How shall emergency rooms operate? Also, how shall people make an initial determination on care when no diagnostics have yet to be performed?
Not all emergency room decision-making happen with blood pumping out of your pulmonary artery. There are parents who take their babies to ERs, and through repeat business decide to like one better (maybe because it's cheaper, maybe because it's a bit more expensive, but never have any waiting time) than the other. There are consumer reporters who will look into why one hospital is cheaper than the other. Smart phone "Yelp for hospitals".
EDIT: Forgot the conclusion: This will drive down prices in the general case, which will also result in lower prices for the emergency case, even if in an emergency you don't have the luxury of calmly evaluating all the options.
> Also, how shall people make an initial determination on care when no diagnostics have yet to be performed?
The same way you decide which restaurant to go to before you know exactly which dish to have: Ranking by a general cost/quality scale.
But maybe I'm projecting, since my experience with ERs tends to be "Oh shit... get me to a hospital now Google Maps" rather than "I should Yelp some reviews of hospitals, because I have time."
Some people will live 10 minutes from one ER and 45 from the next. But some will live 25 from one and 30 from another. Or have three within 15 minutes (ie. short enough that they're equidistant for "the baby has colic"). Some will have more time than money and drive 45 minutes if it means saving $20.
But there's another factor in free markets you're not accounting for: new entrants. If an ER charges high rates because they're the only player in the area, someone could set up a competing ER and charge less.
I'm not in the medical industry (but my g/f was seeking out her own insurance recently), but I would guess that the ER would work similar to a car mechanic. Where the paperwork you're already signing upfront includes a flat price you're paying for diagnostics. Then after the diagnostics (or possibly at the same time you signed the diagnostic paperwork), you agree to a price range for treatment/tests. It would itemize the fixed costs and estimate the variables. If things go outside of that range, there's an amendment. You walk home with the bill.
etc etc.
That way patients can ask the doctors if the tests are actually needed.
You're right that emergency care becomes a lot more complicated.
I really think a big part of the problem in healthcare pricing is insurance company policies regarding networks and guaranteed volume. Your auto insurance doesn't demand you use a certain body shop, why should your health insurance?
Here's a practical example that recently came up for me. My wife is a nurse at a few clinics. At one clinic, she's got health insurance and that clinic provides IUDs via their hospital, which she wanted to get. At this clinic, the price billed to her insurance would be $4700.
At another clinic she works at, she could get the same IUD brand and procedure for $600.
When she asked her insurance about it, they said they would pay 100% of $4700 in-network but 60% of $600 out-of-network. Obviously, being selfish, she decided to let the company eat the $4100 they would otherwise save so that she would pay $0 instead of $240.
It may well be they paid less than $600 for a procedure that lists at $4100.
And of course the government numbers don't take this into account, so what they've published is pretty much worthless.
I don't disagree with you that insurance companies negotiate different discounts, though, which is what I was trying to get at in my post regarding pricing.
You know what is wild though? Federal employees aren't insured by medicare but instead the federal govt pays private insurers to insure them!
If the Feds went to single payer for its employees, things would change quickly.
How does this work? If a doctor prescribes a blood test, he's already said it's needed. Put yourself in a doctor's shoes for a minute. You told the patient he needs a blood test. Then he asks you whether it's actually needed.
How can you possibly say "Nah, just kidding. We don't need that one"?
If they have absolutely no idea what the possibilities are then they wouldn't be ordering tests anyway.
No they don't, except in very rare cases. Doctors order tests to make a diagnosis. The treatment follows from that.
>If they have absolutely no idea what the possibilities are then they wouldn't be ordering tests anyway.
I'm not sure a doctor would have "no idea what the possibilities are" unless you don't have any symptoms. If you don't have any symptoms, why are you at the doctor's office?
What I said didn't contract what you said. If test => diagnosis => treatment then test => treatment.
I don't believe that. Over the years I've had to fight to get tests that turned out to be important, and I'm suspicious of government studies showing "overtesting" right when the government is in the process of taking over health care.
You can certainly eliminate a lot of testing without affecting mortality rates significantly. But that's because in absolute terms a lot of extra people have to die before mortality rates are affected significantly.
Right.