4 ms·

The next logical step is to require written estimates in advance, just like the auto repair industry.

mindslight 8y ago
s/the auto repair/every other/
Scoundreller 8y ago
That only works for non-urgent care and when estimates are cheap enough to encourage shopping around. Although even free estimates cost you time.
- ams6110 8y ago
  Most health care is non urgent.
  - stickfigure 8y ago
    To underline this, the amount of money spent on emergency care (the kind where you might not have the opportunity to get an estimate) is in the single digit percentages, and may be as low as 2%. https://www.politifact.com/truth-o-meter/statements/2013/oct/28/nick-gillespie/does-emergency-care-account-just-2-percent-all-hea/ https://www.politifact.com/truth-o-meter/statements/2013/oct...
- lostlogin 8y ago
  Could you explain a little further? Most industries are able to provide quotes, why shouldn’t healthcare facilities?
  - cheschire 8y ago
    Those industries probably bake the cost of estimating quotes into the manpower cost already. Hospital bills would ostensibly be even higher simply to provide quotes. But I believe his core point was up front. When your arm is off, you're not going to ask for, or even reject, a quote. I would anticipate though that once quotes are known, and posted to glassdoor-like services, one could develop an app where you point to your arm, select "it's fallen off" and then you are provided the cheapest hospitals for your issue and their ratings.
alexis_fr 8y ago
and require the same price for lone customers as what is negociated with insurances.
- HNLogInShit 8y ago
  Exactly. It should be illegal to charge different patients different prices for the same service.
- lostlogin 8y ago
  Is this right though? Surely buying 20k knee joint replacements should earn a discount? Just setting it such that it wasn’t taking the piss would seem a vast improvement.
  - breatheoften 8y ago
    How does prepaying for treatment help with costs at all? Either you _can_ forecast accurately how many knee replacements you are going to do in which case prepaying won’t help you plan better — or you “prebill” for knee replacements and then incentivize doctors to push people into knee replacements to maximize their payouts ...
    - lostlogin 8y ago
      Economies of scale - if you don’t pass on the saving the money is going to someone. I guess you’re picking the providers (hospital and medical companies) and I’m picking the patient.
- redisman 8y ago
  and then strangle the parasitic insurance companies that are paid handsomely by the consumer to build pointless bureaucracy and safeguard their market position
  - lotsofpulp 8y ago
    Considering the patients have no idea what is going on and therefore no way to tell if what they are being sold by medical care providers is appropriate or not, insurance (who also have doctors reviewing the cases) is actually the only entity that is auditing the work of the medical providers to make sure they’re following the proper procedure and prevent overcharging.
mikestew 8y ago
The reason you can get a written estimate is because there’s a big book the service writer flips to, “hmm, front swing arm bushings on a ‘12 Corolla: 2 hours. Front end alignment: 0.75 hours...” Worst case is, I get the acetylene torch out for those rusted-to-hell front end bolts, but it’ll take me about what the book says, usually less. Well, worst case is a bunch more front end parts are shot, waste of money to do just bushings, and customer doesn’t want to spend the money (after the requisite phone call). Bolt ‘er back together still broken, and send them on their way. You figure out how to apply that same scenario to cardiac surgery, and you can have your written estimates.
- stickfigure 8y ago
  Doctoring really isn't all that different in principle. The actuaries have these books and already do estimate these costs. And the overwhelming vast number of procedures are consistently predictable. There's a couple ways of managing unforeseen issues, the simplest of which is to pad the total with a comfortable risk margin. Or allow extra billing for emergencies, but publish rates on how often they "miss" their estimates like restaurant health codes. Right now they're not even trying.

s/the auto repair/every other/

That only works for non-urgent care and when estimates are cheap enough to encourage shopping around. Although even free estimates cost you time.

ams6110 8y ago
Most health care is non urgent.
- stickfigure 8y ago
  To underline this, the amount of money spent on emergency care (the kind where you might not have the opportunity to get an estimate) is in the single digit percentages, and may be as low as 2%. https://www.politifact.com/truth-o-meter/statements/2013/oct/28/nick-gillespie/does-emergency-care-account-just-2-percent-all-hea/ https://www.politifact.com/truth-o-meter/statements/2013/oct...
lostlogin 8y ago
Could you explain a little further? Most industries are able to provide quotes, why shouldn’t healthcare facilities?
- cheschire 8y ago
  Those industries probably bake the cost of estimating quotes into the manpower cost already. Hospital bills would ostensibly be even higher simply to provide quotes. But I believe his core point was up front. When your arm is off, you're not going to ask for, or even reject, a quote. I would anticipate though that once quotes are known, and posted to glassdoor-like services, one could develop an app where you point to your arm, select "it's fallen off" and then you are provided the cheapest hospitals for your issue and their ratings.

alexis_fr 8y ago

and require the same price for lone customers as what is negociated with insurances.

HNLogInShit 8y ago
Exactly. It should be illegal to charge different patients different prices for the same service.
lostlogin 8y ago
Is this right though? Surely buying 20k knee joint replacements should earn a discount? Just setting it such that it wasn’t taking the piss would seem a vast improvement.
- breatheoften 8y ago
  How does prepaying for treatment help with costs at all? Either you _can_ forecast accurately how many knee replacements you are going to do in which case prepaying won’t help you plan better — or you “prebill” for knee replacements and then incentivize doctors to push people into knee replacements to maximize their payouts ...
  - lostlogin 8y ago
    Economies of scale - if you don’t pass on the saving the money is going to someone. I guess you’re picking the providers (hospital and medical companies) and I’m picking the patient.
redisman 8y ago
and then strangle the parasitic insurance companies that are paid handsomely by the consumer to build pointless bureaucracy and safeguard their market position
- lotsofpulp 8y ago
  Considering the patients have no idea what is going on and therefore no way to tell if what they are being sold by medical care providers is appropriate or not, insurance (who also have doctors reviewing the cases) is actually the only entity that is auditing the work of the medical providers to make sure they’re following the proper procedure and prevent overcharging.

mikestew 8y ago

The reason you can get a written estimate is because there’s a big book the service writer flips to, “hmm, front swing arm bushings on a ‘12 Corolla: 2 hours. Front end alignment: 0.75 hours...” Worst case is, I get the acetylene torch out for those rusted-to-hell front end bolts, but it’ll take me about what the book says, usually less. Well, worst case is a bunch more front end parts are shot, waste of money to do just bushings, and customer doesn’t want to spend the money (after the requisite phone call). Bolt ‘er back together still broken, and send them on their way. You figure out how to apply that same scenario to cardiac surgery, and you can have your written estimates.

stickfigure 8y ago
Doctoring really isn't all that different in principle. The actuaries have these books and already do estimate these costs. And the overwhelming vast number of procedures are consistently predictable. There's a couple ways of managing unforeseen issues, the simplest of which is to pad the total with a comfortable risk margin. Or allow extra billing for emergencies, but publish rates on how often they "miss" their estimates like restaurant health codes. Right now they're not even trying.