Just curious why are MRI and CT machines so expensive? They are the ultimate tool for debugging the human body. Shouldn't they be very affordable?
An independent lab, owned by the head of radiology at a hospital in another County, was $268 USD if paid at time of service, cash or credit card.
He used to have several locations, but the other hospital bought out all the locations near them. And closed them almost immediately.
Perhaps any acquisitions in the field of medicine should be subject to antitrust laws?
The Chargemaster rate is the same no matter who you are, the different is what people pay from the chargemaster bill. Let's say you are given tylenol and the charge master is $50. The reason why this is so high is because medicare will then say that they pay , say, 20% the chargemaster rate, and thus elderly patients pay $10. This is why elderly patients are seen as great patients for revenue: They all actually can pay something, even if its only a fraction of the chargemaster. A gold plated insurance patient will pay Medicare+30%, and thus the gold plate insurance pays $20. The patient with no insurance then is also billed $50 because they don't have an agreement with the hospital. Thus, what likely happens is that they pay $0 and goes bankrupt, or more likely, these patients don't have any net worth at all. This creates a weird situation where the homeless, destute, and people with no net worth essentially get infinitely free healthcare. These patients tend to be very high volume healthcare users (homeless patients that take $5000 ambulance rides as taxis because they know they will never actually pay a penny, despite having millions of dollars of charges.). This is what the Affordable Care act tried to prevent: by making people pay something, you were actually decreasing costs for all because you remove free riders who present the majority of sunk costs in the healthcare system. Very few people if ever pay for the full cost of a procedure or chargemaster. The chargemaster is a negotiation tactic. Not a final bill.
That is why a CT Scan costs thousands of dollars. Because everyone knows you'll only end up paying a fraction of that if you have insurance. And if you pay cash, its only a few hundred bucks, because thats how much people get paid anyways.
Source: I'm an ER Doc.I do research in healthcare and billing
In Finland, unsubsidized, undiscounted and no questions asked, just pay prices for scans from a private health company are 258€.
Expensive, yes. Crazy expensive, no.
Fundamentally, they don't need to be expensive; via private medical tourism, you can get any sort of scan at a fraction of the US cost.
The combo means docs, drugs, treatment, and insurance are all more costly.
A fix is hard to come by but would work something like this.
1)subsidize the cost of medical school increasing supply of MDS 2)pass laws to protect physicians from frivolous lawsuits or at least limit damages. 3)disallow drug companies from advertising, ban rampant kickbacks to doc's that prescribe their drugs 4)ban anti competitive practices that prevent insurance companies from negotiating prices directly with manufacturers. 5) provide healthcare centers of last resort(the ER) compensation for patients unable to pay.
My last point is state specific and really controversial but it's based on what I've personally seen.
States with a lot of illegal immigrants spend an enormous amount for healthcare at the ER for these people. Around 1/4 of the people that came into the ER I was familiar with were likely illegal and over 90% either gave a fake name or never paid. The majority of those costs are passed on to those with insurance. I lived in an area with probably 3% of the population were undocumented.
Since the ER is healthcare of last resort they are forced to treat you even if you give them completely false info with no intention of paying. Illegal immigrants know this and preferentially go to the ER because they get treated without probing questions or need to pay. They also already have fake ID's in most cases so giving one to the hospital isn't a big deal. This enomous cost gets buried because it's politically unpopular to say and because the hospital just raises prices in everyone else to compensate.
We're already paying out crazy amounts for doctors time and for expensive visits, might as well make the basic health checks free. No need to bring insurance in on matters like just having a doctor write "you have the flu. Rest 4 days and take this" when the entire operation is 15 minutes for a quick culture.
Won't help - the constraint is that the AMA is a closed shop (same as the BMA in the UK) and won't allow the market to be flooded like that.
Meanwhile we computer folks sit back and let outsourcing and offshoring eat our industry.
Several US states have harsh caps on medical malpractice damages. They still see massively-rising medical costs. And in uncapped states the rate of growth in malpractice damage awards hovers very close to the rate of inflation of the US dollar.
Which sort of destroys the argument that "frivolous lawsuits" and massive damage awards drive medical costs in any significant way.
I used to believe in caps, but I think we could do better than that. Create a no-fault insurance market that pays people without the hassle of civil trials. That has the potential to allow medical professionals to be more open and honest about mistakes they make (similar to the aviation industry). That, in turn, would allow for data-driven decisions about how to make the biggest improvements for the lowest dollar amount.
Oh, and while we're at it, how about a self-driving unicorn that runs on rainbows...
I used to know some people in healthcare tangentially and the answer is $50,000 to $250,000 A YEAR depending on specialty etc.
Sometimes the practice will pay these costs for you, so the doctor might not be paying it directly but the money is coming from somewhere.
My friends told me malpractice insurance was generally about a third of your salary. And this includes people like pharmacists and physicians assistants too. So if much higher than world average doctor salaries in the US are any part of the reason for high medical costs, lawsuits are a third of that
Call a person who has lost their child to a doctors mistake and see how the 'protection' has worked out for them.
And... inflates at a rate which appears to be completely unrelated to malpractice damage awards. So calling for caps and limits on malpractice suits would not solve it.
also, keep in mind that the factor that matters the most for practice patterns (especially defensive ones which drive up cost) is not where a doctor practices, its where a doctor trains. Since most doctors train in high risk litigation environments, and most standard of care procedures are developed with defensive practices in mind, the standard of care is high cost high utilization medicine.
Source: ER doctor
The rat's nest of business entities makes it impossible to figure out where the money is going, or who is making how much. That way, everybody can point the finger at somebody else. I suspect a reason why medicine costs less in countries with nationalized systems is that it's possible to figure out where the costs are going.
I'd favor a system where medical school is free, and doctors work as employees of the government.
There's a law called EMTALA which is basically an unfunded mandate that says, in part, we can't just turn away patients because they can't pay. This was because slot of hospitals (university of Chicago in particular) were dumping or transferring patients to other hospitals who couldn't pay and making huge news stories. As you mention, this means people who can’t pay get free health care.
Who does this end up being? Almost 100% alcoholics and homeless patients, often with severe mental illnesses. When there are no resources for them, they end up taking ambulance rides to the ED, say they have Chest pain, and then we give them thousand dollar workups that you end up paying for. Illegal immigrants at large county hospitals are often grateful for any care and usually actually do end up paying at least some portion of their bill, and often are not super high utilizers.
For example, do you know who the number #1 utilizer of NY state medicare dollars is?
http://nypost.com/2009/07/12/hosp-itality-abue/
Trust me, if hospitals could sort out paying from non paying patients they'd do that in a heartbeat (if they have one). There's lots of programs that try to draw those sorts of patients in, like international elective procedure patients and elderly patients who are universally paid for by Medicare.
Or monopoly economics and market power. There's been a huge amount of consolidation in the healthcare sector in the last few years.
In other news if we just cut some of Comcast's red tape, prices for sure would fall.