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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

#271

Post by amaranth »

tyingq wrote: post #131
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?

What was negotiated was probably more blanket style discounts like "10% off your published medicare rate for procedures in categories a/b/c" for one customer and "15% off retail price for all categories other than x/y/z but only in these geographic areas" for another customer, and so on. But, when publishing, they omit the context and just dump every negotiated rate. Because it's technically compliant, but keeps thin…

This is probably the data as they have it and instead the people responsible for inputting things in to whatever system this data came from just have a little print out taped next to their screen reminding them customer XPN305 has a 10% discount on codes that start with FJR and so on.

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

#272

Post by jaarse »

seaourfreed wrote: post #246

USA Healthcare is 19.5% of GDP. Canada + Australia + UK + (a few similar countries) average 10.5% of GDP. The USA healthcare price gouges via run away prices. Healthcare corporations corrupting congress is the fuel that forces this on people (and breaks a free market).

I’m a Canadian, and I would never want to give up our single payer system.

That being said, Canada has a huge health care problem right now. Frequently they need to close emergency services in major (& minor) cities at night due to staff shortages. The wait times for basic diagnostics is on the order of months (not days or weeks). For example, a relative of mine has lost 90 pounds since the start of the year, complained of chest pains and couldn’t (still can’t) swallow. They just got a basic scan after 6 months of waiting to confirm a baseball sized tumour in their lungs.

For many years we ran with just the bare minimum of staffing and equipment to keep costs low, and now, due to a number of factors our system can’t keep up.

Waste is not good, but a little bit of extra capacity (and cost) isn’t a bad thing when it comes to emergency services.

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

#273

Post by [deleted] »

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…

[deleted]

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

#274

Post by Barrin92 »

refurb wrote: post #237
Barrin92 wrote: post #129

Earlier quoted context omitted.

beyond Europe as well. Singapore which has exceptionally low healthcare spending (5.9% of GDP) heavily controls prices and purchases down to individual equipment in hospitals.

Singapore does not control prices (though it’s moving in that direction), it’s public hospitals are privately run, and it has a system of “forced savings” to make sure patients have enough money to cover out of pocket costs and buy health insurance. It’s ethos is “the patient has to pay something out of pocket, even if it’s just $2”. It’s also more than happy to tell poor patients “if you don’t have enough money, the…

>Singapore does not control prices (though it’s moving in that direction), it’s public hospitals are privately run,

Singapore controls prices through collective bargaining at the national level and unlike the US practically every purchase in its hospitals has to go through registration with the HSA (the country's relevant regulatory agency). You essentially cannot purchase any major equipment without running it by the national government. That's one of the reasons why the country has a very transparent pricing system.

It's not only savings accounts but also a very tight control over costs and acquisitions that keeps the price low, that's completely missing in the American system which just keeps growing.

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

#275

Post by jaarse »

e_i_pi_2 wrote: post #98
coredog64 wrote: post #84

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…

As a Canadian I have only know completely socialized healthcare.

One of our largest problems right now is that our system is failing and can’t keep up.

The solutions being rolled out by the provinces to fix the huge backlog of people waiting for care is to privatize more of the service delivery (while keeping single payer).

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

#276

Post by richiebful1 »

chii wrote: post #253
seaourfreed wrote: post #246

USA Healthcare is 19.5% of GDP. Canada + Australia + UK + (a few similar countries) average 10.5% of GDP. The USA healthcare price gouges via run away prices. Healthcare corporations corrupting congress is the fuel that forces this on people (and breaks a free market).

But looking from another perspective - if healthcare is 20% of GDP, an awful amount of people are therefore paid directly due to this "waste". Any improvement in efficiency would mean those people lose out on jobs. A new use for them must be found, or there will be massive unemployment (at least, short-medium term).

My current job depends on the current system being wasteful (healthcare insurance administration). But I'd much rather have to find a new job in a new industry than have the current healthcare system of the United States.

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

#277

Post by opportune »

nradov wrote: post #204
notch656a wrote: post #196

Earlier quoted context omitted.

My state has a "stupid motorist" law that requires people who negligently put their vehicles in danger and then use state resources to get bailed out, to pay for the rescue themselves. Perhaps we could create a "stupid eater law" for medicare/medicaid, forcing obese people etc to pay for their own private health insurance or healthcare which would free up money for others to buy more healthcare privately (via lower t…

Should we apply the same sort of "stupid X law" to people who drink alcohol or drive motorcycles or play rugby? This is one of the moral hazards of a socialized medical system. When the rest of society is paying for your medical care it becomes tempting to save money be dictating exactly how you're allowed to live your life. Obesity is a serious public health problem but we won't fix it by calling people stupid or ch…

Yes I think that makes sense, to an extent. Maybe not specifically those because they are too hard to measure. But it would be a great way to have people put skin in the game. As a taxpayer paying for others’ healthcare I’d love if they were incentivized to live healthier lives to reduce costs

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

#278

Post by [deleted] »

narrator wrote: post #85
mskar wrote: post #63

Earlier quoted context omitted.

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…

What do you think about how Kaiser has handled the whole thing? The insurance company employing the doctors and just paying them a standard salary seems to create all the right incentives.

[deleted]

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

#279

Post by tzs »

ramraj07 wrote: post #228
tzs wrote: post #218

Earlier quoted context omitted.

> 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? That we spend more per capita for approximately the same level of care as most other first world countries is certainly annoying. But sometimes I think we are too focused on that and not putting enough effort into trying to stop the cost from increa…

Data doesn’t make sense. If US costs went up similar to other countries but US is significantly more expensive than other countries today, does it mean costs in US have always been much higher?

Yes (at least as far back as the data at oecd.org goes, which is 1970).

In 1970 US health care spending was $327.0/per capita. France was $192.1, and UK was $124.0. That's 1.7x France and 2.6x UK for the US.

In 2020 it was $11859 for the US, $5468 for France, and $5019 for the UK. That puts 2020 US spending at 2.2x France and 2.4x UK.

From 1970 to 2020 US went up 36x, France 28x, and UK 40x.

It looks like much of the first world has a serious rising health spending problem, with costs rising roughly the same over time everywhere. The US was more expensive long ago, and since the rising costs have been roughly the same the US has stayed more expensive by about the same ratio.

If we could get our spending down to match the rest of the first world, without reducing the level of care, that would be great.

BTW, it is similar if we go by percent of GDP instead of per capita.

US was spending 6.2% of GDP on health in 1970, France 5.2%, and UK 4.0%.

In 2020 that was 18.8% of GDP for the US, 12.2% France, and 12.0% UK.

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

#280

Post by vineyardmike »

e_i_pi_2 wrote: post #71
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…

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…

I’m not the OP and have no deep knowledge, but I’ve often heard cited that the US out-researches other nations, so we incur “R&D” costs for healthcare that other nations use. Eg pharmaceuticals are researched in the US while the patents are used in other nations through a cost structure that doesn’t allow the original researching party to recoup costs.

On-shoring that research also seems to be an advantage -Looking at the astounding amount of research that poured into covid post 2020 would show that we have a huge dormant muscle that can be flexed in unison during an emergency.

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