I got a bill from the trauma center hospital for something like $500. Based on what I've been conditioned to expect from the U.S. health care system that seemed pretty reasonable. Then I got a bill from Northwell Health where I recieved no care for more than $800! Around that same time the NY Times came out with a piece about Northwell overcharging (https://www.nytimes.com/2021/03/30/upshot/covid-test-fees-le...). It took me months of badgering both my insurance company and Northwell to stop sending me payment delinquency notices.
Now, more than a year and a half later, they started sending me bills for that $800 again! So I'm very excited to see this kind of open source approach at this problem.
For a hospital, your care is not merely the interventional aspect of medicine, but also the vitals, diagnosis, charting, and time spent on reading your documentation by a medical professional with > 20,000 hours experience & training.
I have never in my life experienced an ER doing anything competent that remotely resembles reading documentation as part of triage. Why on Earth should they get paid more than a tiny nominal fee for the use of the waiting room and a bit of time spent by the triage staff?
"Terell's cousin is handy and while he's not the greatest he can probably get 'r done for more time and frustration but a lot less overall expense" is the nuclear option that caps how big a bag of dicks a shop can be.
Barrier to entry is low and they don't have an AMA cartel lobbying the government to protect them which helps a lot too.
Because you're a regular.
If you're not a regular customer of theirs expect a diagnosis fee that's about equivalent to half an hour of labor.
They also won't charge you a diagnostic fee if they know ahead of time that it is a service they won't provide like in the example. If I somehow end up at the tire shop for an AC service, they don't send me a bill 6 months later for an arbitrary amount just because they had to tell me that I need to go to the shop down the road for my issue.
I don't live in the states anymore, but I genuinely don't understand how any of this is legal. If I started sending out invoices to every client months later for services that they didn't know they were getting, with arbitrary prices, sometimes with egregious errors on them, I would expect a knock on the door from the authorities.
The front desk also had a menu of pricing options there for us to see - a rough cost of the entirety of the visit’s potential costs was glanceable right as you walked in the door. It was amazing, excellent, and I’ve never seen anything like it anywhere in the USA or Germany.
You can email me at du@50km.com .
In a world where you're not the primary payer.
The complexity of healthcare prices is an artifact of decades of negotiations between providers and insurers, with the added headaches of linked diagnosis and procedural dimensions.
IME the pricing is so overtly complex that transparency into it isn't going to make much of a difference, it's just going to create more questions. If you want simplicity, switch to single payer.
Medicine is one of the most well-documented, well-studied fields in human history. Every single thing a doctor does and charges for is stored and coded in an electronic system.
It blows my mind that my mechanic can give me an accurate estimate and they are legally bound to honor that estimate. However, my doctor can't even tell me how much my routine medications will cost.
When my wife had our first child, the hospital sent the placenta out for sampling without our permission. This "in network" hospital then billed us for an "out of network" expense on a decision they made without our consent. Same hospital also double charged us for anesthesia because they choose to have a CRNA and anesthesiologist in the room at the same time.
Thankfully, my wife works in healthcare so we called their BS. We suspect that this hospital is doing this to essentially birth.
Happy to see some movement on at least price transparency though.
We should also acknowledge that it costs money to deliver and we live in a resource constrained world.
I know the ship has sailed on this but it I continue to see people truly believe that they are not paying for health care and that sort of misguided understanding of economics shouldn't be encouraged as it makes it difficult to have coherent discussions about many different public policies.
College education should be free...
College loans should be free (even when they weren't when the loan was taken out)...
Income should be free (UBI schemes)...
It seems it's only with healthcare people forget the meaning of the word.
If you have to go to the hospital, that’s not billed to you.
If you see your GP, they charge you up front. There’s no copay as in the US system, the doctor just charges what they want. The doctor doesn’t keep any significant medicine on prem. If you need a vaccine, they write a script that you take to the pharmacy and return with. In either case, you submit your paperwork after the fact and get reimbursed. For office visits it’s 80% of the “reasonable and customary” changes. For medicine it’s usually 50-60%.
You can purchase additional insurance that covers more of these costs, but I didn’t see any value in it for my situation.
When I left, French insurance companies were setting up US style networks with doctors. If you saw an in-network provider, you were reimbursed more.
Only the truly indigent get “free” healthcare under the French system.
So my local hospital just does whatever and charges Medicare their CAH rates, doesn't matter a lot if they suck or could be cheaper, no one else can open a hospital (both by state law and because Medicare probably wouldn't agree to pay them).
Are you saying the majority of patient-practitioner encounters are emergency visits, or that the majority of spending is on emergency care, or something else?
But the biggest bills are probably near end-of-life, and mostly not emergency care.
Thus the ability to "shop around" and thus subjectivity of medical care to price competition definitely exists in the majority of cases. If the system were setup to incentivize and support this. But due to lack of price transparency and skin in the game, there is no competitive pressure on pricing in practice.
https://www.politifact.com/factchecks/2013/oct/28/nick-gille...
Most health insured patients can "shop around" in their network, which is a list of pre-negotiated priced providers that the insurance company has approved. Providers that are already vetted to be the lower cost for insurance, created through purchase power. And that's assuming it isn't an HMO, for which there is no shopping around.
There are not enough options for real market competition in healthcare.
There are obvious flaws in the healthcare system that are apparent from first principles. No need to blindly copy others.
Removing incentives for people to use the system efficiently leads to poor outcomes in different ways
Out of the frying pan, into the fire.
Believe it or not, you were raised by American education to believe this is the best country in the world. Take some trips, you'll change your mind if you get out into the world.
It's wild to me how folks will continue to support the predatory healthcare industry here.
Through competitive pressures which drive down cost and encourage increases in quality.
There is very little competitive pressure in healthcare from the consumer due to the issues already mentioned above
In fact, I think you'll find most of healthcare has already been captured by private equity, resulting in worse outcomes for the both doctors and patients.
Protectionism limiting the number of doctors inflates wages, lack of price transparency removes ability to comparison shop, max out of pocket plans remove incentives to consider cost in care. All of these are easy to solve once they're identified and understood as problems.
When you look at disciplines where pricing is transparent and insurance isn't generally involved, like cosmetics/plastic surgery, the costs are quite cheap. Because it actually acts as a competitive market with incentive for consumers to comparison shop
Or maybe. . . maybe you're talking out your ass.
https://us-uk.bookimed.com/article/where-to-get-cheap-plasti...
If you're not going to bother to be right about that, I can't take you seriously saying that our situation is trivial to solve, but that also the solutions that work in other countries won't work here. Call be crazy.
The problem with this legislation is that prices at one hospital are only useful in comparison to another hospital’s prices. Since the law doesn’t provide a facility for comparison, even the compliant hospital’s data is nearly useless. There needs to be a centralized database with compatible definitions for each procedure that allows consumers not just to see the prices, but to directly compare them.
this happened to me when I was hospitalized for a heart palpitation that matched a side effect for medicine I was on as an emergency that, according to the medicine's documentation, warranted a 911 call. I turned out to be fine, yet my insurance company decided I owed a couple thousand bucks for the ordeal.
I was doubtful and so when I got the bill (3 months later and very unexpectedly), I simply started making calls to get someone to justify me why it was my responsibility to pay the bill and not the insurance company's. The hospital said the insurance company already paid some ungodly amount of money for my bill and the bill was... some made-up clown world insurance company term. Copay, or payable, or deductible, or co-insurance. How many new daft words do they have today? This was 2015.
Insurance company just didn't have clear answers. I read the policy, it was vague enough that I was arguing that the entire hospital visit should simply be 100% covered, I'm guessing the insurance company didn't have a way for their support staff to make the legal argument they'd have to make if I just straight up sued them for it. That's probably the only way to get a clear answer: sue, and get them to trot out a lawyer to say the justification to me.
I honestly was happy to pay what I truly owed, I just wanted to make sure I wasn't overpaying, that's all. But lo, I lost the paper bill, and asked the hospital to send it again in the mail. They did, 6 weeks later. The account number on it was different than what I wrote down. I asked them to check. They sent another one, 6 weeks later, correct account number, my name mispelled. This comedy continued until the bill was sent to collections, a year after the original bill. The collections agency couldn't provide proof of debt, and it was sold again, to a different one. This one also couldn't provide proof of debt. 3 years later I'd still get random calls from some new debt collector. The original hospital had shut down, and so nobody could provably connect the debt they had bought with my phone number on it, to the identity of the person that walked into the hospital. I mean, honestly at this point I'm not even sure if there was a genuine mistake in billing: there's literally no way to know now.
Regardless, I never paid the bill, and this remained my strategy for the miserable few remaining years I had to deal with the USA healthcare system: just make some phone calls and the bureaucracy will get so tangled up in itself it seems I could continually just slip through the cracks unscathed.
Before anyone asks, nope, the unpaid bills never showed up on my credit report.