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Hospital prices are about to go public in the U.S.

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Re: Hospital prices are about to go public in the U.S.

#201

Post by mirimir »

eitally wrote: post #174
mirimir wrote: post #49

Earlier quoted context omitted.

In my experience, Russia had a decent healthcare system in the Soviet era. Care was (obviously, I guess) pretty much free. Most physicians were female. And most of them were apparently driven by moral conviction. The US was rather a shock for me. Costs were mind-boggling, and most physicians struck me as jerks. At least, the male ones did, and they predominated. Nurses, on the other hand, generally seemed OK. Somehow…

This is anecdotal. To counter, my family have had very good overall experience with physicians in the US. Moreover, my college friends who went on to become physicians are all people I'd happily take my own family to see. One of the problems with care in the US are clinics that treat Drs (and NPs and PAs) essentially as billing machines, and don't allow them any time to build any rapport or relationship with patients…

Yes, it's just my experience.

For what it's worth, my experience teaching premeds was also not so great :) That's also anecdotal. But colleagues had similar complaints.

Also:

> And we fail to recognize that what we really have is a distribution problem. Parts of this country have lots of doctors, perhaps too many. ... A result is that many rural areas, and less popular cities, experience more of a doctor shortage than others.

> The other distribution issue is in specialization. When it comes to generalists, we ranked 24th of 28 countries in doctors per 1,000 people. Specialists are a different story. There, we were 11th. This is an important fact about the American health care system. We sometimes hear that we have too many specialists and too few generalists. That’s not necessarily the case. We have an average number of specialists compared with other advanced countries, and even shortages in some specialties. It’s the ratio of specialists to generalists that’s the problem. When you compare the percentage of physicians who are generalists with those who are specialists, the United States beats only Greece among developed economies.

> Here, financial drivers play a role. Doctors who choose to specialize can make much more money, millions more dollars over a career, than primary care physicians.

https://www.nytimes.com/2016/11/08/upshot/a-doctor-shortage-...

Also see https://www.politico.com/agenda/story/2017/10/25/doctors-sal...

Re: Hospital prices are about to go public in the U.S.

#202

Post by lettergram »

codingdave wrote: post #176

I'd be happier to see regulated business practices. While I agree that the prices are a problem, I've felt more pain from bills that keep coming in for more than a year after a major event. And when I go to complain, they say that someone made a mistake, the insurance took a long time to respond, or some other excuse. Give me a final bill with all charges within 30 days, then 30 more days to resolve any issues with t…

One thing that troubles me, is the hospital near me does the same thing, but "consoladates the bill". This literally is just a never ending fee that increases and they never list for what.

Every single month I call and they give me the run-around. After 6 months of this, I have yet to pay the full bill until they mail me an itemized list and without fail it's wrong. I contact them, they remove two or three charges, I ask them to mail me the updated one. They do, then next month I receive a bill for those proceedures they removed the last time.

Its to the point every month my bill now goes from $0 to ~$800, then back to $0 by the end of the month. Unfortunately, they now called and threaten the ~$800 "over due bill" to collection's. Luckily, I've recorded and documented everything, so I got it removed (again).

However, I'm just waiting for this to go to collection's at some point, even though I owe zero at the end of every month. I'm 90% sure this is a bug in their system, but I can't seem to get around it.

Having worked for a medical billing office, I hate to say it, but this is the norm. The billing office is often not officially the hospital or medical practice. Although we got all the records, we never really interacted and it was just files on a computer. I used to do write-offs, which was basically taking $10m a day and just clicking "don't need to pay". Usually it was dead people, poor, etc. At least that part of the job seemed somewhat nice.

Re: Hospital prices are about to go public in the U.S.

#203

Post by LeftTurnSignal »

codingdave wrote: post #176

I'd be happier to see regulated business practices. While I agree that the prices are a problem, I've felt more pain from bills that keep coming in for more than a year after a major event. And when I go to complain, they say that someone made a mistake, the insurance took a long time to respond, or some other excuse. Give me a final bill with all charges within 30 days, then 30 more days to resolve any issues with t…

The part I love is when the insurance company points the fingers at the clinic, and clinic points fingers at insurance for how long the whole thing takes, meanwhile I get sent to collections.

/now I pay a few dollars (no matter if I owe something or if they owe me) near the end of the 90 days those two companies have to figure out how much I owe so I don't have to deal with collections.

Re: Hospital prices are about to go public in the U.S.

#204

Post by giancarlostoro »

codingdave wrote: post #176

I'd be happier to see regulated business practices. While I agree that the prices are a problem, I've felt more pain from bills that keep coming in for more than a year after a major event. And when I go to complain, they say that someone made a mistake, the insurance took a long time to respond, or some other excuse. Give me a final bill with all charges within 30 days, then 30 more days to resolve any issues with t…

I've heard of why the insurance companies usually take a while, something to do with HIPAA and some insurance companies being bought out, so now they have to forward information back and forth, all whilst remaining compliant. At least something along those lines is what someone from HR at my company (not related to the medical industry) was telling us one time. I wasn't able to find a good article on it though sadly.

Re: Hospital prices are about to go public in the U.S.

#205

Post by sharemywin »

Now if we could just get some kind of all payer system in place. so everyone pays the lowest prices offered. but I guess its a start. The problem is there's not enough competition and not enough schools and we don't allow doctors from other countries to test to become a US doctor. with out basically starting over.

https://innovation.cms.gov/initiatives/Maryland-All-Payer-Mo...

Re: Hospital prices are about to go public in the U.S.

#207

Post by assblaster »

___alt wrote: post #196
assblaster wrote: post #189

Earlier quoted context omitted.

I'm so glad I live in the United States, arguably the greatest country in the history of the world.

US is a great country for many things, but having any serious health problem putting you in financial jeopardy (or throwing you in an inextricable administrative maze to dodge high and cryptic charges) in ridiculous for a "great" country. Having a life-threatening condition is already scary enough that you don't also have to dread bankruptcy at the same time.

If you have any life threatening condition, go to the ER of any of your local hospitals and receive great medical care.

If you didn't pay for insurance, you'll pay for the services rendered directly.

People buy car insurance and home insurance and life insurance and disability insurance to pay for catastrophic incidents related to those things.

Health insurance should similarly be for catastrophic events, but unfortunately it's come to be responsible for all care, even routine care. The introduction of third party payments is a root cause of pricing difficulties.

Outside the United States in many of these "single payer" countries, you will have rationed care, whether that's in use of archaic procedures or medicines, or waitlists, or outright denial of service.

At least in the United States you can get whatever you need without much waiting.

Re: Hospital prices are about to go public in the U.S.

#208

Post by vxNsr »

nicoburns wrote: post #181
QuantumGood wrote: post #129

Earlier quoted context omitted.

We had to pay our ~$8,000 deductible, everything above that was covered. We paid by negotiating a one lump sum payment and got 25% off. Had a relative with more cash flow make the payment all at once then paid them in installments. Was told by a doctor later that they only get paid 75% of what they bill by the insurance company, and that considering that, the 25% discount made sense. Tried for a 30% discount but 25%…

> We were able to pursue some things we probably wouldn't have otherwise. Simple things like having more cough syrup on hand became a no-brainer as cost of visit and prescription was guaranteed to be $0 This is one of the big upsides of always free at the point of access healthcare like we have in the UK. Although there is some inefficiency, in practice I beleive it actually lowers the total cost of healthcare as peo…

Someone recently pointed out here that in the UK you still have pox parties because the chickenpox vaccine is considered too expensive by NHS. So that's another way to lower costs, of course you now have a 20% possibility of getting shingles and dealing with that pain.

Re: Hospital prices are about to go public in the U.S.

#209

Post by neffy »

peteretep wrote: post #73
feanaro wrote: post #71

Earlier quoted context omitted.

That still doesn't explain how prices of medical services in many other countries turn out several order of magnitudes smaller than commonly encountered prices in the US.

Are the prices that Medicare pay orders of magnitude different? ISTR that Medicare and the VA both pay about $10k per patient per year, which I think is comparable with the NHS. No sources as this is half-remembered.

US health spending in aggregate is between 2-3% more than comparable European countries. Life expectancy is several years lower.

Re: Hospital prices are about to go public in the U.S.

#210

Post by Holybeds »

karmelapple wrote: post #195

I was in a hospital in Singapore recently, and the prices for doctor consultation fees, staying in a room, and even certain tests were listed right at the front of the emergency room desk. After the patient I was with was stabilized, the nurse confirmed with us verbally what the rough cost should be for the rest of what the doctor prescribed, and asked if we wished to proceed. We could have said no and gone elsewhere…

Where I live you know the cost before you go to the doctor since you will only pay a symbolic sum of 30 USD even if the visit ends up with something like a life long cancer treatment. If you need medicine you will pay at most 120 USD per year regardless of the costs.

The idea that your access to healthcare should be linked to your own or your parents financial is crazy.

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