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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

#161

Post by estel »

danmaz74 wrote: post #139
matwood wrote: post #127

Earlier quoted context omitted.

"You know sir, with insurances we have all those additional costs...". Well, with many insurance companies there can be an additional cost. Submitting the claims, filling out the paperwork, proving the work was done, etc... all add up. Depending on how much work a person does with an insurance company it could easily add up to another full time employee.

I believe that there are some additional costs. But come on, more than double the price... ;)

Depending on the hourly rate, €80 of paperwork isn't all that much.

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

#162

Post by DanBC »

veidr wrote: post #61
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.

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…

> Something wonky with your knee? OK, let's get an MRI and check it out.

Maybe; let a doctor look at it and decide. An MRI may be useful. It might just provide complex hard to interpret images that don't provide any more information than an experienced orthopod could find with some manipulation.

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

You need to provide some evidence for that claim. There's a number of flaws.

Giving everyone screening MRIs needs many more staff. Those staff are diverted from other areas of healthcare, so that's one negative impact.

You'll get bottlenecks in screening and interpreting results, so some people who need treatment may end up waiting longer than someone who's just getting a screening MRI.

MRI scans are complex and hard to interpret. Knowing that every MRI is called for by a doctor makes people screening them look hard for problems. Knowing that there's a bunch of screening of probably healthy people means that screeners may not look so hard, and may miss minor (or major and hard to see) problems.

A patient who is healthy but who has a blob on MRI will be under considerable stress until that blob is investigated and ruled safe.

Investigations carry some risk. You have to drive to the hospital (which will cause many deaths and injuries); you're mixing with ill people; you're increasing the number of people visiting hospitals and thus increasing the numbers of people with MRSA and NORO virus and etc visiting hospitals - you're increasing the number of healthy people carrying illnesses visiting hospitals which have people unable to resist those illnesses.

That's just off the top of my head. I'm sure there are many more problems.

But I don't have numbers, so I can be persuaded if someone has good quality reports.

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

#163

Post by ktizo »

mikeash wrote: post #121
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.…

This PDF shows the 65+ demographic as accounting for 35.6% of health expenditures in 2004: https://www.cms.gov/NationalHealthExpendData/downloads/2004-... It seems highly unlikely that it would change so drastically in just 8 years. Where does your 85% figure come from?

Was probably found from the same source that I used when researching the worrying fact that, as it turns out, 78.2% of statistics are made up on the spot.

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

#164

Post by jakeonthemove »

I always had the idea that American health care is more expensive because there's not much competition - there are just a few major companies that control the pharma industry and the hospitals, and it's pretty much impossible for someone to just barge in and start offering their services at a lower price - they'd have to pass by the government first (with their impossibly high fees and heavy regulations), then if successful, they'd be harrased to bankruptcy by the established monopoly.

It's much easier to open a private practice or hospital in the EU, for example...

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

#165

Post by Symmetry »

yequalsx wrote: post #148
yummyfajitas wrote: post #138

Earlier quoted context omitted.

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.

I'm confused, could you name a situation in which this wouldn't be the case? The profits that an insurance company makes are the amount it charges for its services minus the amount that it pays out, it seems that reducing the amount they pay out would necessarily increase profits.

I'm not aware of any insurance companies that charge on a cost-plus basis, and the insurance companies can't just charge companies as much as they want (or else they'd charge an infinite amount).

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

#166

Post by rdl »

phren0logy wrote: post #102
rdl wrote: post #79

Earlier quoted context omitted.

All the rads I've talked to/worked with hate "screening" MR (or CT! Some morons do CTs for random checkups!) not so much for the cost of the procedure (since they directly or indirectly were getting paid), but because it leads to finding basically insignificant incidental findings which then cause the patient to worry, and/or have unnecessary surgery. The benefits are questionable if anything, but the costs of the un…

Exactly this. Unnecessary imaging needs to unnecessary follow-up evaluations like biopsies which in turn have additional complications. When I was in med school we spent a lot of time in a hospital providing indigent care. We ordered tests that we needed to determine how to treat someone, but not more than that. When I worked in a private hospital, most patients got lab tests done daily, with no specific reason for o…

I'd be willing to buy that imaging is sometimes underused with some patient populations, and sometimes overused -- just like medications, even painkillers, which are dramatically overprescribed in some places (old people, Florida, pill mills for diversion) and underprescribed for others (some chronic pain patients, terminal care).

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

#167

Post by ck2 »

shingen wrote: post #119
ck2 wrote: post #113

Because if it was $280 in America the insurance ceos, investors, doctors and administrators would not be able to buy their second vacation homes. As long as healthcare is a profit center, you will only have the right to die quietly if you cannot afford it in America.

It's a profit center whether you like it or not, with or without the government. With the government the profit goes into the bureaucracy. The medicare + medicaid system has shown itself to be an extreme profit center for government employees and the bureaucracy. They take home massive sums in profit: wages and pensions. The government doesn't make the system more efficient by reducing profit from the equation. They…

Except if the government wasn't taking their cut, the private executives would be working on their THIRD vacation homes.

The government is a shield against abusive private industry, they just happen to be bad at it and expensive.

Giving the government less money won't make it more efficient, just worse at it's job.

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

#168

Post by ktizo »

J3L2404 wrote: post #123
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…

First of all: "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" Although it dovetails with the well worn narrative on HN, this comparison fails due to the level of care. Also, from the article comments: "There are just a couple problems. In 2009, the French Society of Radiology equipment in France was critically undermining care, an…

That comment seems to claim that the French government is keeping the cost per scan low by having less scanners available to people.

Now, I'm no economist, but that argument does seem to make absolutely no sense whatsoever.

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

#169

Post by madflo »

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.…

My grand-parents, at 86 and 87, recently had multiples surgeries: eyes, hips, pacemakers... They are quietly approaching the bionic state.

Those are costly procedures, taking place in public hospitals without any extra. Yay for socialized medecine !

Which brings me to my question : what kind of surgeries can't you get at 80+ years old in France ?

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

#170

Post by _delirium »

iwwr wrote: post #77
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…

Don't forget that in Canada it's illegal to be a private medic. Medical services are ostensibly free, but rationed through queues. If you have a medical condition that's not immediately threatening, you may find yourself waiting for years for treatment, or have to go across the border to buy it.

That's not a requirement of such a system, though; France has a dual public/private system, where everyone is guaranteed service at the public system, but well-off people who wish to pay extra can purchase private care.
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