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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

#141

Post by ktizo »

yummyfajitas wrote: post #110
s_henry_paulson wrote: post #108

Earlier quoted context omitted.

Not true. The largest savings would be in not having to deal with the administrative overhead of our current system. A full 1/3 of the cost of healthcare in America goes into maintaining our system and not into actual patient care.

Um, no. Patient care is the biggest culprit in US overspending on medicine. Administrative overhead is minor. http://theincidentaleconomist.com/wordpress/what-makes-the-u...

Insured middle classes competing directly with the super-rich over a limited pool of medical professionals is probably the biggest culprit.

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

#142

Post by DanBC »

ktizo wrote: post #111
shingen wrote: post #91

Want to get our costs down to competitive levels? 85% of all healthcare costs in America are for those over the age of 65. America has the leading health care system for the elderly. We pay for 80 year olds to have surgeries that they can't get in Canada or France. Nobody wants to talk about it though, because it's not a nice thing to say, that grandma is buying six extra months at a price of a million in treatment.…

If the US has the leading healthcare for the elderly in the world, how come it comes 36th in terms of life expectancy?

Because people have to reach old age before they get "leading healthcare for the elderly"; the ones that don't reach old age cause low ranking in life expectancy charts.

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

#143

Post by tsotha »

malay wrote: post #128
ktizo wrote: post #117

Earlier quoted context omitted.

So you are saying that US insurance companies are dramatically lowering the prices. If so, then compared to what exactly? The US has some of the highest costs per treatment of just about anywhere in the world, so if the insurance companies are dramatically lowering prices, then the only conclusion I can draw is that the US healthcare providers must be powering all their equipment by burning money for fuel or somethin…

They are certainly lowering the prices, hence the constant back and forth (literally for 30 years straight) of local market consolidation between the buyers (health insurers) and the suppliers (hospitals/physicians). There are legal fights going on all over the country because of all the pricing issues; Pittsburgh is a great example of how the dominant insurer (Highmark) simply refused to pay the dominant provider's…

>The problem is actually pretty simple: hospitals are terrible at cost accounting and totally game it.

It's not that they're terrible at cost accounting. The problem is the hospitals are required to provide care to people who can't pay, particularly in the ER and obstetrics. So costs are shifted from other departments to pay for these services.

That's why people who are trying to hold down costs by zeroing in on this test or that procedure are destined to fail. Somehow the service the hospital is required to provide without reimbursement will have to be paid for, either explicitly or through the sort of sleight-of-hand accounting we see today.

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

#144

Post by malay »

ktizo wrote: post #137
malay wrote: post #128

Earlier quoted context omitted.

They are certainly lowering the prices, hence the constant back and forth (literally for 30 years straight) of local market consolidation between the buyers (health insurers) and the suppliers (hospitals/physicians). There are legal fights going on all over the country because of all the pricing issues; Pittsburgh is a great example of how the dominant insurer (Highmark) simply refused to pay the dominant provider's…

So if they have been lowering prices for 30 years, why do the prices keep going up? I know there are increased costs due to medical advances, but this only accounts for half the increase in costs according to studies, so the rise from 5% of GDP in the 60's to 16% of GDP today, especially seeing the massive increase in GDP during that period, does not chime at all with the idea that the insurance industry is lowering…

My comment should have said that absent insurers over that time period, prices would be higher than they are currently. The effect they have is on controlling the level of price increases, not on lowering price absolutely (which I doubt is possible if people wish to keep extending their lives).

I am not saying that insurers are the most effective option or advocating for them; I am only saying that without them, prices would be significantly higher.

If you need evidence, simply compare the total price of any health care service (i.e. total cash outlay by all parties) between a person who carries health insurance and a person who does not. Universally, the price of the service is higher for the uninsured as they lack negotiating power.

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

#145

Post by rospaya »

matwood wrote: post #133
vacri wrote: post #40

Earlier quoted context omitted.

He did mean developed country. The US pays about two-thirds what Australians do for petrol, who in turn pay about two-third what Europeans do for petrol. The panic that the US gets itself into when discussing fuel prices is amusing to watch. Australia is a big country with spread out cities like the US (or even more than the US) and similar wage levels, yet we don't have problems with post-paying cash for our fuel. I…

I never found a single place where I could post-pay with cash - they were all too afraid of drive-offs. Many municipalities in the US have made post-pay illegal, so even if gas stations wanted to offer it they couldn't.

Excuse my ignorance, but what does "post-pay" mean?

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

#146

Post by phren0logy »

yequalsx wrote: post #132
phren0logy wrote: post #97

Earlier quoted context omitted.

I am a physician, and I teach in a medical school. Although they are 2% of total costs, they drive up the cost in unnecessary procedures that patients demand without medical indication. Those $1080 MRIs are often ordered to avoid a lawsuit. That adds up to a lot more than 2%.

As I understand it now, doctors have largely invested in testing companies. When they (not all doctors obviously) - I probably thinking primary doctors - order tests the test is a money maker for the doctor. Wouldn't a calculation of the effect of litigation include the scenario you mentioned? Otherwise it would seem to be a bad calculation. Do you have any studies that show how often a test is ordered simply to avoi…

Even if many testing companies are owned by doctors, the overwhelming majority have no stake in one.

Citations re: excess testing:

http://www.ncbi.nlm.nih.gov/pubmed/15928282 http://www.ncbi.nlm.nih.gov/pubmed/10136689

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

#147

Post by jshen »

matwood wrote: post #126
Joeri wrote: post #95

Earlier quoted context omitted.

Malpractice suits are about 2% of healthcare costs, and that percentage is stable, so you're not going to make a huge difference by focusing efforts there. Tort reform is a diversion, not a solution.

Malpractice suits are about 2% of healthcare costs, and that percentage is stable, so you're not going to make a huge difference by focusing efforts there. The cost to avoid lawsuits adds up with a lot of tests that are not needed. Doctors end up doing whole batteries of tests on everyone to avoid the 1:1000 or higher chance that the person in their office with a headache really had an aneurysm and get the doctor sue…

Do you have data to backup these claims?

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

#148

Post by yequalsx »

yummyfajitas wrote: post #138
yequalsx wrote: post #131

Earlier quoted context omitted.

Do you have evidence that you are normative in terms of comparison shopping for healthcare? It seems to me that costs won't vary much between providers and that comparison shopping would be a mostly useless thing to do in the U.S. Indeed, your own experience in comparison shopping is that the price differential was not that great. Health insurers in the U.S. have a captive audience. Most people before the age of 60 w…

I don't live in the US, but India does have a health care system fairly similar to the US. The biggest difference is it has less red tape than the US, and insurance companies play a minor role. Most people pay out of pocket and comparison shop. Costs here did vary significantly for the surgery - the dirty hospital was 0.9-1.5lac (depending on general ward vs private room, etc), the place where I had it done was about…

Insurance companies don't have a great incentive to lower the cost of their biggest expense? Um, ok.

They only have such incentive if it increases their profit margins. There are a number of scenarios where this wouldn't be the case. They aren't interested in lowering cost just for the sake of lowering cost. I don't have data either way and so my belief in this is easily shaken.

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

#149

Post by Cadsby »

yummyfajitas wrote: post #138
yequalsx wrote: post #131

Earlier quoted context omitted.

Do you have evidence that you are normative in terms of comparison shopping for healthcare? It seems to me that costs won't vary much between providers and that comparison shopping would be a mostly useless thing to do in the U.S. Indeed, your own experience in comparison shopping is that the price differential was not that great. Health insurers in the U.S. have a captive audience. Most people before the age of 60 w…

I don't live in the US, but India does have a health care system fairly similar to the US. The biggest difference is it has less red tape than the US, and insurance companies play a minor role. Most people pay out of pocket and comparison shop. Costs here did vary significantly for the surgery - the dirty hospital was 0.9-1.5lac (depending on general ward vs private room, etc), the place where I had it done was about…

> The biggest difference is it has less red tape than the US, and insurance companies play a minor role.

If true, you are glossing over a pretty substantial difference between the two systems.

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

#150

Post by jksmith »

I just got my shoulder redone by arguably one of the best sports orthos in the country. This guy handles a substantial percentage of high profile professional athlete cases per year. He charged me $3200 for a rotator repair and bicep reattach. I think that's a bargain for his skill level.

My guess is the total bill will be another story though. I suspect my insurance will be dinged for about $11k. O.R. rental, nurse anesthetists who make $150/hr, etc are the source of expensive healthcare in the US, at least for surgery.

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