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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

#61

Post by veidr »

rdl wrote: post #7
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…

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.

I call bullshit on your first point--that MRIs are "overused" in Japan.

MRIs aren't something that can really be overused. Unlike CT scans, or pretty much any non-MRI method of imaging the inside of the body, they don't harm the patient.

Even though you are right that many of the MRI machines in Japan are lower-resolution cheaper models, that is largely because there are way more MRI machines here, and they are used for routine diagnostics, to find actual problems. Your local single-doctor clinic in the boonies often has mRI equipment here.

I have a personal interest in this topic, as I have MS. Lucky for me, I am doing fine, but in Japan I get a brain MRI every 6 months just to keep an eye on how it is going. When I was back in the states 3 years ago I had a typical employer-based HMO. I went to the doctor and told him here's my deal, I have MS, my doctor in Japan said I should have another MRI in October to see what's up with it.

The doctor flatly refused -- MRIs were only available after physical symptoms had developed. Of course, at that point, the available treatments for a flare-up of MS are less effective at preventing long-term neurological problems. (Happily, I am back in Japan now.)

My point is that MRIs are a wonderful tool, and as you and other commenters have pointed out, they are much more widely used here than in the US. Something wonky with your knee? OK, let's get an MRI and check it out. I don't see anything wrong with that.

And in cases where there is a problem, there is no difficulty at all here in getting a referral to a specialist at a hospital with the latest cutting-edge MRI gear if necessary.

Using MRI technology for health screening and preventative/proactive treatment is great.

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

#62

Post by underwater »

droithomme wrote: post #18

The US has inexpensive MRIs as well. This nationwide chain provides MRIs as low as $335 depending on the state. http://a2zimaging.com/ No insurance accepted, no payment plans. Those cost money. Just charges the cost.

As someone who had insurance that doesn't help me. I might not have a pay out of pocket for an MRI but I'm still having to pay for it through higher charges. I'm unable to shop around to reduce the insurance company's (and therefore my own) costs.

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

#63

Post by veidr »

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…

That's basically true, but I'd just point out that MRIs really are harmless, unlike unnecessary antibiotic prescriptions.

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

#65

Post by Cass »

yummyfajitas wrote: post #50
Vivtek wrote: post #35

Earlier quoted context omitted.

I've heard this before. Do you think that Germans or the French end users care about the price? No - they're insured far better than any American without a (D) or (R) after their name. They just _go to the doctor when they're sick_. Period.

So France and Germany have some non-price rationing mechanism. Whatever mechanism they have, it causes them to half less than half as many MRI's (per capita) than the US. http://www.oecd-ilibrary.org/docserver/download/fulltext/811...

MRIs in Germany (or at least my part of it) tend to be relatively rare and booked almost completely full, because with the prices the way they are, they're not profitable unless they're utilized as much as physically possible. There's therefore usually a waiting period of a few days for a non-emergency MRI, which tends to make them a less attractive option for doctors and patients than they might be if they were instantly available. On top of that, they're still relatively pricy compared to other diagnostic procedures, and in Germany, a doctor or hospital who prescribes too many expensive procedures may get personally stuck with the cost, instead of being able to pass them on to the patient or insurer.

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

#66

Post by underwater »

Cadsby wrote: post #52
jostmey wrote: post #26

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.

This is because no one is quite sure what it should cost. Literally. The hospital will try and charge whatever wild number they can get away with, and the insurance company will negotiate it down to whatever they feel they're willing to pay. My wife is a nurse and has seen this play out multiple times with patients and their families. Just to give you an idea of how disconnected the price is from logical factors, con…

People argue that the current system works because capitalism is more efficient. But when the prices are hidden from the customer by either fudging prices or hiding costs behind a fixed fee in the form of insurance the system is broken.

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

#67

Post by waitwhat »

asmithmd1 wrote: post #39

High health care spending is yet another way the US subsidizes other countries. From the article: "This is a good deal for residents of other countries, as our high spending makes medical innovations more profitable. “We end up with the benefits of your investment,” Sackville says. “You’re subsidizing the rest of the world by doing the front-end research.” In the past 30 years have you heard of any medical innovation…

In the past 30 years have you heard of any medical innovation or drugs coming from anywhere other than the US?

Of course the MRI machine was itself invented in the US

I have no way of judging the value of their respective contributions to the field, but I do know that the Nobel prize for magnetic resonance imaging didn't even go to Damadian, but was instead shared by a different American and a Brit. http://en.wikipedia.org/wiki/List_of_Nobel_laureates_in_Phys... (2003)

The development of the MRI machine falls a little outside this 30 year window, but at almost exactly the same time that IVF was being developed in the UK. http://en.wikipedia.org/wiki/Louise_Brown

For more recent innovation, how about cloning? http://en.wikipedia.org/wiki/Dolly_%28sheep%29

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

#68

Post by underwater »

tzs wrote: post #16

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 governm…

This kind of problem seems fairly widespread in America. Americans are incredibly self-confident, innovative and have achieved a great deal as a nation. They are also extremely proud of their country.

Unfortunately this combination often leads them to assume things are good purely because they are American. They tend to accept their own familiar values and ideas and readily dismiss alternatives because that would be admitting failure. As a result you get incredibly conservative attitudes in some areas side-by-side with world leading innovation in another.

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

#69

Post by Cass »

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.

MRIs aren't much use for screening. They can't be used to diagnose many diseases at all, and for many others, their sensitivity and specificity are quite low. In addition, they produce a large number of huge, highly complex images that have to be reviewed by a human being, and it's incredibly easy to overlook something if you don't know what to look for. If I had a coffee for every time our radiology specialist has said some variant of "I wouldn't even have noticed that if I didn't know that's where the pain is -" well, let's just say, I'd find it a lot easier not to fall asleep in the radiology demonstration.

If you want one yearly screening procedure available to anyone, there are many better choices than MRIs, especially considering their high costs (even in non-US countries.)

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

#70

Post by Cass »

true_religion wrote: post #41
Aloisius wrote: post #38

Earlier quoted context omitted.

Shouldn't that make the cost in the US go down? After your fixed investment, the only thing you are paying for is the person running the machine.

Not necessarily, if the person running the machine or the person screening the results has to be a trained medical professional. In those cases, due to monopoly and other concerns, we'd have a supply bottleneck which would increase price given increased demands. I don't however know if you have to be medically trained to use a MRI machine, or interpret the results

You don't need to be a doctor to run an MRI scan, but you do need to be one to interpret the results. In addition, you should really have at least one doctor around to decide exactly what you need to MRI in which way for optimal results for any given clinical problem, as the doctors who ordered the MRI done aren't usually specialists in that area.
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