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

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

#21

Post by yummyfajitas »

mikebike wrote: post #15
yummyfajitas wrote: post #11

Earlier quoted context omitted.

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...

My Mom (no insurance) shops around as follows: "Hi, I'm told I need X done, but I need to know the price. I don't have insurance, and I want to make sure I have enough money to pay for it."

She tends to get accurate estimates, probably because hospitals don't like to hear "I thought it only cost $X, I don't have $X + $Y, so, umm..."

Granted, what she gets isn't likely to be a "a complete cost estimate [...], [...] reflective of any negotiated discounts, [...] inclusive of all associated costs, and did not identify consumers’ out-of-pocket costs", which is what the GAO wanted. But it's certainly good enough for shopping around.

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

#23

Post by rdl »

yummyfajitas wrote: post #12
justinsb wrote: post #10

Earlier quoted context omitted.

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 p…

At least MRI doesn't really screw the patient much, and doesn't screw society at all, unlike overprescription of antibiotics.

(I'm in favor of complete availability of most scheduled drugs -- narcotics, pot, LSD, whatever -- but restriction of antibiotics to those with a prescription. Drug resistant bacteria is no joke.)

There's probably some argument for 0.5T MR being diagnostic now, with faster computers. I just think Japan pushed to low-field earlier because they don't actually care about the results. Also Japanese tend to be physically smaller, so maybe a 0.5T there is as effective as a 1T in the land of the super-sized drive-through.

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

#24

Post by rdl »

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.

Other "special" things about MRI:

1) The trucks -- a lot of times MRI trucks are driven around to various hospitals, and scheduled in advance, for non-emergent studies. These obviously get scheduled during "working hours", and then the emergent off-hours MR studies are done by transporting the patient to a higher level facility and thus might get shot whenever.

2) The whole "doctor owned imaging center" scam or "perverse economic incentive", where doctors own imaging centers and then refer a lot of patients to them, increasing the use of the technology for basically no need. These are easy to schedule during working hours, too.

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

#25

Post by nhebb »

The problem with studies like this is that they pick a single issue within healthcare and try to make a broad assessment from it. There have been other studies that break down the overall costs of health car in the US that are more informative. It's four years old, but this McKinsey study is a good example: http://www.mckinsey.com/Insights/MGI/Research/Americas/Accou...

The Interactive Flash slide show is interesting as well (where "interactive" is defined as clicking forward and back buttons, I guess).

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

#26

Post by jostmey »

I once had to have a CAT scan done. I was really scared. I asked how much it would cost. No one was able to tell me! I was told the price would be negotiated with my health-care provider, if they opted to cover the procedure.

How can there be competition when no-one can give you the price of the procedure? Seriously WTF.

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

#27

Post by darksaga »

"The question, of course, is why Americans pay such high prices — and why we haven’t done anything about it."

This is probably the same reason we've taken close to 40 years to finally try and get off our dependence on foreign oil after Jimmy Carter said we needed to in 1978. Yet, we still pay more than we really should and haven't done anything about it.

Why? Lobbyists, too many layers of bureaucracy, special interest groups. Take your pick, but at the end of day, it takes a lot of people wanting to do the right thing to make things change. In this country, that's a lot harder to do than most people think.

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

#28

Post by aphexairlines »

aculver wrote: post #5

For what it's worth, it's ~$160 in Japan. ( http://www.npr.org/templates/story/story.php?storyId=1205455... ) Interesting seeing this here on HN after my wife and I just finished watching "Frontline: Sick in America" on Netflix tonight, in which an American reporter travels to 5 countries that provide some form of universal healthcare to discuss (with doctors, administrators, and patients) the different mechanics, wh…

I took 4 MRIs last month in Japan. The first one (lower back) was ~$100. The rest (left foot, right foot, upper back) were each on average about half that at Medical Scanning:

http://www.medicalscanning.net/access/shinjuku/

That was what I paid out of pocket, which is 1/3 of what the clinic actually charges. Insurance paid the remaining 2/3 of the cost.

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

#29

Post by accountoftheday »

rdl wrote: post #23
yummyfajitas wrote: post #12

Earlier quoted context omitted.

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 p…

At least MRI doesn't really screw the patient much, and doesn't screw society at all, unlike overprescription of antibiotics. (I'm in favor of complete availability of most scheduled drugs -- narcotics, pot, LSD, whatever -- but restriction of antibiotics to those with a prescription. Drug resistant bacteria is no joke.) There's probably some argument for 0.5T MR being diagnostic now, with faster computers. I just th…

Antibiotics are restricted to those with a prescription in most European countries, for the reason you mentioned. That said, I still keep some in reserve (purchased via prescriptions from doctors in my family) to use judiciously when traveling or living abroad without wanting to deal with the local healthcare system.

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

#30

Post by redwood »

darksaga wrote: post #27

"The question, of course, is why Americans pay such high prices — and why we haven’t done anything about it." This is probably the same reason we've taken close to 40 years to finally try and get off our dependence on foreign oil after Jimmy Carter said we needed to in 1978. Yet, we still pay more than we really should and haven't done anything about it. Why? Lobbyists, too many layers of bureaucracy, special interes…

One note here: we pay less for petrol than any other developing country, which makes it harder for alternatives to make economic sense.
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