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Why an MRI costs $1,080 in America and $280 in France

washingtonpost.com

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Re: Why an MRI costs $1,080 in America and $280 in France

#11

Post by yummyfajitas »

jrwoodruff wrote: post #6
rsanchez1 wrote: post #2

Anyone who has insurance doesn't care about the price. They only care about the deductible. When people shop around, they look for the insurance companies that provide the lowest deductibles and stick with them. After that, there's no pressure on the providers to lower prices. The insurance companies in the US don't negotiate lower prices, they just pass on the cost to policy holders in their deductibles. The provide…

I don't know about you, but next time I need an emergency room or surgical procedure, I'm not going to be shopping for the cheapest one. The article addressed this - how do you 'shop around' when you're under anesthesia, and would you really hire the cheapest doctor to diagnose your daughters life threatening ailment? It just doesn't play out in reality.

Most medical procedures are not emergent. It's hard to shop around for emergency care, but shopping around for everything else is pretty straightforward.

We have strong experimental evidence that when people are not insulated from price, they shop around and consume less medicine with no measurable effect on their health.

http://www.rand.org/health/projects/hie.html

Re: Why an MRI costs $1,080 in America and $280 in France

#12

Post by yummyfajitas »

justinsb wrote: post #10
rdl wrote: post #7

Earlier quoted context omitted.

MRI specifically is overused and kind of crappy in Japan. In the rest of the world, the standard is for a 1-3T MR study; in Japan, you get a lot of 0.5 and even lower (0.2T! wtf) MR studies. They're used for a lot of health screenings, whereas in the rest of the world they're more often used for actual problems.

Is this because as the price drops more applications become cost-effective?

From what I've been told (I used to do research in MRI), it's because MRI's are Japan's preferred method for allowing doctors to show they care.

MRI's are used in Japan the way antibiotics are used in the US. Patients are often unsatisfied if the doctor tell them to go rest and hope things improve on their own (even if that is the best treatment), so doctors perform some harmless token medical procedure to make the patient feel he helped them.

Re: Why an MRI costs $1,080 in America and $280 in France

#13

Post by tibbon »

rsanchez1 wrote: post #2

Anyone who has insurance doesn't care about the price. They only care about the deductible. When people shop around, they look for the insurance companies that provide the lowest deductibles and stick with them. After that, there's no pressure on the providers to lower prices. The insurance companies in the US don't negotiate lower prices, they just pass on the cost to policy holders in their deductibles. The provide…

You make a good point, in that the end users in the US just care about the deductible.

Part of this is that its hard (if not impossible) to find out what something will cost. The doctors don't (or rarely) know the cost, and it just isn't in the standard vocabulary of patients to inquire the cost and/or shop around.

Re: Why an MRI costs $1,080 in America and $280 in France

#14

Post by Anechoic »

yummyfajitas wrote: post #8
dhughes wrote: post #3

If there was medical procedure that would cost a lot in a hospital an MRI would not surprise me, it such a large powerful, power hungry, complex device I can't see how it couldn't. I wish each person could get access to an MRI each year it would be nice to track your health visually.

The capital costs for an MRI, while large, are not the biggest part of the price. I had an MRI done in Pune (with a good machine, 3T/32 channels) for 6500rs/$130. Labor costs are a biggie. In the US, you need to pay technicians high US salaries, in the $60-70k neighborhood from what I hear. In Pune, the technician is almost certainly poorer than 95% of Americans. The high ratio of capital costs/labor costs also cause…

in the US, many MRI places are 9-6

A nit, but is this actually true? I've had 7 MRI's (5 health-related, 2 research-related) and only one of them was during business hours. I've had MRIs done at 9pm, 11pm, 1am, 4:30am, 6am etc.

Re: Why an MRI costs $1,080 in America and $280 in France

#15

Post by mikebike »

yummyfajitas wrote: post #11
jrwoodruff wrote: post #6

Earlier quoted context omitted.

I don't know about you, but next time I need an emergency room or surgical procedure, I'm not going to be shopping for the cheapest one. The article addressed this - how do you 'shop around' when you're under anesthesia, and would you really hire the cheapest doctor to diagnose your daughters life threatening ailment? It just doesn't play out in reality.

Most medical procedures are not emergent. It's hard to shop around for emergency care, but shopping around for everything else is pretty straightforward. We have strong experimental evidence that when people are not insulated from price, they shop around and consume less medicine with no measurable effect on their health. http://www.rand.org/health/projects/hie.html

This article suggests that shopping around for, say, knee replacement surgery, is not so simple:

http://www.washingtonpost.com/blogs/ezra-klein/post/how-much...

Re: Why an MRI costs $1,080 in America and $280 in France

#16

Post by tzs »

What annoys me as an American about our health care is not that some other countries achieve better outcomes at much lower cost--it is that they do so in so many different ways.

For instance, if they all did it by having the government completely run the health care system, with all doctors working for government hospitals and clinics, and being trained in government medical schools, with all costs set by the government, then I could understand the US rejecting that as being too much government intrusion. (Note I didn't say I'd necessarily agree with such rejection--good health care arguably is more important than limited government power--I'm just saying I could understand such rejection).

But looking around, what stands out is how diverse the approaches of other countries are. There are some that do have the government finance and provide health care, much the way the police or military are provided by the government.

There are some that use private insurers paying, with care provided by private hospitals and doctors, but the insurance companies are non-profit and regulated.

There are some that provide care via private hospitals and doctors, but have a government run insurance program to pay for it.

There was a good look at how it is done in 5 capitalist democracies here: http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/c...

See also the link on that page to the explanation of the four basic models used around the world. That page includes a striking way to explain the other systems to Americans:

   These four models should be fairly easy for Americans to
   understand because we have elements of all of them in our
   fragmented national health care apparatus. When it comes
   to treating veterans, we're Britain or Cuba. For Americans
   over the age of 65 on Medicare, we're Canada. For working
   Americans who get insurance on the job, we're Germany.

   For the 15 percent of the population who have no health
   insurance, the United States is Cambodia or Burkina Faso
   or rural India, with access to a doctor available if you
   can pay the bill out-of-pocket at the time of treatment
   or if you're sick enough to be admitted to the emergency
   ward at the public hospital.

Re: Why an MRI costs $1,080 in America and $280 in France

#17

Post by yummyfajitas »

Anechoic wrote: post #14
yummyfajitas wrote: post #8

Earlier quoted context omitted.

The capital costs for an MRI, while large, are not the biggest part of the price. I had an MRI done in Pune (with a good machine, 3T/32 channels) for 6500rs/$130. Labor costs are a biggie. In the US, you need to pay technicians high US salaries, in the $60-70k neighborhood from what I hear. In Pune, the technician is almost certainly poorer than 95% of Americans. The high ratio of capital costs/labor costs also cause…

in the US, many MRI places are 9-6 A nit, but is this actually true? I've had 7 MRI's (5 health-related, 2 research-related) and only one of them was during business hours. I've had MRIs done at 9pm, 11pm, 1am, 4:30am, 6am etc.

I'll take your word for it, you've had more MRI's than me. But I've always had to take half a day off from work to get an MRI done.

I imagine it would also be different for a hospital MRI (which needs to be available for emergencies) and outpatient MRI centers (which is where I've always gone).

Re: Why an MRI costs $1,080 in America and $280 in France

#20

Post by mindcrime »

Can't believe they didn't even mention the Monopoly Protection Certificate racket run by the government in many states:

http://en.wikipedia.org/wiki/Certificate_of_need

And never mind the huge monopoly granted to AMA certified physicians, in terms of providing medical care. Of course those guys have a huge incentive to keep as many people out of the physician pool as possible. We certainly couldn't allow competition, which might drive down costs. :~(

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