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Fed Up with Drug Companies, Hospitals Decide to Start Their Own

nytimes.com

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Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#141

Post by dx034 »

icantdrive55 wrote: post #95
shykes wrote: post #86

This article makes it seem like drug companies alone are responsible for predatory pricing in US healthcare, with hospitals being somehow on the consumer's side of the issue. In reality US hospitals are just as guilty of predatory behavior. If they do achieve lower costs through a new generics company, I do not trust them one bit to pass on the savings to patients. Why would they?

Never forget being charged 14.99 for one Acetaminophen while in a hospital, and this was years ago. My father had good insurance. He went in for a spider bite. He needed to stay the night. I arrived and he thanked me for Teddy Bear, and flowers. I told him I didn't send you anything. He said, "Well someone did?" Weeks later he called me up, and said the gift shop on the hospital send the gift, and charged the Insuran…

I don't understand how charging different prices for the same service is legal. If that would be declared illegal (as it is in many other countries) it would probably already fix a lot. Some insurances would pay more but people without insurance vastly less.

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#142

Post by fvdessen »

selectodude wrote: post #132
Consultant32452 wrote: post #66

Earlier quoted context omitted.

I could design such a system overnight. Starting tomorrow instead of paying for medical care the US Medicare and Medicaid programs will simply cut a check to the people who they were previously funding care for. Then those people may choose to spend the money on anything they wish, healthcare or otherwise. The days of not being able to price shop are over, competition will drop prices through the floor. The hospital…

“Let me price compare my heart attack operation before I decide on which hospital I want this ambulance I found on Expedia to take me to before I die.” I mean this nicely but sincerely, are you high?

Most medical interventions are not about immediately life threatening situations.

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#143

Post by chillydawg »

TillE wrote: post #32
fludlight wrote: post #27

Let's say they succeed in launching a new generics company. Ten years down the line they will divest in order to build each hospital a shiny new geriatrics wing. Within six months the spun-off drug company will jack up prices and the cycle will continue.

From that perspective, does any country have their own publicly owned pharmaceutical manufacturer? It's the kind of thing the NHS should do, since they control most other aspects of health care, but I don't think they do. There's so little benefit to competition with generics, you may as well have that vertical integration to at least provide what hospitals need.

Because of the purchasing power of the NHS (enormous) they don't usually run into many problems like described in this thread, although they do happen here. Drug company monopolies need a drug purchasing monopsony to keep them in check.

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#144

Post by Symbiote »

nkrumm wrote: post #111
shykes wrote: post #86

This article makes it seem like drug companies alone are responsible for predatory pricing in US healthcare, with hospitals being somehow on the consumer's side of the issue. In reality US hospitals are just as guilty of predatory behavior. If they do achieve lower costs through a new generics company, I do not trust them one bit to pass on the savings to patients. Why would they?

Even if they do not directly pass this on to patients, cheaper generics will benefit patients in terms of their availability. I recently was involved in a case where a flucytosine (an old, generic anti-fungal) was considered for a patient, but the cost of treatment was $7,000 (as an outpatient) and therefore not considered (despite this being the best option). For an interesting analysis of this, see [1]. [1] https:/…

"Due to generic drug manufacturer monopolization, flucytosine currently costs approximately $2000 per day in the United States, with a 2-week flucytosine treatment course costing approximately $28 000. The daily flucytosine treatment cost in the United Kingdom is approximately $22."

Would it be permitted to travel to the UK (or somewhere closer) and buy the medicine, then bring it back? Or even order online, there's at least one British pharmacy that can deliver abroad.

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#146

Post by Symbiote »

sbov wrote: post #68
telchar wrote: post #56

Earlier quoted context omitted.

I work for a hospital and I agree with you that the billing practices are shitty, but I couldn't tell you what a procedure will cost you even if ordered to. At best I could give you an average for a procedure but if you're in for a few days you may see dozens of doctors and have hundreds of procedures including an operating room procedure or two and a whole lot of blood tests, imaging, poking and prodding (e.g. asses…

It's not only that. Our local hospitals can't give us prices for procedures that other places can. We tried price shopping an hsg test because we had to out of pocket it. Hospitals took hours on the phone and multiple call backs. Other places could give us a quote in minutes. We chose a hospital based on price. The morning of the procedure they told us it doesn't include everything. But they said we were wrong and ou…

An HSG test at a private hospital in the UK is about £400, if you'd like to compare. That's according to forum posts, the provider's websites are mostly referring to a newer procedure now, with a similar cost. (Just search HSG test UK private.)

I think private healthcare in the UK would have very clear pricing. They have to compete with "free" (in this case, "free but not urgent, so your appointment is in six weeks") and deceiving patients is not going to attract further custom.

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#147

Post by lostlogin »

Gustomaximus wrote: post #118
icantdrive55 wrote: post #95

Earlier quoted context omitted.

Never forget being charged 14.99 for one Acetaminophen while in a hospital, and this was years ago. My father had good insurance. He went in for a spider bite. He needed to stay the night. I arrived and he thanked me for Teddy Bear, and flowers. I told him I didn't send you anything. He said, "Well someone did?" Weeks later he called me up, and said the gift shop on the hospital send the gift, and charged the Insuran…

One of the best rules for US hospitals (other than universal care) would be for all hospitals to publish prices annually and charge one set price, be it a walk in patient or large union. This should be a reasonable rule if people want to keep capitalist system healthcare. Its not stopping them competing, only applying a transparent and level playing field to the market.

Careful, next you’ll have death panels.

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#148

Post by refurb »

usefulcat wrote: post #116
mirimir wrote: post #82

Earlier quoted context omitted.

Even generics need FDA approval. Manufacturers must demonstrate therapeutic equivalence.

And in order to get that approval, you will likely need a sample of the product that you intend to demonstrate equivalence to. Good luck getting that sample from the maker of the incumbent product who has nothing to gain and much to lose if your product were to get approved.

Not being able to get a sample to prove bioequivalence is typically very easy. There are a handful of drugs that have a REMS program whereby the manufacturer is required to restrict access. We're talking maybe a few tens of drugs.

And yes, drug companies playing the game of "I'm not allowed to give you a sample" is super shady and ridiculous. Wouldn't surprise me if this gets fixed super fast.

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#149

Post by lostlogin »

thaumaturgy wrote: post #122
siquick wrote: post #113

Earlier quoted context omitted.

> If they do achieve lower costs through a new generics company, I do not trust them one bit to pass on the savings to patients. Why would they? As a non-American (UK and Australia citizen) it bewilders me that this is considered a possibility. Why are hospitals doing the opposite to offering the best care possible to all citizens? Are they for-profit in the US?

> Are they for-profit in the US? Yes, with few exceptions. Here's how this goes: "But if they weren't for-profit, then it would be more like Canada's or England's health care, and I've heard you have to wait months for anything over there. Also it would mean they wouldn't have as much money for innovation, and, y'know, the US has the best health care technology in the world. Oh, sure, only the rich can afford it, but…

One issue with the above.

> England

You mean Britain.

It wouldn’t be HN without a rant correction.

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#150

Post by refurb »

CoolGuySteve wrote: post #96
indescions_2018 wrote: post #61

I always assumed it would be CVS that got into the game. There are are probably a dozen or so drugs that account for the majority of consumption. Flu vaccines, blood pressure, cholesterol, thyroid, insulin, asthma, progesterone, beta-blockers, gerd, etc. Providing these at minimum cost, as well as community public health services. Could be enormously cost effective. And extend general wellness and productivity many t…

Aside from generics, Boots in the UK used their patent on ibuprofen to dominate their market. I’m always surprised there isn’t more pharmacy-driven research or investment into exclusive over-the-counter medicines to mimic that strategy, or bidding wars to get exclusive pharmacy rights to new drug patents so that firms can get halo effect shopping. (Not that I endorse this sort of corporate lechery, I’m just surprised…

Why would a pharmacy care? They typically make a margin on each drug they fill. The more expensive the drug, the more money they make.
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