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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

#101

Post by shingen »

phren0logy wrote: post #98
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.…

Although I disagree with your flippant tone, it's a fact that over 30% of medical costs come from care delivered in the last 6 months of life. Obviously you'd expect some top-heaviness here, but it makes one wonder about the cost of futile care (both in $$ and human suffering).

It wasn't meant to be flippant (or insensitive), just matter of fact.

My grandmother extended her life by about eight months by having breast cancer surgery at 87 or so. Was that ok? Personally I loved my grandmother. However, it was paid for by taxpayers. Her quality of life was terrible in those last eight months, but she did want to keep fighting to live. It's an extremely sensitive issue to debate on either side. The obvious bottom line is that we can't keep having our cake and eating it too.

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

#102

Post by phren0logy »

rdl wrote: post #79
veidr wrote: post #61

Earlier quoted context omitted.

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…

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 ordering them.

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

#103

Post by justincormack »

rfrey wrote: post #36
redwood wrote: post #30

Earlier quoted context omitted.

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

Did you mean "developed countries"? Because I got tired of copying Wikipedia ( http://en.wikipedia.org/wiki/Gasoline_and_diesel_usage_and_p... ) after: Country US$ / US Gallon U.S. $3.74 Vietnam $1.03 Yemen $2.76 Turkmenistan $0.72 Tunisia $3.75 Trinidad $2.42 Taiwan $3.78 Syria $3.15 Saudi Arabia $0.49 Quatar $0.83 Puerto Rico $3.63 Peru $3.60 Panama $3.14 Pakistan $3.46 Malaysia $2.31 Indonesia $2.23 Egypt $1.17

Most of those are oil producing countries which subsidize oil locally, and several of them are not developing countries.

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

#104

Post by Joeri »

phren0logy wrote: post #97
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.

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%.

My dad is a surgeon, so that's my appeal to authority and anecdote. In my country litigation isn't a problem, but unnecessary treatment is. People go doctor shopping to find one that gives them the treatment they want. Same problem, different cause.

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

#105

Post by agravier »

18pfsmt wrote: post #83

Without yet reading any of the other comments, I have an anecdote that may be interesting to others: One of my father's business partners has a mother that lives in France. She is ~88 years old, and the family's net-worth is on the order of 100s of millions ($USD). She had a medical condition which required surgery, but due to her age, she was not eligible in France, so she had to come to the US for her surgery. So,…

Could it be that the surgery was deemed too risky to perform on an 88 years old person by french surgeons, and not by the american ones? I have heard similar stories, and that was the case.

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

#106

Post by gautamsivakumar »

phren0logy wrote: post #97
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.

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%.

I'm a doc based in the UK. I know that we order fewer useless investigations than you do in the US. Thankfully we don't have a litigation heavy medical culture yet. Although, I think it's slowly heading that way.

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

#108

Post by s_henry_paulson »

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.…

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.

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

#109

Post by yummyfajitas »

Nitramp wrote: post #92
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…

I think what all of these countries have in common is that they have a strong entity negotiating prices on behalf of the patients, drastically lowering the price, and to a varying degrees also dictating what treatment is appropriate. It'd be really nice if health care could work like a regular market, but evidence and intuition suggest it simply doesn't. As others have commented, people don't comparison shop even if…

I think what all of these countries have in common is that they have a strong entity negotiating prices on behalf of the patients, drastically lowering the price, and to a varying degrees also dictating what treatment is appropriate.

The US has these entities too - they are called "insurance companies".

As others have commented, people don't comparison shop even if they could.

This is simply false. People with low deductible insurance don't comparison shop because they have no incentive to do so. I have no insurance (my startup is minimally funded), and I do comparison shop.

It's a bit like having no idea how a car works or what could be wrong with it, and then being asked to pick the best mechanic and strategy to fix it.

Here is what I did a few weeks back. I went to a doctor who ordered an MRI. I called around, discovered the price of MRI's varied from 5-7k (INR, not USD), and then picked the closest one to my home (the price difference was small enough that I didn't care).

When it came time to get treatment, I did research on the internet, as well as asking three separate doctors. They all independently had the same recommendation - microlumbar discectomy on L5-S1. This was fairly apparent based also on the pattern of pain I was suffering, and just by looking at the MRI. I ruled out one hospital because it seemed dirty, chose a doctor/hospital to have it done (not the cheapest, but not the priciest), downgraded from a deluxe room to a private one [1], and got myself fixed up.

This doesn't work for emergency medicine, but most medicine is not emergencies.

[1] The default over here is to give white guys the gold-plated options.

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

#110

Post by yummyfajitas »

s_henry_paulson wrote: post #108
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.…

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...

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