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I was in a hospital in Singapore recently, and the prices for doctor consultation fees, staying in a room, and even certain tests were listed right at the front

I was in a hospital in Singapore recently, and the prices for doctor consultation fees, staying in a room, and even certain tests were listed right at the front of the emergency room desk. After the patient I was with was stabilized, the nurse confirmed with us verbally what the rough cost should be for the rest of what the doctor prescribed, and asked if we wished to proceed. We could have said no and gone elsewhere if we wanted, since the patient at least was relatively stable and we knew what was wrong. I want this experience to be the norm in the USA.

Holybeds 8y ago
Where I live you know the cost before you go to the doctor since you will only pay a symbolic sum of 30 USD even if the visit ends up with something like a life long cancer treatment. If you need medicine you will pay at most 120 USD per year regardless of the costs. The idea that your access to healthcare should be linked to your own or your parents financial is crazy.
- conanbatt 8y ago
  With the difference that a long-cancer treatment might cost hundreds of thousands of dollars in the US and simply bankrupt the hospital. Its easier to eat up cost if its a lot lower and has caps. The US has no apetite for those level of restrictions.
  - Holybeds 8y ago
    Not sure if you are joking but the hospitals are paid by the government for the provided services (via tax money). Obviously a life long cancer treatment will cost much more than 30 USD.
    - conanbatt 8y ago
      If the government has a final say, then it has to restrict supply to keep costs down. It cant say yes to everything.
      - Holybeds 8y ago
        Doctors are expected to give the proper amount of care so they do that. Doctors doesn't care about what this will eventually cost for the government. The doctors work for private companies so the have no incentive to limit the care. They also have no big incentive to provide more care than needed. Anyone can go to a doctor to get an appropriate level of treatment. If you want more than that, to the degree that you want to waste your own money, then of course you can do that by paying for it out of your own pocket. It's funny that we are having this discussion. This is a solved problem in large parts or the world and the only reason it's an issue in the US is due to people being crazy.
        conanbatt 8y ago
        I don't think its a solved problem at all. Healthcare costs are an issue in terms of spending per capita in the whole world. And the "whole world" depends in great amounts on the pharma and medical research that is developed in the U.S., and exported for very little in return. Furthermore, countries have varying levels of care based on the countries budget. When the rich people in europe get sick, they go to the U.S..
- miketery 8y ago
  I agree in principal to an extent - however economics need to be tied to the end product somewhat. Otherwise many people would opt for $100k healthcare cost (at the expense of the public) to extend their life for a few more months, this is not reasonable. Resources are finite - therefore we need appropriate allocation. In the end I agree that a basic safety net is necessary and serves a greater good - providing things like normal checkups, preventative services, and acute trauma care is reasonable. However $200k for a second heart surgery for someone who hasn't taken heed of earlier exercise or diet advice by a practitioner should not be supported.
  - jlebar 8y ago
    Serious question: Do you live a perfect life? Do you exercise daily? Do you never eat processed meat (linked to cancer)? Do you never drink soda (linked to metabolic syndrome)? Do you not smoke? Do you not drink any alcohol (linked to cancer)? Do you live close to your work so as to minimize the time spent in a car (car accidents are a major cause of preventable death)? Are you not overweight, even a little? And so on. Do you think that someone who follows all but one of those rules still deserves healthcare? All but two? What's the moral difference between someone who smokes and someone who hasn't taken heed of diet/exercise advice after getting heart surgery? Where do you draw the line? It's easy to say, "I don't want to pay for the healthcare of some hypothetical 'slob'". But make it real, consider what this actually means, and I think it's not something most of us want. None of us is perfect. I'm sure that even olympic athletes occasionally eat bacon. Let he who is without sin cast the first stone, right?
    - antisthenes 8y ago
      > Do you think that someone who follows all but one of those rules still deserves healthcare? All but two? What's the moral difference between someone who smokes and someone who hasn't taken heed of diet/exercise advice after getting heart surgery? Yes. Yes. Moral difference no idea, but neither one should expect to have society foot the entire bill for their bad habits. > Where do you draw the line? Probably around morbid obesity that's unrelated to genetic/chronic issues. > Let he who is without sin cast the first stone, right? By setting an unreasonable standard and saying no one under it has the ability to cast judgment is extremely anti-intellectual. If 2 people were telling you about health habits and one of them was an olympic athlete (who occasionally ate bacon), and the other was a random overweight person from the street, whose advice would you give more weight to?
- AnthonyMouse 8y ago
  > Where I live you know the cost before you go to the doctor since you will only pay a symbolic sum of 30 USD even if the visit ends up with something like a life long cancer treatment. If you need medicine you will pay at most 120 USD per year regardless of the costs. Then the problem is you have no pricing mechanism for determining how much the provider should actually be paid. If you offer less than what people value the service at, you'll get shortages (or, in this context, waiting lists and less life-saving medical R&D). If you offer too much, you're overpaying (see also US government contractors). Governments in Europe apparently solve the "paying too much" problem by systematically underpaying, but that doesn't work if everybody does it. The US can't subsidize your medical R&D if they're doing the same thing. > The idea that your access to healthcare should be linked to your own or your parents financial is crazy. I've never understood why people have this idea about healthcare but not even more immediate necessities like food and housing. It's not as if the solution you're proposing is even analogous to the solutions we use for the poor there (i.e. free clinics akin to homeless shelters and soup kitchens). If the problem is that free clinics are poorly funded, why isn't the solution to fund them better rather than nationalizing the entire healthcare system?
  - Holybeds 8y ago
    > I've never understood why people have this idea about healthcare but not even more immediate necessities like food and housing. Hmm but I have the same view for food and housing. Where I live if your mother doesn't have allow money to buy proper food the government will contribute (both for food and housing).
    - AnthonyMouse 8y ago
      The difference is that the government doesn't take over all farms, restaurants and grocery stores and require you to get your food from them even for everyone who can afford it themselves.
      - Holybeds 8y ago
        Hmm but the government also doesn't take over the medical facilities where I live? Most medical facilities here are normal private companies (some privately owned, some publicly listed etc). So what do you mean?
itissid 8y ago
Playing the devil's advocate for a sec here. But If you paid out of pocket and later got reimbursed by the insurance company, I think, you would have to deal with the insurance company later. The system in the US is quite different and although broken it can be fixed by just fairer price comparison mandated by law.
- phkahler 8y ago
  The only way that will work is if the insurance companies have to pay the posted prices, which I advocate as well.
geomark 8y ago
That's similar to my experience in Thailand. Everyone in my family has had one or more hospital stays for illness, surgery or injury. Prices for common procedures are posted. After initial evaluation there is a discussion about what the estimated total cost will be. I would never again want to have medical treatment in the USA.
dfxm12 8y ago
We could have said no and gone elsewhere if we wanted, since the patient at least was relatively stable and we knew what was wrong. Next question, if the patient did go elsewhere, would they get to keep all the test results/would the hospital share the test results with the new facility? Or would the new place have to rerun all those tests?
- karmelapple 8y ago
  I believe so. We specifically asked if we could take our results with us, although I didn’t specifically ask what would happen if we rejected further treatment. I think it would have been fine, though, and likely they would have charged us at least a small amount (maybe around $100 USD).
- Faark 8y ago
  > would they get to keep all the test results Huh, is that a thing in the US? I understand the old hospital might not automatically giving them to you or the new one rerunning them anyway for practical reasons. But if you've payed for the tests, I'd expect you to own the results...
thefringthing 8y ago
Would you prefer the Singaporean norm (clearly posted prices) to the Canadian/European one (free at the point of use)?
- coredog64 8y ago
  There is no single "European" model.
  - tobib 8y ago
    Neither is it "free", at least not in Germany. It gets charged to your insurer.
  - jimmyrussel 8y ago
    True. In fact it is worth noting that a large portion of the ACA/Obamacare model was based upon Swiss healthcare (specifically the individual mandate in particular) due to its heavy private market presence. First line in Wikipedia (https://en.wikipedia.org/wiki/Healthcare_in_Switzerland https://en.wikipedia.org/wiki/Healthcare_in_Switzerland) There are no free state-provided health services, but private health insurance is compulsory for all persons residing in Switzerland (within three months of taking up residence or being born in the country). The difference being their version of the individual mandate was not struck down or watered down to becoming a 'penalty'. Instead it was like what we do with auto insurance.
- raven105x 8y ago
  Personally, yes. Like many posters here I am an Engineer not in the medical field, so take my opinion with a grain (read: mound) of salt. Most "free" healthcare systems have either (1) horrible quality of service or (2) impossibly long waits unless your life is in danger or close to it. The latter is a systemic issue I've noticed in that healthcare, regardless of pricing or structure, does not aim to foster optimal health, but merely to prevent mortality - so if you go with a 'minor' issue such as recurring headaches or chronic fatigue, it will be dismissed entirely. I don't have the right answer here and am all for people having affordable options from 'free, wait 3 months' to '20K, full service now', but once again, personally speaking, I'm not rich enough for 'free' things. I'd rather pay and know exactly what (and in this case, much more importantly, when) I'm getting. And from what I've noticed, my personal beliefs that people should strive for optimal health rather than mere preservation of life, is a popular opinion deemed 'unrealistic' by experts.
cryptonector 8y ago
What are prices like? I suspect they are much lower than the equivalents in the U.S. Thesis: transparent pricing tends to keep prices down.
philwelch 8y ago
It is if you're a pet. This is exactly how my veterinary visits go.

Holybeds 8y ago

Where I live you know the cost before you go to the doctor since you will only pay a symbolic sum of 30 USD even if the visit ends up with something like a life long cancer treatment. If you need medicine you will pay at most 120 USD per year regardless of the costs. The idea that your access to healthcare should be linked to your own or your parents financial is crazy.

conanbatt 8y ago
With the difference that a long-cancer treatment might cost hundreds of thousands of dollars in the US and simply bankrupt the hospital. Its easier to eat up cost if its a lot lower and has caps. The US has no apetite for those level of restrictions.
- Holybeds 8y ago
  Not sure if you are joking but the hospitals are paid by the government for the provided services (via tax money). Obviously a life long cancer treatment will cost much more than 30 USD.
  - conanbatt 8y ago
    If the government has a final say, then it has to restrict supply to keep costs down. It cant say yes to everything.
    - Holybeds 8y ago
      Doctors are expected to give the proper amount of care so they do that. Doctors doesn't care about what this will eventually cost for the government. The doctors work for private companies so the have no incentive to limit the care. They also have no big incentive to provide more care than needed. Anyone can go to a doctor to get an appropriate level of treatment. If you want more than that, to the degree that you want to waste your own money, then of course you can do that by paying for it out of your own pocket. It's funny that we are having this discussion. This is a solved problem in large parts or the world and the only reason it's an issue in the US is due to people being crazy.
      - conanbatt 8y ago
        I don't think its a solved problem at all. Healthcare costs are an issue in terms of spending per capita in the whole world. And the "whole world" depends in great amounts on the pharma and medical research that is developed in the U.S., and exported for very little in return. Furthermore, countries have varying levels of care based on the countries budget. When the rich people in europe get sick, they go to the U.S..
miketery 8y ago
I agree in principal to an extent - however economics need to be tied to the end product somewhat. Otherwise many people would opt for $100k healthcare cost (at the expense of the public) to extend their life for a few more months, this is not reasonable. Resources are finite - therefore we need appropriate allocation. In the end I agree that a basic safety net is necessary and serves a greater good - providing things like normal checkups, preventative services, and acute trauma care is reasonable. However $200k for a second heart surgery for someone who hasn't taken heed of earlier exercise or diet advice by a practitioner should not be supported.
- jlebar 8y ago
  Serious question: Do you live a perfect life? Do you exercise daily? Do you never eat processed meat (linked to cancer)? Do you never drink soda (linked to metabolic syndrome)? Do you not smoke? Do you not drink any alcohol (linked to cancer)? Do you live close to your work so as to minimize the time spent in a car (car accidents are a major cause of preventable death)? Are you not overweight, even a little? And so on. Do you think that someone who follows all but one of those rules still deserves healthcare? All but two? What's the moral difference between someone who smokes and someone who hasn't taken heed of diet/exercise advice after getting heart surgery? Where do you draw the line? It's easy to say, "I don't want to pay for the healthcare of some hypothetical 'slob'". But make it real, consider what this actually means, and I think it's not something most of us want. None of us is perfect. I'm sure that even olympic athletes occasionally eat bacon. Let he who is without sin cast the first stone, right?
  - antisthenes 8y ago
    > Do you think that someone who follows all but one of those rules still deserves healthcare? All but two? What's the moral difference between someone who smokes and someone who hasn't taken heed of diet/exercise advice after getting heart surgery? Yes. Yes. Moral difference no idea, but neither one should expect to have society foot the entire bill for their bad habits. > Where do you draw the line? Probably around morbid obesity that's unrelated to genetic/chronic issues. > Let he who is without sin cast the first stone, right? By setting an unreasonable standard and saying no one under it has the ability to cast judgment is extremely anti-intellectual. If 2 people were telling you about health habits and one of them was an olympic athlete (who occasionally ate bacon), and the other was a random overweight person from the street, whose advice would you give more weight to?
AnthonyMouse 8y ago
> Where I live you know the cost before you go to the doctor since you will only pay a symbolic sum of 30 USD even if the visit ends up with something like a life long cancer treatment. If you need medicine you will pay at most 120 USD per year regardless of the costs. Then the problem is you have no pricing mechanism for determining how much the provider should actually be paid. If you offer less than what people value the service at, you'll get shortages (or, in this context, waiting lists and less life-saving medical R&D). If you offer too much, you're overpaying (see also US government contractors). Governments in Europe apparently solve the "paying too much" problem by systematically underpaying, but that doesn't work if everybody does it. The US can't subsidize your medical R&D if they're doing the same thing. > The idea that your access to healthcare should be linked to your own or your parents financial is crazy. I've never understood why people have this idea about healthcare but not even more immediate necessities like food and housing. It's not as if the solution you're proposing is even analogous to the solutions we use for the poor there (i.e. free clinics akin to homeless shelters and soup kitchens). If the problem is that free clinics are poorly funded, why isn't the solution to fund them better rather than nationalizing the entire healthcare system?
- Holybeds 8y ago
  > I've never understood why people have this idea about healthcare but not even more immediate necessities like food and housing. Hmm but I have the same view for food and housing. Where I live if your mother doesn't have allow money to buy proper food the government will contribute (both for food and housing).
  - AnthonyMouse 8y ago
    The difference is that the government doesn't take over all farms, restaurants and grocery stores and require you to get your food from them even for everyone who can afford it themselves.
    - Holybeds 8y ago
      Hmm but the government also doesn't take over the medical facilities where I live? Most medical facilities here are normal private companies (some privately owned, some publicly listed etc). So what do you mean?

itissid 8y ago

Playing the devil's advocate for a sec here. But If you paid out of pocket and later got reimbursed by the insurance company, I think, you would have to deal with the insurance company later. The system in the US is quite different and although broken it can be fixed by just fairer price comparison mandated by law.

phkahler 8y ago
The only way that will work is if the insurance companies have to pay the posted prices, which I advocate as well.

geomark 8y ago

That's similar to my experience in Thailand. Everyone in my family has had one or more hospital stays for illness, surgery or injury. Prices for common procedures are posted. After initial evaluation there is a discussion about what the estimated total cost will be. I would never again want to have medical treatment in the USA.

dfxm12 8y ago

We could have said no and gone elsewhere if we wanted, since the patient at least was relatively stable and we knew what was wrong. Next question, if the patient did go elsewhere, would they get to keep all the test results/would the hospital share the test results with the new facility? Or would the new place have to rerun all those tests?

karmelapple 8y ago
I believe so. We specifically asked if we could take our results with us, although I didn’t specifically ask what would happen if we rejected further treatment. I think it would have been fine, though, and likely they would have charged us at least a small amount (maybe around $100 USD).
Faark 8y ago
> would they get to keep all the test results Huh, is that a thing in the US? I understand the old hospital might not automatically giving them to you or the new one rerunning them anyway for practical reasons. But if you've payed for the tests, I'd expect you to own the results...

thefringthing 8y ago

Would you prefer the Singaporean norm (clearly posted prices) to the Canadian/European one (free at the point of use)?

coredog64 8y ago
There is no single "European" model.
- tobib 8y ago
  Neither is it "free", at least not in Germany. It gets charged to your insurer.
- jimmyrussel 8y ago
  True. In fact it is worth noting that a large portion of the ACA/Obamacare model was based upon Swiss healthcare (specifically the individual mandate in particular) due to its heavy private market presence. First line in Wikipedia (https://en.wikipedia.org/wiki/Healthcare_in_Switzerland https://en.wikipedia.org/wiki/Healthcare_in_Switzerland) There are no free state-provided health services, but private health insurance is compulsory for all persons residing in Switzerland (within three months of taking up residence or being born in the country). The difference being their version of the individual mandate was not struck down or watered down to becoming a 'penalty'. Instead it was like what we do with auto insurance.
raven105x 8y ago
Personally, yes. Like many posters here I am an Engineer not in the medical field, so take my opinion with a grain (read: mound) of salt. Most "free" healthcare systems have either (1) horrible quality of service or (2) impossibly long waits unless your life is in danger or close to it. The latter is a systemic issue I've noticed in that healthcare, regardless of pricing or structure, does not aim to foster optimal health, but merely to prevent mortality - so if you go with a 'minor' issue such as recurring headaches or chronic fatigue, it will be dismissed entirely. I don't have the right answer here and am all for people having affordable options from 'free, wait 3 months' to '20K, full service now', but once again, personally speaking, I'm not rich enough for 'free' things. I'd rather pay and know exactly what (and in this case, much more importantly, when) I'm getting. And from what I've noticed, my personal beliefs that people should strive for optimal health rather than mere preservation of life, is a popular opinion deemed 'unrealistic' by experts.

cryptonector 8y ago

What are prices like? I suspect they are much lower than the equivalents in the U.S. Thesis: transparent pricing tends to keep prices down.

philwelch 8y ago

It is if you're a pet. This is exactly how my veterinary visits go.