WhiteCoat

Focus On The Cost

Yeah, I agree with Howard Fineman. You got a problem with that?

Read his Newsweek article about his experiences being admitted to an Argentinian hospital and how he believes we should be focused on the costs of health care in this country.

His bill for a hospital stay with dehydration in Argentina: About $1500. Similar hospitalization in the US: $10,000 to $15,000 – if he was lucky. Money quote: “Most Americans have no idea how much their health care really costs, nor do they know how well it really works ….”

We desperately need price transparency in our health care system.

Look at the four systems in Pennsylvania that I reviewed in a previous post. If one hospital cost 4 times as much as another hospital for treating the same medical problem, would that affect anyone’s decision on where to go for medical care?

One commenter to the article noted that “Health services are often urgently needed and the consumer doesn’t have the time or inclination to shop around.” If people shop around for weeks to find the best deal on a car and spend all Sunday morning going through newspaper ads to find the cheapest head of broccoli at the grocery store, I have no sympathy for those who “don’t have the time or inclination” to research where they would want to go if their life was on the line or if they needed specialized surgery.

Regardless of what health care reform measures are taken, we still need to be educated consumers with our most important assets – our lives.

39 Responses to “Focus On The Cost”

  1. Soronel Haetir says:

    One problem I see with this argument is that the incremental value of even marginally ‘better’ (or even the perception of better care) is high for many people. That is many people would be willing to pay much more for care that is only somewhat better. Making this even more complicated is that medical services are extremely difficult to judge on quality. Look at the arguments here and elsewhere if you want proof of that, your own administrators don’t seem able to do it in a reasonable manner.

    So you end up with a situation where perception of quality is a huge determinant in where people go and yet price itself ends up being a proxy for that measurement.

  2. Meghan says:

    If patients wish to pay more for better care, or perceived better care that’s fine; they are paying for it. However, I am currently paying for health expenses out of pocket (decent job but no insurance…), and there is NO price transparency. Trying to price out a procedure is a nightmare. One hospital gives you a price, but then mentions that it doesn’t include X, Y, or Z. For those figures I would have to call other people; the surgeon, anesthesiologist, etc. Another hospital will give me a quote, but specify that this doesn’t include any post-op care… I am pulling my hair out. Please can we have price transparency.

  3. Matt says:

    Until there is no third party payor system, costs will not be contained by the patients. Or the physicians for that matter.

    Costs will be contained by the payors. No one else has the incentive to do so.

  4. Ed says:

    If I get nailed while crossing the street I am not about to ask the ambulance to drive to several different hospitals so I can do some comparative shopping.

    Not that I have much choice where I am. It is the local hospital or an hour drive to the next nearest.

    • WhiteCoat says:

      If you get nailed while crossing the street, you have to take the cards you’re dealt. However, if you need a hip pinning after you have been stabilized, you can certainly request to be transferred to a different hospital where the care might be better and/or cheaper.
      If you could save $40,000 being treated at the hospital an hour away (see the wide price discrepancies in the referenced post above), would you make the trip?
      You’ll never know about the price disparities until you become an educated consumer.

  5. NormD says:

    This should be obvious to anyone who thinks agout it.

    1. People all over the world want the same things we want: cars, iPods, TVs, food, Healthcare

    2. People in most countries cannot afford to pay as much as we do.

    3. Suppliers who service the other countries will figure out how to supply people at a cost they can afford.

    4. If we are smart, we can take advantage of the lower priced goods and services. We do for many manufactured goods, but we don’t for many services like medicine.

    The problem with US healthcare is not figuring out who should pay for it. The problem is that we pay far too much.

  6. ERP says:

    People ask me “how much will it cost to get my hernia fixed here?” I reply, “you have no way of knowing until they send you the bill”.

  7. DensityDuck says:

    Ah-heh. I’m reading the part where they don’t have a water-tight dressing for his IV site, and they kludge something together out of a rubber glove and a couple of Band-Aids. This is presented as a wonderful example of money-saving improvisation. If this were the US, we’d be telling the exact same story as a woeful example of desperate responses to cost-cutting…

    • WhiteCoat says:

      Instead people willingly pay significantly more money for some duded up rubber glove and extra special adhesive in cool packaging to cover their IV site – because the money to pay for it doesn’t come out of their pocket.
      If you had to pay out of pocket – 10 cents for the glove or had to pay $5 for the specialized cover – which would you choose?
      We are in a position where many people need to take desperate measures.

  8. Guaiac says:

    Not only is there no transparency for patients but none for physicians as well. Working in toxicology I was curious to find what the actual billed cost of Crofab (snake antivenom) was. The wholesale acquisition cost is little less than $1000 a vial. Typical treatment can involve anywhere from 4-20+ vials. I was rather rudely rebuffed and informed that I was not authorized to have such information by several people, enough so that I gave up. The same applies, I suspect, for something as simple as an EKG.

    • CroFab User says:

      My husband was recently bit by a copperhead and was treated with 4 vials of CroFab at our local hospital. I just received the itemized bill that I requested.. a whopping $14,900 for 4 vials (that comes to $3,725 per vial) Just thought you might would like to know since you had such a hard time finding out.

    • Mara says:

      My son was bitten by a copperhead snake in Texas. I am self employed and currently paying for maternity care for my daughter since private insurance no longer covers maternity at ALL. During this lapse in private insurance for my son and I, he got this snakebit and CROFAB was administered. I had heard some nightmare stories but nothing like the bill I received which now sits at a total of $68,000!! The CROFAB has a lot of adding and subtracting lines of different amounts. When i finally did the math, I am being charged for a qty of 10 which adds up to $59,975.00!!! My son had 4 bags total of this stuff and was in the hospital from midnight on a Sunday night until 5pm on Tuesday. This is absolutly UNBELIEVABLE and I really would like to know if there is ANYTHING I can do about this outrageous bill!! Surely there is some legal protection out there. This liquid cannot possiby cost $6000 per vial if that is what the qty means.

      • Ed Julian says:

        My niece was bitten on big toe April,2011 in Georgia. The hospital, Kennestone, charged her over 8,500.00 per vial of CroFab for a whopping bill of over $112,000.00!! 2 nites in hospital; she had to demand release! During course of applying for assistance, they arbitrarily turned her over to collection atty. She’s from Nicaragua
        where 31.00/month covers both health and social security FOR THE FAMILY!

  9. Doc99 says:

    Ms. Chana Joffe-Walt and Mr. David Kestenbaum
    All Things Considered
    National Public Radio

    Dear Ms. Joffe-Walt and Mr. Kestenbaum:

    Your excellent February 26, 2010, report on the history of how government officials chose the different methods that Medicare has used over the years to determine doctors’ pay is frightening because…

    … in your report, Joe Califano, a chief architect of Medicare, admits that the first method of determining doctors’ pay was chosen for political reasons, namely, to buy doctors’ support for Medicare.

    … you report that Mr. Califano, LBJ, and Congress were genuinely surprised by the rapid cost increases sparked by this first method.

    … you reveal that much of the treatment that Medicare paid for was previously provided free by physicians; that is, Medicare crowded out a sizable chunk of private-sector philanthropy.

    … you tell how attempts to change this first method of paying doctors were deeply influenced by skilled lobbyists working on behalf of doctors.

    … in describing the development of the method currently used for determining doctors’ pay, you (perhaps without realizing it) reveal that this current method is the product of a comically childish labor-theory-of-value analysis – the same sort of analysis that is at the foundation of Marxian economics.

    … your report ends with the admission that, because the current method isn’t working so well, Uncle Sam – 45 years after Medicare was launched – is still searching for a sound method for determining physicians’ pay.

    Given this history, what reason is there to suppose that Obamacare is a good idea?

    Sincerely,
    Donald J. Boudreaux
    Professor of Economics
    George Mason University
    Fairfax, VA 22030

    http://cafehayek.com/2010/02/open-letter-to-two-npr-reporters.html

  10. DefendUSA says:

    I think I have said this before. When I “needed”(read defensive medicine) an MRI, I could not find out the cost of what it would be out of *my* pocket.

    At the time, I was DX’ed with a sacroiliac joint inflammation that was not treated with typical generics or muscle relaxers. I opted for PT because I could afford fee for service. Three local practices refused to tell me the cost of an MRI.

    It’s a pisser, for sure.

  11. Anonymous says:

    Best solution IMO is to do like my university campus health does…you get a menu of services provided with the cost right there next to them.

    “If one hospital cost 4 times as much as another hospital for treating the same medical problem, would that affect anyone’s decision on where to go for medical care?”

    I’ll answer this as a lay person. I broke my finger and I opted for the best orthopedic hand surgeon in the city to fix it. Cost way more than it would have cost to just cast it and let it heal deformed, but it’s more than worth it to have a healed finger that was fixed so perfectly you can’t even see the fracture on xray anymore.

    So the answer is yes and no. Yes, I’ll shop around for prices on routine stuff like physicals and dental appointments, but for important stuff I don’t want to penny pinch.

    • WhiteCoat says:

      Your finger fracture example is exactly how the system should work.
      You want the best car, you pay more at a luxury care dealer.
      You want the best meal, you pay for the best restaurant.
      Want the best surgeon? Find the one you like and pay their fee.
      I realize that emergencies and some highly specialized urgent procedures are excepted, but this is the model we need to move toward.

  12. throckmorton says:

    DefendUSA:

    Part of the problem with why you could not find out how much it would be out of your pocket is because the you are dealing with a insurance issue. If you pay cash, you can call around and not only get prices you can negotiate. As you must know, with insurance, the cost is negotiated between the insurance company and the provider, not the patient. This is the problem. Have you ever seen a hospital advertise a sale on total hips? You wont. All the negotiating occurs between the hospital and the insurance company. The patient is stuck with the difference.

    When you separate people from their money, their money gets wasted. Health insurance is like income tax. They both take your money and people think they get a great deal when they get some of it back. One of our medical centers has done well marketing itself to Canadians and Europeans by offering total joints. This is cash pay and concierge. These patients will go where they can get the best deal.

  13. Joe says:

    WC,

    I know you’re a very smart person. But your comparison of shopping for healthcare to shopping for a head of broccoli sounds incredibly naive.

    I tried to shop for medical care back when I didn’t have insurance. I would ask how much something would cost, and they would refuse to tell me over the phone; I would have to make an appointment to see the doctor (at $80+) just to get a price. Also, I would have to sign a paper promising to pay whatever price they decided to bill. When I asked the doctor, the inevitable answer was, “Ask your insurance company.” When I specified that I would be paying cash up-front, they would say that they really didn’t know what they would charge.

    If this is how you shop for broccoli, I suggest you try a different supermarket.

    I don’t mean this personally, because I respect you, but I think it’s really irresponsible to perpetuate the right-wing myth that it’s the patient’s fault when they don’t know the price of their care.

    I think a good first-step solution would be to require doctors to publish price lists for their services, and to forbid them from charging private-pay patients any more than insured patients pay for the same service. This would establish price-transparency and reduce the influence of monopolistic insurance companies, both of which are antithetical to a free-market system.

    • WhiteCoat says:

      I wouldn’t write this blog if I couldn’t accept the notion that people would disagree with me. I don’t take anything personally when people question my assertions, so don’t be afraid or ashamed to do so – just ask Matt.

      I agree with you that prices are difficult to get from many facilities. That’s why I think we desperately need price transparency in medicine.

      The inability of patients to obtain this data is multifaceted. Part of the problem may be that patients just don’t know how to go about finding prices.
      If you go to my “Other Useful Links” page in the upper right corner, you’ll find a link to an AMA site listing payments that physicians accept from Medicare for many procedures. That will give you a starting point.
      If the hospital/doctor will not provide you with a price in advance, then you have several options.
      You can go to your state legislator and raise the issue. Perhaps you can get the ball rolling in your state to create a law where medical providers are required to disclose their prices.
      You can confirm that they refused to give you a price in advance and then raise a consumer fraud issue when they bill you excessively. Most state consumer fraud statutes allow complainants to receive attorneys fees, so filing such a complaint may cost you nothing.
      You can go to court and argue the charge. If they call to collect some outrageous sum, state that you will agree to pay them whatever they charge Medicare as a reasonable rate. Pay them that amount and no more. Dispute any excess as being unreasonable. Disputed charges can’t go on your credit report. A contract in which there are indefinite terms (such as “I agree to pay you everything that you charge me”) is unenforceable. Even if it was enforceable, any discrepancies would be decided in your favor since you were not the party that created the contract.
      If they try to get you to sign something stating that you agree to pay whatever they decide to charge you, write “hospital refused to disclose prices to me prior to providing services” on the margins of the contract and keep a copy for your records. Such an agreement is void on its face.
      Unfortunately, my experience has been that not many people even try to obtain pricing information from hospitals and don’t care about the costs because the costs of care don’t come out of their pocket.
      This mindset has to change.

      • Matt says:

        Why would the mindset change if the payor doesn’t change? As long as the buyer (the patient) and the seller (the physician) aren’t negotiating the price of the service, neither has an incentive to change.

        It doesn’t all lie with the patient. As the recent article discussing the advent of Medicare and getting docs onboard noted, physicians are no more interested in cost control than anyone else.

        You guys talk about the Medicare cut as if it’s the end of the world, and it definitely hurts, but at the same time, welcome to the economy. You’ve had guaranteed raises in good times and bad because the government was paying. Every year you banked on an SGR “fix”, rather than considering this is the year it might end. Well, it finally did.

        You say overhead costs are going up, well, cut overhead. That’s what everyone else in the real world does. I realize that’s easier said than done, but all of us who run businesses do it. Sometimes we even have to lay people off, which sucks, but we do it. And we don’t run to the government (well, unless we’re an investment bank, and even they had massive layoffs) to give us more money.

        You guys say you want more free market – well, that’s part of it. It ain’t all upside.

      • Matt says:

        Here’s the article I was referring to, which discusses how docs got on board with Medicare:

        http://www.npr.org/templates/transcript/transcript.php?storyId=124090475

      • WhiteCoat says:

        The payor is the patient. He doesn’t have any insurance. Read his comment.
        More and more people are going to find themselves in this predicament with job losses and increased insurance premiums.
        More and more people will turn to states for help, but as state budgets go, so go state services.
        Overhead is also being cut in many aspects of emergency care. Medical providers are doing what they need to do to survive.
        Just had a meeting today with representatives from several large medical groups. They’re cutting back staffing in hospital emergency departments to stay afloat. Guess what that will mean …
        Only so many people can fit in a safety net before it breaks. Just hope it isn’t busy when you have your emergency.
        The paradigm will change. Unfortunately I think that many people will die before the paradigm changes. But it will change.

      • Matt says:

        ” Unfortunately I think that many people will die before the paradigm changes. But it will change.”

        Little dramatic, don’t you think? Considering how often physicians say that “how can you be sure if X or Y was done they would have lived anyway”, it’s amazing you would go to the “if X or Y isn’t done people will die” claim.

        However, I don’t know why you think that politicians will let people die. Or let them start paying out of pocket for healthcare. Nationalizing you is much easier than telling a baby boomer on a fixed income that the fixed income just got a little less discretionary because Medicare is scaling back and they’re going to pay out of pocket.

      • Joe says:

        WC,

        I don’t think that the problem is that patients don’t know how to go about finding prices. I think that the problem is that the procedure for finding prices requires resources that the average patient just doesn’t have. For example, I went to the website you mentioned. In order to find out how much it costs to fix my RSI (for example), I need to know the CPT code. Now, I’m a fairly highly educated guy, but I am not at all confident that I could figure out the CPT code for “My arm hurts” — I think that requires medical knowledge. Even if someone were to tell me that I need XYZ procedure, well, I might be able to figure out the CPT code for XYZ with my google-fu, but I have no confidence that Bob the Factory Worker would be able to.

        You list several ways for me to dispute unreasonable charges. What I think you’re missing is that they all require a substantial investment of time and effort and emotional energy that most people, especially sick people, just don’t have to spare. Filing complaints? Going to court? You compare all this to buying a head of broccoli?

        People that I know have other important things going on in their lives. They work long hours, some at multiple jobs, and they’re getting by on $23K/year. They’re dealing with all the details that seem so trivial when you’re making $50K+ — expecting them to file a court complaint (and skip work to go to court) every time they see a doctor is just absurd.

        I’m surprised that you’re not more familiar with the “you will pay what we decide to charge” contracts — I’ve had to sign one at every medical provider I’ve seen in two states. Of course, they don’t say “whatever we decide to charge”; they call it the “UCR” rate, which is anything but U, C, or R. I doubt that they would permit modifications or write-ins in the margin.

        Isn’t it possible that the people who don’t even try to obtain pricing don’t do so because they know that asking will be futile? That’s why I no longer ask — and despite my now having insurance, I still pay for the majority of my care out-of-pocket.

        I really think you are laying too much blame on the patient here. I think that patients should be expected to show an interest in keeping costs down, but beyond that the onus is on the doctors and insurance companies to give patients the information they need to make informed choices.

      • throckmorton says:

        Joe:

        I am suprised that you couldn’t find out prices. We quote prices everyday to cash pay patients. In our area you can call to any number or places and get a price for a cash pay chole, lumlam etc. These include facilty fees, anesthesia and surgery. The only resource needed is a phone or an ability to send an email.

      • throckmorton says:

        Matt:

        The payor does not have to change, the payee does. With car insurance you can go and get estimates. The insurance company then sends you a check. You then go and have your car fixed, if you are lucky you can find a good deal and not have to spend the whole amount. Sometimes you want better than the insurance will pay, so you pay extra. This is how health insurance should be for nonurgent care. The patient should shop around and be the one who ultimately has to be responsible for the bill. Right now the insurance customer is not the one negotiating the charges. You have to keep the client and the money together.

        It is also important to know how insurance companies work. Most if all the money they take in has to go back out in services. They make money on the intrest they make while holding your money. For an insurance company to make the most, it has to be the middle man for the most money. This is done by having the most people pay the most for their care. In this way the insurnace company gets the most money in intrest. It is not in their best intrest therefore for costs to be cheaper. If they are, they have to take in less money and therefore make less in intrest. This fact is not lost on our politicians who have long realized that the private insurance has offset the nonviability of Medicaid and SCHIP.

        Long and short, have patients be the ones that pay the bills, have pateints be the ones who directly have to send money to their health insurance company, and have patieints be the ones who try to get reimbursed. By doing this, you will have commercials on every channel like GEICO, ALLSTATE, etc trying to get your business and you will have doctors, hospitals and clinics advertising discount colonoscopies.

      • Matt says:

        Throck, I think we agree in large part. By changing the payee I think you change the payor, so we may be saying the same thing.

        One thing I found interesting about your post was this:

        “It is also important to know how insurance companies work. Most if all the money they take in has to go back out in services. They make money on the intrest they make while holding your money. For an insurance company to make the most, it has to be the middle man for the most money. This is done by having the most people pay the most for their care. ”

        Couple thoughts. One, it’s not necessarily interest, but it’s investments with the float (see Warren Buffett’s annual letter to shareholders for a readable explanation, as insurance is Berkshire’s true cash cow). Often insurers actually lose money when you just look at premiums in v. admin costs & paid claims. That’s part of the business model few realize. You could tell how few physicians knew it as one of their bases for tort reform in the last “crisis” was that X insurer paid $1.30 for every $1.00 they took in, and therefore insurance was unaffordable and their rates were jacked. The truth is payouts were steady, but the float income had declined with the recession. That’s what really mattered and caused the “crisis”.

        Point is that people paying the most for their care doesn’t necessarily make the health insurer the most money. Investing wisely does, although it helps to have a larger premium pool to scale up the returns. To get that larger pool, insurers will often underprice premiums. Which works until the returns on the float fail, and voila “crisis”! Where do they make it up in a down economy? Jacking premiums. And again, we may be saying the same thing in different ways about insurance.

        The one rub, the elephant in the room, with putting your proposal, which I largely agree with, to work, is that the government is in there paying 1/2 of all healthcare costs. GEICO (Berkshire company), Allstate, State Farm don’t really compete with the government for car insurance.

      • throckmorton says:

        Matt:

        What do you think would happen if the government did compete with auto insurance? I believe that Medicare and Medicaid should also reimburse the patient, not the provider. Lets allow the patients to see how their Medicare trust fund money is spent.

      • WhiteCoat says:

        Joe,
        Several things.
        I’m not saying that doing any of the things I suggested would be easy and I don’t compare them with buying a head of broccoli. I’m contrasting how many people think nothing about spending a half hour plotting how to save 10 cents on groceries, but they refuse to spend any time planning how to potentially save tens of thousands of dollars on their health care costs.
        I don’t blame patients. I blame the thought processes. I don’t agree that people don’t have the time to take affirmative steps. Even if someone has to take a couple of days off of work to go to court, which is better – taking off work or declaring bankruptcy and having to go to court anyway when you get sued for the bills?
        If more and more people started doing these types of things and complaining to their lawmakers, I think the paradigm would change.
        In terms of medical care, I pay out of pocket for my family’s dental care. No insurance. I called around to the dentists in the area, requested prices for cash, even talked to several of the dentists. Settled on one who we have been seeing for quite a while, now. And we actually got to know each other, not just choose some random doctor who will take our insurance for the next 12 months. This is the type of system I think we need to move toward.
        You’re right – the onus should be on the medical providers to provide proper information. To this point it isn’t. The question is … how do we change to that model? Learned helplessness isn’t the answer.

        Throckmorton,
        I’m making you a write-in candidate for the next Secretary of Health and Human Services.
        Not only do you “get it,” but you explain the issues amazingly well.
        We have to sit down for beers some day.

  14. Art says:

    As you must know, 30 years ago the federal government after studying the “true costs” of providing care at Yale Hospital, put in place a system called Diagnostic Related Groups [DRG's] that placed a fixed reimbursement rate on all Medicare billings.

    Until then, when one was admitted the process was to charge based on the procedure and the number of days spent in the hospital which averaged $800 per day. As soon as DRG’s went into effect, the mother and the baby from a natural childbirth went from staying 3 to 5 days to going home the next day and most surgical cases went to being done on an out patient basis.

    As more and more of our citizens are covered by the Federal and state governments the costs will increase and the only offset can be is reduced care. If that happens will the U.S. end up with still the highest costs and fall even further in quality of life issues? Or does it even matter if everyone has access to care that is limited?

  15. Finn Haddie says:

    “I have no sympathy for those who ‘don’t have the time or inclination’ to research where they would want to go if their life was on the line or if they needed specialized surgery.”

    Seriously? We’re all supposed to research every possible surgical procedure we could ever need just in case we might need it some day? And we’re supposed to do that in addition to researching which hospitals we’re supposed to direct our ambulances to take us to if we get hit by a bus, have a stroke, have a heart attack, begin to hemorrhage, develop anaphylaxis, rupture an aneurysm, break our backs, and every other possible life-threatening emergency? I guess those of us who live in cities with multiple hospitals will have to keep this list in our pockets along with our med lists because the best ERs for trauma, stroke, MI, etc. are probably going to be at different hospitals. Such research is also pointless for anyone who lives in a rural area with only one nearby hospital, and anyone whose insurance is an HMO and therefore has no choice in hospitals.

    Even assuming we all had the time to do this and that the information were readily available–which it most certainly is not–, what would be the point? The problem isn’t that the PATIENTS don’t know what things cost, the problem is that we have NO CONTROL over what things cost. That’s a big problem: Insurance has built such a wall between patient and provider that patients have no idea what anything costs and providers can’t tell them, because it costs a different amount for every insurance plan, private or public, and a bloody fortune for anyone who’s uninsured.

    • WhiteCoat says:

      I can give you preferred hospitals for most specialized services within a 50 mile radius of my home. Granted, knowing this information helps me in my job, so I have an incentive to obtain the information.
      You have heart disease, you damn well should know where the best cardiac surgeons are.
      You have an aneurysm, yes you should know what hospitals do endovascular repair and who the best surgeons are.
      Even the patients in the small town where I moonlight know who the best orthopedic surgeons and the best obstetricians are.
      Anyone can make excuses why the information shouldn’t matter, but if people engage in this line of thinking, I don’t sympathize with their arguments.

      You’re right that people with insurance have no control over costs. Unfortunately more and more people are losing their insurance.
      Patients without insurance have absolute control over the costs. You can negotiate with hospitals and doctors offices. If they won’t negotiate with you, find one that will – or that will at least give you pricing information.

      People have no problem demanding estimates from mechanics, why is demanding an estimate from a health care provider such a foreign concept?

      I’ll have to go back and find a post on my old blog about this and re-post it.

      • Matt says:

        “You have heart disease, you damn well should know where the best cardiac surgeons are.
        You have an aneurysm, yes you should know what hospitals do endovascular repair and who the best surgeons are.
        Even the patients in the small town where I moonlight know who the best orthopedic surgeons and the best obstetricians are.”

        How in the world would they know who the best are? You’ve spent post after post telling us that ordinary people aren’t smart enough to judge doctors actions, but now we can decide through word of mouth who the best ones are? That doesn’t make sense.

      • Max Kennerly says:

        “People have no problem demanding estimates from mechanics, why is demanding an estimate from a health care provider such a foreign concept?”

        First, because the costs usually exceed their ability to pay.

        Second, because they have no understanding of what the market price is, nor which services may, or may not, be needed in their case. (If you don’t trust an impartial jury with expert testimony to determine which services are needed, how do you trust a single consumer whose own health is on the line?)

        Third, because pricing often can’t be disclosed due to various insurance and government restrictions.

      • DensityDuck says:

        “Finn Haddie says: Seriously? We’re all supposed to research every possible surgical procedure we could ever need just in case we might need it some day?”

        “WhiteCoat says: I can give you preferred hospitals for most specialized services within a 50 mile radius of my home.”

        So, yes, WC thinks that we *should* identify the best place for every possible emergency procedure, just in case we need it someday.

        I’d be a little more on-board with the whole “just get transferred to wherever you like” if this very blog didn’t have posts bitching about patients doing that!

  16. Finn says:

    “You have heart disease, you damn well should know where the best cardiac surgeons are.
    You have an aneurysm, yes you should know what hospitals do endovascular repair and who the best surgeons are.
    Even the patients in the small town where I moonlight know who the best orthopedic surgeons and the best obstetricians are.
    Anyone can make excuses why the information shouldn’t matter, but if people engage in this line of thinking, I don’t sympathize with their arguments.”

    All well and good for pre-existing conditions, but what about the new ones? When I learned that I had ovarian cancer, how long should I have spent researching hospitals before scheduling surgery? I know that cancer isn’t an emergency but mine was very aggressive, so a month’s delay could have meant the difference between stage II and stage III.

    I’m not surprised that residents of a small town know who the best orthopedic surgeons and OBs are, but I’m a Bostonian. There are 27 hospitals within 15 miles of my house; comparing them all would take far more time than comparing a handful of orthopods or OBs serving a small town even for me, and I work in health care so I have a lot of resources at my fingertips.

    I’m not making excuses why it shouldn’t matter; I’m pointing out that regardless of how much it matters, most people simply can’t get it because they lack the substantial time and/or resources needed to find it.

  17. The stakes in medicine are much higher than in the grocery business. Interestingly, the cheaper hospitals in my city are known as the places with the poorest outcomes, and one is about to close. The places where everyone gets an MRI when they walk in the door waste a ton of money, but because they have intelligent staff and a reputation for making the right diagnosis, they stay afloat.

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