence.com/news/medicare-advantage-...)

- In Urban areas, Medicare Advantage costs less per capita to administer than Medicare — and that's not including the extra Medicare Part D insurance that you would have to buy if you're on the Original Medicare plan (https://www.commonwealthfund.org/publications/issue-briefs/2...)

So no, you cannot look the cost difference between the US and other countries and simply conclude that it's because of private insurance, because the actual data tells a different story. And "universal healthcare" is not the same as "public" healthcare. It might help to think about it this way: universal access to food can be achieved without nationalizing the food industry, or the food payment industry.

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

#106

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"

There are a lot of billing codes. It’s not as simple as you hope. A giant csv export is easy enough to process and synthesize for normies.

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

#107
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…

Is the data unique or has it been duplicated for multiple formats? In other words is there a CSV file right alongside a Json file and an XML file that contains the exact same data, just in different formats? Is the data partitioned at all (e.g. by state) so that you can just download the data for California without downloading all the data; loading it into a huge database table; and then querying it (e.g. SELECT * fr…

There is some duplication, where different networks under the same carrier could benefit from normalization, but in-general duplication isn't the primary issue.

The data is partitioned for some carriers at the network level, but unless that carrier has networks that are unique to a given state it's difficult to partition by location.

The majority of the data is lumped into very large, single JSON (not newline delimited), so an initial parsing step is required to break out substructures for parallel processing via warehousing technologies. I think Aetna has a 300Gb compressed (single) json file.

After breaking the json to a single array entry per provider/network, parsing is still a bit tricky because there are some very "hot" keys. Some provider array entries may only have 1000 code and cost entries, others may have 100k. We've seen array entries >50Mb for a single provider/network/carrier.

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

#108

Earlier quoted context omitted.

> 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…

I'm sure the real reason is that the hospital up the road will set up a sign "Broken arm repair: $9k" to compete and that isn't something the lobbyists want.

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

#109
post #27

Seems like every week there's a new massive scale DB project or company getting announced on HN. If they're looking for projects that create public value and demonstrate the power of their products at scale, digitizing this and making it searchable may be a good marketing project that's appealing to certain kinds of customers.

It would appear us SQLite zealots have encountered the final boss. Petabytes uncompressed would be tricky if you need to slice those columns. SQLite caps out at ~281 terabytes of storage before it can't track any additional pages. None of this is to say you couldn't partition the data across a lot of SQLite instances in varying ways. I will probably take a shot at it this weekend. Looking to see just how unlimited my…

>It would appear us SQLite zealots have encountered the final boss.

Just wait. It's actually a multi-boss fight, since you have to wrangle the Pharmacy Benefits Management datasets, plus Medispan, plus Medicare, plus all the MedicAid datasets, plus VA.

Are you and all your mightiest boxen bad enough dudes to make sense of the entire U.S. Healthcare industry?

You are not prepared!

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

#110
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…

Sounds like an application for ML, to determine which codes frequently coincide per-patient at each provider and then assign those groupings to cross-provider "Treatment XYZ" buckets to enable apples-to-apples comparisons.

Great call, many orgs in health tech use billing/procedure code embeddings to group, just like you're suggesting.
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