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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

#331
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?

There is not a universal practice. Predominantly just excel, a lot of emails, conference calls and meetings. Different institutions have distinct personalities and that reflects in how things are done between them. Some people still have actual mainframes involved.

When it comes to large parties, multi-practice groups, health systems, etc, an overall fee schedule or charge master for an existing institution is typically not renegotitated line by line every year but as incremental changes from the previous. Many/most of the parties involved have been working together for decades, some even longer.

Many plans administered by familiar names like Anthem are actually funded and controlled by the large employers the plan services. In those cases the employer plays a role in defining what will and will not be covered and what will be paid and the insurer is a middleman (acting as a third party administrator).

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

#332
Nothing enrages me like US healthcare.

Physicians have a monopoly on treatment and restrict supply through the ACGME.

Hospitals and physicians have spent 1Billion on lobbying.

I could go on, I want a science based healthcare as an alternative to our authority based system.

It would be one thing if our system healed everyone, but the number of mistakes is enough to make me lose faith completely.

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

#333
post #324

To save anyone else similarly curious the trouble, here's a sample record from the Humana data set: {'REPORTING_ENTITY_NAME': 'Humana Inc', 'REPORTING_ENTITY_TYPE': 'Health Insurance Issuer', 'LAST_UPDATED_ON': '2022-08-24', 'VERSION': '1.0.0', 'NPI': '1629053517,1659354272', 'TIN': '593279318', 'TYPE': 'ein', 'NEGOTIATION_ARRANGEMENT': 'ffs', 'NAME': 'Nasal Prosthesis Replacement See Also Code 21087', 'BILLING_CODE_…

For comparison, here's the first bit of an Anthem file (which contains some of the data that's just another row in the Humana record), along with the first record

  "reporting_entity_name": "Excellus BlueCross BlueShield",
  "reporting_entity_type": "Health Insurance Issuer",
  "last_updated_on": "2022-06-14",
  "version": "1.0.0",
  "provider_references": [
    {
      "provider_group_id": 302.1518360704,
      "location": "https://mrf.healthsparq.com/exc-egress.nophi.kyruushsq.com/prd/mrf/EXC_I/EXC/providerReference/Providers/S-000000001063.json"
    }
  ],
  "in_network": [
    {
      "negotiation_arrangement": "ffs",
      "name": "Brief (20 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a benefi",
      "billing_code_type": "HCPCS",
      "billing_code_type_version": "2022",
      "billing_code": "G0081",
      "description": "Brief (20 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a benefi",
      "negotiated_rates": [
        {
          "negotiated_prices": [
            {
              "negotiated_type": "fee schedule",
              "negotiated_rate": 51.1,
              "expiration_date": "9999-12-31",
              "service_code": [
                "11"
              ],
              "billing_class": "professional"
            }
          ],
          "provider_references": [
            302.1518360704
          ]
        }
      ]
    },

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

#334

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

Across the board price controls seem to be a common to the various European health care systems. It is my understanding that upper limits are set for the cost of medicine. There is quite a bit of variety across Europe - U.K. is 100% government run, France is a public/private mix, Germany is similar to Obamacare in some ways, others are single payer, apparently some are private, also. But I've read that they all have…

> U.K. is 100% government run

This is not true.

Private healthcare is alive and well in the UK in the supply of both privately and publicly-commissioned healthcare.

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

#335

Earlier quoted context omitted.

> Healthcare is such a base layer of the economy Academically this sounds enlightening, but it only takes one cursory walk around a supermarket in the US to see this is unequivocally false. Healthcare is an externality, not a base of anything. From the average customer to the product in the aisle to the marketing - everything is 100% not a direct cost benefit function in terms of healthcare.

Walk around the supermarket that you drive to, hopefully not being maimed or maiming someone else on the way. A ludicrous expenditure of energy to avoid physical activity so that you can buy products to help alleviate the symptoms of the energy expenditure and laziness. Can’t walk, or bike, or take the non-existent public transit. That’s for sure.

I don't think driving is merely to avoid physical expenditure. Driving is a result of rural and suburban living as well as poor urban planning. Lots more people would walk or bike if it was reasonably feasible.

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

#336
post #231

Earlier quoted context omitted.

After you criticized the comment as only “sounding enlightening” I was eager to hear your thoughts. Unfortunately I think your comment is even less enlightening. I mean, not all healthcare problems are caused by lifestyle. So clearly healthcare is a base layer - there is no situation where it wouldn’t exist.

I'll concede that the comment was vague and relied too heavily on a shared intuition. Though I will admit, the reward became well played dry comedy throughout your sibling comments. So I'll break down my reasoning a bit. It requires a full blog post to get out, so please forgive the abridged version. Healthcare is a catch all for all the other problems of society. The top costly conditions in the US are (in order of…

The workers who are not allowed to sit their entire shifts, a uniquely American cruelty

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

#337
post #272

Earlier quoted context omitted.

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, complai…

Much of the current failures are due to conservative provincial governments (looking at you, Ontario...) purposely underfunding before and into the pandemic. We are now reaping what they have sown. This is a classic "underfund to prove the system doesn't work thus we must privatize it!" move.

It seems a bit strange to call out the Conservatives specifically. Ontario has been purposefully underfunding healthcare for decades upon decades, with most of the damage done decades ago. Peterson (Liberal) forced practitioners to operate under fixed rates defined by the province, which even lead to a doctors strike. Rae (NDP) eliminated 8,000 acute care beds. Harris (PC) eliminated another 6,000 beds.

Governments of the last 20 years have held the status quo, which leaves them equally culpable.

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

#338
post #284

Earlier quoted context omitted.

> In fact, of the countries that usually make up the global leaders in health/medical innovators, all but 1 (the UK) engage in price controls ( https://immigrantinvest.com/insider/the-best-healthcare-coun ...), and the UK's NHS is suffering from a rationing crisis, and (ironically) a cost crisis. The UK's difficulty lie in their leadership and political issues and in the economic consequences of Brexit. I'm not sure…

The NHS's difficulty lies in the simple fact that it is understaffed ( https://www.express.co.uk/life-style/health/1633058/general-... ) and the staff are underpaid ( https://www.bbc.com/news/newsbeat-62290577 ) — leading to unprecedented wait times. This is because the "list prices" that the NHS pays for GP, nurses, and services are not subject to market forces, they are set by the government. The government is curr…

>Brexit's influence is tenuous at best.

Indeed. It's basically the convenient bogeyman for opponents of the current government.

>The NHS is a third rail of politics and real reform is extremely difficult given the political buy-in necessary.

Private Eye on "24 Hours to Save the NHS https://twitter.com/KulganofCrydee/status/833654730849136641>

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

#339
post #253

Earlier quoted context omitted.

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).

Yes, and we should also think of the blacksmiths and the elevator operators, milkmen and horse carriage drivers, who will unfortunately be out of a job if we make our society more efficient.

Why not go further still. Smash a window so that window makers can make a living, slash someone's tires so that tire companies can employ more people.

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

#340

Earlier quoted context omitted.

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…

> I don't think that disproves a general trend that increased socialization in healthcare costs leads to better outcomes and less per-capita spending. You also haven't given even a hint of proof for this alleged trend. Maybe there is a trend, but let's look at some serious data before we just assume it's an obvious fact.

Here is your evidence:

In an analysis we published in 2011, the ratio of social service spending to medical care spending was significantly associated with better health outcomes across 34 OECD (Organization for Economic Cooperation and Development) countries between 2000 and 2005.

and

When comparing state-to-state spending between 2000 and 2009, those states with higher ratios of social service spending to health care spending had better outcomes on average.

[1] https://qualitysafety.bmj.com/content/20/10/826.abstract

[2] https://www.rwjf.org/en/blog/2016/08/how_social_spending.htm...

[3] http://content.healthaffairs.org/content/35/5/760.abstract

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