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Comment by HighFreqAsuka | Hacker News Reader

Whenever I run into a doctor like this I just assume they're willfully ignorant because they don't want to rock the boat. How can you not be curious about such a large part of your profession?! It's a pretty negative signal in a person in my opinion.

I've spent considerable time tracking down why X costs Y, explaining it to a doctor, only to have the reply be "woah, you should tell people!" No, you should tell people, that's part of your job! Mind blown at some of these people.

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While I agree that this would be nice to be able to do, it's very difficult for a physician to figure this out in many care systems.

(1) the cost is intentionally not displayed to the physician when tests are ordered;

(2) the cost is not provided to the patient before services are rendered;

(3) the price being charged varies by insurance plan; and

(4) the number of different insurance plans is vast

How exactly do you expect physicians to be able to provide these estimates for each of their patients? There are certainly simple examples where the physician ordering a test is also the one providing it, but those simple examples don't really exist in major healthcare systems.

A lot of doctors are fee for service in Canada/USA. So especially in a clinic setting, they would know roughly how much certain procedures/consults impact their bottom line (i.e. how much they're getting paid). It's like a consultant not knowing their hourly billable rate.

Yes, I do agree that in that case, they can know the price. I tried to account for that in my comment. Having never worked outside of a major academic medical center, my impression is that this is not how most people get care, but I know my experience is limited.

Interesting, would you say your work compensation model at a major academic medical center is not the norm then? Most hospitalists I've talked to (non-academic) have told me they get paid based on volume

Physicians just have a different utility function drilled into their heads. I strongly disagree with this utility function but they really are trying to strictly maximize health outcomes for their patients. Knowing billing information would be unlikely to change care, so they aren't really interested in learning about it. If it might effect care then they would end up in court one day, because the law shares the same narrowly-defined utility function.

I wish they would, both to "rock the boat" administratively and to empower patients to include price sensitivity in their own choices. They already spend half their time arguing with insurance companies though.

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