21 ms·

Show HN: Compare prices that US hospitals charge patients, insurance companies

447 points by ageitgey 6y ago

KingMachiavelli 6y ago
It would be nice to be able to see the lowest & highest prices & other stats. I can manually find the lowest price by sorting by price but I can't seem to reverse it to show the highest price first... Anyway, it seems that there are orders of magnitude differences for the same service. The service 'MRI Lumbar Spine With & Without Contrast Material' has a lowest price of $210 while the closest and highest I personally could find was ~$4109. How can there be such a large difference in price for something that, I believe, is legally & medically the same procedure?
- nugget 6y ago
  In 2015 I did several months of due diligence in this market - price comparison for diagnostic imaging - before concluding that it wasn't feasible to build the product we wanted to build. This new law provides the data that we were unable to access (at scale) on our own. From the data we did get our hands on, I remember seeing price differences like $200 vs $4k for the exact same procedure. The low cost provider was usually a private practice radiologist in a small shopping mall type retail location who ran a very efficient, low overhead practice. They were terrible at marketing and ran discounts for volume from certain channels. They were only open Monday to Friday from 8am to 4pm, read times could often (but not always) be slow, they handled the least complex cases and no emergencies. Cash pay up front from patients resulting in no/minimal collections. The high cost provider was usually a large University affiliated medical center who ran a less efficient, high overhead radiology department but who also, in their defense, had to handle more complex cases as well as be open 24/7 to service one or multiple emergency departments with faster read times. Lots of fighting with insurance companies for eventual reimbursement. Lots of bad debt that went to collections and had to be written down. If you pay University prices for a simple MRI you are effectively subsidizing the ED admit who needs a complex imaging procedure in the middle of the night. If consumers start to shop for MRIs the way they shop for airline tickets - which they probably should - one downstream effect will be to remove billions of dollars of "subsidies" from the most well-resourced radiology departments in the country. If I remember correctly the diagnostic imaging market was something like $150 billion/year in 2015, and probably even bigger now, i.e. plenty of potential fat to cut.
  - kfarr 6y ago
    Response time / availability is not something I considered in medical service pricing before but wow it makes a lot of sense.
  - wjossey 6y ago
    For folks who don’t believe in universal medical coverage, this is part of the reason why it’s so inefficient for it not to exist. The uninsured person going to the hospital at 1AM that requires an MRI because slipped a disc in their back still ends up getting that MRI. When they fail to pay that bill, which would be 5%-10% of their annual earnings, we all still pay for it. We just decided to layer in debt collection, anxiety, and depression onto the patient in lieu of cash. As someone who still considers themselves a fiscal conservative, and also believes we need true universal coverage for all Americans, this seems like a no brainer to me at this point (and I say that as someone who would have not supported this in the 00s but has evolved significantly on this issue).
    - nugget 6y ago
      My takeaway from all that research was the same. Almost everyone benefits from universal coverage but the system has to incentivize patients to shop around for the optimal balance of price, quality, and convenience. This can be accomplished with an annual deductible of a few thousand dollars perhaps capped at a % of income. Without this incentive, costs skyrocket. Price transparency is a pre-requisite without which consumers can't easily shop around, so this law is a giant leap forward in the right direction. That is the #1 most effective thing that Americans can do to reduce health care costs. #2 would be to change the standard American diet and eat healthier to reduce rates of obesity and diabetes. Almost every other proposed structural change or intervention we looked at was minimal by comparison.
      - zaphod12 6y ago
        There was an attempt at this with prescription drugs. Encourage patients to take generics by forcing a larger amount of cost onto the patients in the form of higher copays. Pharma companies realized and started giving copay vouchers (still charge insurance more, but short circuit the patient incentive). When that loophole got tighter they formed charitable foundations to give the vouchers instead. I'm not disagreeing with your points, per se. It's just amazing what entrenched interests can manage.
- subhro 6y ago
  > How can there be such a large difference in price for something that, I believe, is legally & medically the same procedure? I hope this never happens, but let’s say you got in a motorcycle accident and need that lumbar MRI to figure out the damage. What are going to do, get back on that wrecked motorcycle with a fucked up spine and go to that 210$ place? They do it because they can do it and get away with it.
  - eldavido 6y ago
    I see this argument a lot. The trouble is that emergency care isn't what drives the majority of healthcare spend. What does is actually chronic conditions: dialysis, diabetes, autoimmune disorders, chronic weight conditions. That's what we need to worry about. And if there was a real market here, you wouldn't need to shop around because all the people that do, would enforce some level of price discipline on the market. Think about it. For any good sold at, say, Wal-Mart, say Gatorade, there are some people that want it a LOT, even NEED it, while others are more on the fence. There's only one price on the shelf and it's calculated to get a lot of people buying. So in effect, the people who are more indifferent (want it less) are actually doing a pretty significant service to the people who want it a lot, by guaranteeing the price will be set low for everyone. There's no reason something like this can't apply in healthcare.
- LatteLazy 6y ago
  >How can there be such a large difference in price for something that, I believe, is legally & medically the same procedure? If no one publishes their prices how do you set yours? 2 dollars? 2000 dollars? 2m dollars?
  - spaetzleesser 6y ago
    I am pretty sure the providers and insurers know exactly what everyone is charging. It’s the patients that are being kept in the dark.
    - deleted 6y ago
      [deleted]
    - LatteLazy 6y ago
      Like any opaque market, bigger players will have more info, but I doubt anyone will share information as its collusion (maybe illegal) and also advantages either your negotiating opponent or your competitors...
      - mrnickel001 6y ago
        Exactly. Small payers are actually pretty hungry for this data. Generally, big payers are more privy to market rates (by paying for datasets, owning clearinghouses, etc).
    - sib 6y ago
      When I needed a similar non-emergency procedure (cervical, rather than lumbar, MRI), my neurosurgeon, at a large, university-affiliated hospital, referred me to the in-house radiology department. Within a day or two, I received a phone call from some department at my health insurance provider telling me "Hey, we see that you are going to get an MRI; did you know that you can get the exact same procedure at providers A, B, and C, for a lot lower cost?" They did this even though the hospital's radiology department was in-network. In this case, the cost difference was similar to what's noted here - about $4,000 vs $450. Since the insurance company was paying most of it, aside from my copay / share of cost, they were motivated to provide me a little transparency. To be honest, as a patient, I would have preferred to get the MRI at the hospital; their facility was nicer, cleaner, more modern, and there was better data integration for getting the results to my neurosurgeon and keeping them as part of my holistic medical record. Nonetheless, I went to the cheaper provider.
- mrnickel001 6y ago
  Thanks for the feedback! We'll be improving our filter/sort here in the coming days and we'll take this feedback into our plan.
  - ilaksh 6y ago
    My searches so far show insane differences between insurance rates and cash rates. The cash can be 5-10x higher than what the insurance company pays. It seems like a clear case of systemic fraud to me. Am I missing something? Also I am not able to find any fundoplication or LINX (43284).
    - mrnickel001 6y ago
      Many hospitals don't discount from their list price for self pay. Medicare pays ~10% of list price. So, for example, if there is an insurance rate set at "130% medicare" (common to have a coefficient between 1 and 2), then yes, you'd still see many cash rates that are 5x insurance. However, many hospitals also listed Managed Medicaid insurance rates. These are generally 3-5% of list price & look for similar to normal insurance plans. So, what you're seeing may also be comparing a Medicaid rate to a very high cash rate. Will add 43284 & other gastro procs shortly. Thanks!
fartcannon 6y ago
Is there a Walmart for medical procedures? A jiffy-lube?
- dakial1 6y ago
  Come to Brazil. The best Brazilian hospital (Albert Einstein Hospital in Sao Paulo) charges 1.7k USD for a C section (my son was born recently there), while the lowest I've found in that site is 2.6K USD (don't know about the quality) and median seems to be 8K USD. I bet the other procedures have similar price differences. You can pay for the trip, get the best care (it is a really good, international level, hospital) and still have some loney left.
  - pqdbr 6y ago
    And what about an MRI? This website lists rates around 2k USD, while in Brazil you can get one (in high-end modern hospitals in São Paulo) for around R$ 600 (== $120).
    - xtracto 6y ago
      MRI in Mexico cost ~$200 USD ( https://www.chopo.com.mx/zapopan/estudios/resonancia-magnetica https://www.chopo.com.mx/zapopan/estudios/resonancia-magneti... ) and is way closer than Brazil. There are laboratories even at walking distance of the USA haha ( https://www.google.com/search?tbs=lf:1,lf_ui:4&tbm=lcl&q=laboratorio+chopo+tijuana https://www.google.com/search?tbs=lf:1,lf_ui:4&tbm=lcl&q=lab... )
      - dakial1 6y ago
        Might be interesting to check how much "Medical Tourism" happens between US and other countries. This might be an interesting industry to get into. If I remember well there was a health insurance company that was promoting Medical Tourism for their clients
        xtracto 6y ago
subhro 6y ago
This seems to be the GoodRx of medical procedures. This is tremendously helpful. How do you plan to keep the data current? Also, in the US, is a patient realistically able to say, “Hospital X is able to get my compound fracture surgery done for 65% less. Match it or I walk”, especially when insurances have negotiated rates. Or is this only useful for people with no insurance?
- mrnickel001 6y ago
  Hey man! This is a great comment. I work with Turquoise. We're actually building some stuff where patients can collectively bargain outside their insurance. But for now, it's most useful to people with insurance that see that one hospital down the road has a lower rate for their given insurance. (EG, the blue cross rate is better the next town over). We're going to make it easier to filter for insurance shortly. Also, very useful for cash pay.
  - applecrazy 6y ago
    This is an amazing product and I congratulate you on your launch! Like the parent, I'm also really curious how you plan to update the data and also wanted to ask how you normalized the data. I ask because this space has always been interesting for me. Funny enough, I helped build almost the exact same thing at a hackathon (https://devpost.com/software/liform https://devpost.com/software/liform), but the project didn't pan out after that due to our team's lack of medical knowledge. So I'd love to learn from your experience processing this data into a usable form.
Pjki889 6y ago
The branding (design, typography) looks very similar to OneMedical.
rplnt 6y ago
Why are the prices so insane? Where do the money go? I'm from Eastern Europe so of course the prices would be different, but by an order of a magnitude at the minimum seems strange.
- dnautics 6y ago
  - paying for services for people who don't have/can't afford insurance. - medical malpractice insurance -> legal system - big pharma/med devices industry
  - spaetzleesser 6y ago
    You should add - doctors are paid higher in the US than in another countries - billing staff overhead because of the insane insurance system - highly paid hospital administration - lots of middlemen that stay invisible because there is no price transparency - shiny new buildings that are built by friends of the hospital administration
    - excannuck 6y ago
      "billing staff overhead because of the insane insurance system" While true, I would generalize to "insane bureaucratic system" unless you want to include public "insurance" into the mix. Medicaid and Medicare aren't simple!
    - ArtDev 6y ago
      Look up the salary of your local hospital president. In my medium town of (Pop 200K) they pay him $980k per year. That is an absurd salary for a relatively small hospital!
      - therealdrag0 6y ago
        How do I look that up?
        huitzitziltzin 6y ago
terse_malvolio 6y ago
Sometimes the cost is bigger than the cost in a different country plus the plane ticket.
- dominotw 6y ago
  I guess you could roll the dice and hope the for best but you will lose your ability to sue the hospital for malpractice if they mess up.
  - terse_malvolio 6y ago
    Maybe there is a chance that insurance could be enabling malpractice? I'd have to get hard data on this to make a determination but I'd wager that most reputable medical professionals try to avoid malpractice regardless of country.
  - BurningFrog 6y ago
    The alternative is often to not have the procedure at all.
  - jasonpeacock 6y ago
    You're making a lot of assumptions here that an out-of-country hospital would be of questionable quality and not have medical malpractice laws. Just because other countries medical & legal systems are different than the US doesn't mean they are inferior.
    - learc83 6y ago
      The GP was talking about losing your ability sue for malpractice not implying that every other country has inferior medical or legal care. A country can have a fine legal system for locals that's difficult or prohibitively expensive to access for non-citizens living outside the country.
      - londons_explore 6y ago
        One of my businesses refuses to serve Americans simply because they have a habit of reaching for the legal system if they aren't happy with the service. All the Americans end up going to my competitor, who is currently in the midst of three lawsuits which will probably sink the company. Two of the lawsuits are with clients I turned away simply because they looked likely to sue! You can bet that as an American, you will pay substantially more than a local for many services simply because Americans have a reputation for this sort of stuff, and local businesses don't want to take the risk. I really wish there was some kind of certificate saying "I have never set foot in a courtroom, threatened legal action, or hired a lawyer".
forgingahead 6y ago
This was a big accomplishment of the Trump admin. Regardless of what your other opinions of his administration are, healthcare pricing transparency in the US is a very important step forward to improving the healthcare situation there. Source (one of many): https://www.reuters.com/article/us-usa-trump-drugs/white-house-says-medical-insurance-price-transparency-rule-finalized-idUSKBN27E2X0 https://www.reuters.com/article/us-usa-trump-drugs/white-hou...
- ttul 6y ago
  It’s too bad that all the other insane things he did will overshadow literally anything of value that he accomplished.
  - the-dude 6y ago
    Could you enlighten me and name some of those things? Not things he said, but things he did according to you.
    - hedora 6y ago
      These are all well documented: https://www.indy100.com/news/donald-trump-bad-things-list-b1785865 https://www.indy100.com/news/donald-trump-bad-things-list-b1... There are 55 things on the list. There’s a mixture of things he said and things he did. As president, his words have real consequences, so drawing the line at “things he said” is strange.
      - the-dude 6y ago
        Are you serious about bringing that article/site to the table as a source to try and make your point? Or is this sarcasm?
        zingermc 6y ago
        Don't feed the troll.
azalemeth 6y ago
I think something else that would be of interest would be doing this for drug prescriptions: compare the cost that my employer, the NHS, pay for a compound and those that Americans pay for the exact same compound. This is easy on my end at least -- prices and prescription guidance are released in the BNF / British National Formulary annually and are all made available in public. I have never understood the US system of "co-pays" and found the whole thing very confusing. For a few "popular" random examples that I think HN might have heard of: one branded Epi-Pen is £26.45; Naproxen (the NSAID painkiller) is £4.29 / 56 pack; and omeprazole (PPI used to treat gastric reflux) is £0.84 / 28 pack. A more expensive example might be the cystic fibrosis "designer drugs" lumacaftor with ivacaftor -- 112 tablets are £8000 (to be prescribed by a specialist, if the patient has the genotype to respond to it -- a total annual cost of about £26k). The US equivalent is $379,780 [1]. (NB: The price you pay as a British patient is usually £0, unless you are a working-aged and working English person -- at which point it is £9.15 per item [independent of its cost] or a fixed "all you can eat" prepayment certificate that works out at about £8.83/month -- which is what I have. Oh, and plus the taxes, of course...). [1] https://www.jmcp.org/doi/pdf/10.18553/jmcp.2018.24.10.987 https://www.jmcp.org/doi/pdf/10.18553/jmcp.2018.24.10.987
- CogitoCogito 6y ago
  > I have never understood the US system of "co-pays" and found the whole thing very confusing. I think you're mixing up a few things here. The co-pays are meant to make the patient directly pay some of the cost to decrease abuse of the system. There are many different structures for co-pays so saying anything general is kind of difficult, but there are reasonable arguments supporting such a system. In Sweden for example you do have to pay certain costs (which are capped) for essentially the same reason. But that has nothing to do with the fact that prices vary so widely for the same products and services. Personally I think that the US system should at a minimum require that 1. All medical products' and services' costs to published publically; 2. All costs to be non-discriminatory (meaning everyone regardless of any insurance plan or none must pay the same); 3. All costs be available prior to any services provided. In other words, there are no negotiated plans with different prices, there are no surprise bills, patients actually are able to understand costs, and real competition is actually theoretically possible. None of this would necessarily preclude an insurance plan from having co-pays, it would just make the only point of the insurance plan purely financial and open as it should be. Of course the US could just move to a single-payer government-run system, but that's a different discussion. If the goal truly is to have a market-based system, then I think my points above should be implemented.
hedora 6y ago
It would be nice if I could set my insurance plan once, and then see the cash and insured prices in the search results.
- ageitgey 6y ago
  This is in the works! We hope to implement this as soon as we've cross-referenced all the plans across providers.
dr_faustus 6y ago
It's always fascinating to see that even compared to prices you pay as a self-paying patient in Germany (which are already 1.5x - 2x higher than what the "public" insurances, ie. 85% of the population, pay for the same procedures), the prices in the US are about 5x to 10x higher. The standard of care seems to be quite comparable if you look at outcomes, so there must be huge inefficiences in the American system (doctors in Germany are consistently ranked as the highest paid academics, so I guess it cant be doctors' salaries alone).
- emteycz 6y ago
  I don't believe any medical professional in Germany has wage exceeding 150k EUR yearly after taxes - doctors in the US sometimes have multiples of that, coincidentally 5x to 10x more is not unusual.
  - Redoubts 6y ago
    I’m sure German doctors don’t have oodles of student debt too.
    - emteycz 6y ago
      Yeah, that for sure.
  - travisp 6y ago
    It's true that US doctors are paid more (although the gap isn't as big as it used to be). However, pay for US doctors makes up a fairly small portion of overall US medical expenditures (less than 10%). So, you could ask every doctor to work for free and not significantly change costs.
    - tfehring 6y ago
      There’s a similar (but smaller) differential for other medical professionals too. But more generally, when I’ve done high-level comparisons of medical spending between the US and Western European countries, it seems like every single cost element is more or less proportionately higher in the US. It seems like basically everyone is spending money in roughly the same proportions, including on things like doctors’ salaries - everything is just scaled up by ~40% to ~100% in the US, depending on which country you compare it to.
hehehaha 6y ago
Here’s another consideration: care quality is very disparate across the country in the US. And what’s even more frustrating is that cost is not correlated to quality. While I am a bit more critical because I’ve seen “how the sausage is made” first hand for years, this also makes it that much harder to implement universal health care in the US. Don’t think someone living in rural Wyoming should pay the same HC tax/premium as someone living right across the street from MGH.
- ageitgey 6y ago
  Definitely true - quality and price are only very loosely related. Right now we have care quality information on the hospital "information" page, but most people aren't finding it in the current design and we are going to re-work it so it's more visible when browsing prices.
mtalantikite 6y ago
This is great (and totally unfortunate that it needs to exist in the US), thanks for building it. One issue: it looks like the search is not respecting the zip code for me if I change it. For example, if I search for a procedure using the zip code the site auto-populates, my results are great. However, if I change the zip code to my actual neighborhood here in NYC, I'm seeing results from all over the country.
- ageitgey 6y ago
  Thanks, I'll take a look! If you don't mind, would you mind dropping me an email at adam@turquoise.health with the zip code you are trying?
k3liutZu 6y ago
Oh wow, so a "Tonsil Removal (Patient Under 12)" procedure has a huge price-range: $298.00 $7,830.76 $7,299.85 $10,243.23 $13,964.19 --- How are these even comparable?
- theplague42 6y ago
  It's probably bad data. 7k vs 13k is reasonable, but nobody is removing tonsils for $300.
  - CogitoCogito 6y ago
    $300 seems low to me as well, but the order of magnitude spread isn't suprising at all. About 5 years ago I went into the ER in NYC due to extreme dehydration. They gave me some saline and sent me home a few hours later. Later I got a bill for $250 which was above my ER $150 copay so I called them up and it turned out they didn't realize I had insurance. A month later I got a "fixed" bill for $3000 to my insurance of which $150 was my responsibility. My example of a magical 12x increase given single exact same procedure coded identically, means I find a price increase of ~43x from $300 to $13,000 between different hospitals quite believable.
Abishek_Muthian 6y ago
Congratulations on the launch! Turquoise Health could be solving this need gap - 'How much will I be charged for my treatment'[1] posted on my problem validation platform. You're welcomed to explain how Turquoise Health helps solve their problem in that thread. [1]https://needgap.com/problems/122-how-much-will-i-be-charged-for-my-treatment-hospital-bills https://needgap.com/problems/122-how-much-will-i-be-charged-... (Disclaimer: It's a problem validation platform I created).
smueller1234 6y ago
Suggestion: I hope I didn't completely miss something, but the site seems to put average prices for procedures all over the place when the median price would actually be much more informative to somebody searching for a provider. Looking at a few procedures, the prices seem to have significant outliers, which exacerbates this.
- ageitgey 6y ago
  Thanks, we're working on figuring out the best way to represent those and maybe making them more location-specific. Even with median prices, it doesn't always make sense to show a country-wide median since there is a huge difference in price ranges between markets. A super high price in Nashville might be a super low price in Los Angeles, for example.
11thEarlOfMar 6y ago
Even I am surprised: Appendectomy: MSDRG 343: at Kaiser in Santa Clara: $56,000 Appendectomy: MSDRG 343: at Holston Valley Medical Center, TN: $4,700 Our healthcare system is even more broken than I ever imagined.
- yyhhsj0521 6y ago
  Too bad it is an emergency condition, otherwise people could just fly to TN for the same procedure...
  - dudul 6y ago
    I used to think that, but my wife had one last year and she only got her surgery almost 2 months after the diagnosis. She was on antibiotic the whole time to reduce and control the infection. Apparently it's the new way to deal with it, since it makes the surgery much easier to perform, instead of when the patient is in pain. Anecdote aside, your point stands. Shopping, across state lines for surgery is ridiculous.
- azalemeth 6y ago
  For a contrast [1] from the other side of the pond, you could get by on about $3k USD (most British people have no idea about this! [2]): > RESULTS > Fifty laparoscopic appendicectomies were performed. Median operative time was 60 min. The median total operative cost of laparoscopic appendicectomy was £906. Median equipment cost for laparoscopically completed cases was £254. Median total in-patient cost was £1617 (range, £880–£3360). This compared with a mean re-imbursement of £1981 representing a [hospital] cost benefit of £233 per case (P = 0.0009). > CONCLUSIONS > Despite a liberal use of disposable equipment, laparoscopic appendicectomy can still be performed within the confines of the national tariffs. There is a considerable variation in the cost of this procedure, and it may be possible to reduce costs by more stringent use of disposable equipment and standardising recovery protocols. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2966171/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2966171/ [2] https://www.theguardian.com/society/ng-interactive/2016/feb/08/how-much-have-i-cost-the-nhs https://www.theguardian.com/society/ng-interactive/2016/feb/...
- 6y ago
fireeyed 6y ago
This is made possible thanks to the current administration’s CMS price transparency rule which went into effect Jan 1,2021 http://www.cms.gov/hospital-price-transparency http://www.cms.gov/hospital-price-transparency Edit: By “current” I mean the Trump administration.
- apiimporter 6y ago
  And by "current" administration you mean the Trump administration because people here don't like to give credit where credit is due.
  - lostcolony 6y ago
    I mean, we can discuss how much credit and where it's due, but I'm pretty sure "current administration", on a given date, makes it kinda apparent?
    - ogre_codes 6y ago
      I think the idea is that the poster wants people aware that at least once in his administration Trump has done something remotely correct. Of course the fact that he did this after spending 3 years trying his damndest to gut our already mediocre public healthcare system makes it a bit of a eye roller, but you know, even a broken clock is right and all that.
      - 11thEarlOfMar 6y ago
        For completeness, a couple of other health related actions by the current administration: - 'Most Favored Nation' drug pricing. Also as of 1/1, big pharma has to charge US payers the same price as the lowest price they charge to other countries. One example cited is insulin. Apparently, the price of Insulin from the same pharma is 10% the price in Canada as it is in the US. Now that this law is enacted, that pharma has to charge the same in the US as they charge in Canada. - 'Right to Try'. Greatly reduces restrictions on terminally ill patients' access to experimental treatments. - Removed the mandate on the affordable care act. People who do not have any health insurance were liable to pay a fine. That fine was removed. - eHealth across state lines. Doctors were not permitted to see patients via video calls across state lines. During the pandemic, that restriction was removed.
echelon 6y ago
How do we disrupt the fucking debacle that is US healthcare? Would it be possible to create a subscription-based health network that was vertically integrated and provided just basic outpatient needs? Charge $9/mo or something ridiculously low and encourage everyone to check their health often and maintain healthy lifestyles? Use automation to reduce costs. Then gradually increase the scope of care. That won't help with surgery, cancer, childbirth, etc. right away, but it might create a gravitational shift that puts swaths of expensive general practitioners out of business, creating excess supply and lowering the range of what insurance covers. That might greatly reduce costs. We have to eat away at this bloated, inaccessible system somehow.
- SteveCoast 6y ago
  IMHO You need to make it legal to open and run a hospital (hospitals are basically local state-granted monopolies like cable companies). You make it legal to offer differential pricing. You decouple healthcare from employment. You allow employers to offer more than one insurer. Most of what we need to do is just remove the monopoly rules.
hkt 6y ago
Just came here to remind everyone that free at the point of use healthcare is great. I tried to total the cost of the care my son received when he was born, had we been American. I stopped counting at $1million. Being in the UK, I even got a few meals at the hospital canteen thrown in. Not to mention the time in nICU etc. It is horrifying that people have to compare prices and haggle for care anywhere on earth.
- ageitgey 6y ago
  Fun fact - I'm a cofounder of this and a US citizen, but I live in London. I agree completely with this. I spend my days working on US healthcare data and seeing how crazy it is while I use the NHS for my actual care. But the US system is tricky because while it is an huge mishmash of layers of middlemen and clearing houses taking a slice of the pie, those layers also employ a huge number of Americans across the country. It would be extraordinarily difficult (both logistically and politically) to rip all that out in one fell swoop. I feel like the only possible way to bring in socialized medicine in the US would be a gradual expansion of opt-in 'Medicare for All' or something along those lines.
  - hkt 6y ago
    It doesn't seem like there's a way to do it without aggressive opposition, really. Divide and rule (taking out one rentier middleman at a time) will take decades I'd imagine. So yeah, expand and improve existing programs until they're universal and comprehensive like the NHS. Sane approach.
treeman79 6y ago
Walked into a clinic for a weekly shot. Paid 60 dollar co-pay each week. One day I asked how much go get shot without insurance. It was $15. I was paying 4x to use insurance. And insurance was getting billed on top of that.
- kwhitefoot 6y ago
  Did you switch to getting it without insurance?
- bszupnick 6y ago
  Same happened to me. A test with insurance cost $3000 with insurance. They paid $2250 leaving me with $750. I asked how much it would be without insurance and they quoted me $350.
- ahepp 6y ago
  My understanding is that the insurance does not actually pay the price they tell you in your explanation of benefits. So if it's any comfort, I'd guess your insurance wasn't getting billed on top of that. They probably paid $15 and pocketed your copay. Some might call this "keeping two sets of books", but apparently it's par for the course here in the glorious USA. Up until recently [0], it was common for insurers to have rules preventing health care providers from telling you when it was cheaper to pay cash. [0] https://www.aarp.org/health/drugs-supplements/info-2018/gag-rules-pharmacists/ https://www.aarp.org/health/drugs-supplements/info-2018/gag-...
- three_seagrass 6y ago
  If it's any consolation, the insured patient payments are subsidizing the non-insured cash cost.
ketanmaheshwari 6y ago
Looking at some of the prices, I can't help but think how great an incentive it is to be healthy in the US. "Health is wealth" if it applies anywhere it is in the US. I have taken extra measures to ensure that myself and my family are healthy in the last year and with a tax-free HSA account that is invested into ETFs, I am literally printing dollars just by following basic principles of being healthy.
- originalvichy 6y ago
  Health privilege becomes a thing when access to healthcare becomes a barrier. I know the word ”privilege” is quite radioactive. I was sick often as a kid and after finding a diagnosis I’ve been performing well among my age peers. Thank you Finnish healthcare. Couldn’t imagine how much it sets you back cognitively to have health issues as well as financial issues burdening your mind 24/7. Completely avoidable pain and suffering purely for profit.
  - ketanmaheshwari 6y ago
    Agreed. I was just looking at the positive aspect of it.
zirkonit 6y ago
Cardiac valve procedure at Kaiser Foundation Hospital - Redwood City Medical Center - $458,254.00 cash price. Oh my. I get it that it's an expensive procedure, but OH MY.
- huitzitziltzin 6y ago
  Kaiser might be a weird outlier. IT is a very different kind of organization (vertically integrated - physicians/insurers/hospitals). It might be that the price is that insane elsewhere, but Kaiser may not be the best way to judge.
baskire 6y ago
Having hospitals compete on price will bring healthcare costs down. Just like how we can choose between generics and name brands. Great job!
voicedYoda 6y ago
Looks interesting. How is this different than test claim submissions available from Eligible, Waystar, PokitDoc, etc? And are you licensing out cpt codes from the ama? IMHO the AMA and their copyright of CPT codes is the biggest setback to progressive change, transparency, and adaptive change in tech... Payers and well funded companies can afford licensing, otherwise they will strangle you with lock down...
yding 6y ago
Very cool! We've been working an app that is looking for this exact type of data. Do you have an API or plans for making an API for this?
- ageitgey 6y ago
  We do have plans for an api, but we are currently working out the model for it - feel free to get in touch via the site and let us know you are interested and what you might want to do with it.
  - yding 6y ago
    Thank you. Just did.
duffpkg 6y ago
One important piece of context here is that these rates are negotiated as part of a contract bundle where an insurer is bringing a pool of patients to the facility. Prices can vary widely procedure to procedure because they are associated with over or under representation of certain factors within that pool. For example, grossly simplified, I might have a particular service line, hip replacements (an ortho program). The insurer whose patient population is going to 'keep the lights on' in that service line is going to see a very different rate per service than a different insurer who rarely has patients that need it. Nothing about these prices shown are really reflective of the costs of doing the procedure such as pricing in a retail store. I do think this transparency initiative will result in more consistent costs but not necessarily net lower costs. Comparisons to other countries that are smaller than the united states are somewhat apples to oranges. There are a lot of factors that are glossed over when someone says "costs are 5x higher in the US than my country" including real estate, energy subsidy, and so on. Its a deep well.
brundolf 6y ago
I had this exact idea ~6 months ago but didn't know where to begin. I'm sincerely glad someone else built it. We're in such desperate need of justice when it comes to U.S. healthcare and this is a really good first step in holding the system just a little bit more accountable.
curiousllama 6y ago
Great solution. I hope this will make asking about costs at the hospital more normal! I once went to a doctor for vaccinations before traveling. The nurse said "You need X, I recommend Y, and the CDC recommends Z." I responded "great, let's get X right now. Not sure about Y or Z - how much do they cost?" The question just didn't compute. No matter how I phrased it ("just want to price compare" ... "there's a bunch of travel clinics and I'm trying to get this cheaply" etc), I couldn't make myself understood. The NP ended up coming in to give me their "anti-vax" spiel. I had walked in to a hospital wanting a vaccine, and asking about costs was so foreign to them that they thought the only reason I could hesitate to get a vaccine was anti-vax sentiment. All this to say - this tool is very much needed, and has the potential to do a lot of good!
deleted 6y ago
[deleted]
ummonk 6y ago
And of course the FTC doesn’t care about the blatant anticompetitive behavior by hospitals.
- huitzitziltzin 6y ago
  Where do you get that from? The FTC has challenged a lot of hospital mergers. They are not always successful, but they do challenge them. Source: healthcare/competition economist.
SteveCoast 6y ago
A number of people, including me, have been building similar things, see http://price.hospital http://price.hospital The problem seems to be figuring out a revenue model, and translating all the medical terms in to human.
- egillie 6y ago
  Same, I've been mapping out CA average prices at http://hospitalprices-env.eba-r2yhwdcw.us-west-1.elasticbeanstalk.com/common-procedures/ http://hospitalprices-env.eba-r2yhwdcw.us-west-1.elasticbean... Comparing just the price of a hip replacement is difficult, because there are so many other services that will bundled in with a hip replacement (anesthesia etc) that may not be represented in the service price alone. The "average cost by diagnosis code a patient comes in with" transparency requirement is an attempt at solving that, but doesn't differentiate between insurance plans. Also, I love OpenStreetMap, thanks for your work on that!
  - technics256 6y ago
    Are you scraping this or just visiting each site manually and getting the machine readable data? Cool stuff!!
    - egillie 6y ago
      California collected all of their hospitals' data at https://oshpd.ca.gov/data-and-reports/cost-transparency/hospital-chargemasters/ https://oshpd.ca.gov/data-and-reports/cost-transparency/hosp... The average prices for common procedures is on the 1045 sheet I have my gripes with California but I love that they did this
      - technics256 6y ago
        Woah, I'm a CA resident and also surprised and happy. Are you seeing a lot of non-compliance?
        6y ago
dubcanada 6y ago
How accurate is this? Some of the threads point out extremes between different hospitals, is that because X hospital does more stuff then Y, and Y charges you the same as X it's just a bunch of hidden/extra stuff that isn't billed as "MSDRG 343"? Or is it because the hospital like any business can charge you what ever you want and may charge more or less depending on the neighbourhood, rent, etc?
- ageitgey 6y ago
  I think part of it is that there is a huge difference in cost between some facilities. But another part of it is that a lot of hospitals don't really know what they charge. They had to scramble and hire consultants to come up with these numbers to meet the deadline and the numbers will probably get more accurate and vary less over time as hospitals get better used to working with prices out in the public.
zachmu 6y ago
We're running a $10,000 bounty to assemble this information into a queryable database: https://www.dolthub.com/repositories/dolthub/hospital-price-transparency/bounties/00000000-0000-0000-0000-000000000001 https://www.dolthub.com/repositories/dolthub/hospital-price-... You get paid based on the percentage of rows you contribute to the dataset. So if you fill in 20% of the rows, you get $2,000. More details here: https://dolthub.awsdev.ld-corp.com/blog/2021-01-14-hopsital-prices-bounty/ https://dolthub.awsdev.ld-corp.com/blog/2021-01-14-hopsital-...
- egillie 6y ago
  This is amazing! Will the data be public after it's assembled?
  - zachmu 6y ago
    Yes. It's public now, just incomplete.
stevofolife 6y ago
Can someone explain why US medical costs are so absurd? Why is it the way it is?
rohanagarwal94 6y ago
Hope this was available for India
4ec0755f5522 6y ago
I just read an article about quiet / dream jobs (park ranger etc.) In it, every single person has a side gig(s) or is otherwise making decisions on their careers based on medical coverage. Every one of them! One of the people says most people leave when they turn 26 because they can't stay on their parents' health insurance. What?! > And like other dream jobs I learned about, it’s not enough to survive on: During > off-seasons, Krumbholz also works as a substitute teacher and an aquarium dolphin > tank cleaner; since being on university health insurance would mean she’d constantly > lose it during the off-season, Krumbholz decided to stay on the state exchange > instead. The idea that health care is tied to your employer, and your employment status, is so unacceptably broken. I've never heard of anything so broken in terms of the obvious social and economic harm a bad policy is creating. Having the freedom from health care costs is more freedom for more people than the "freedom" to not pay health insurance or taxes to cover it.
- peytn 6y ago
  That sounds extreme. Without taking sides, I suggest another possibility is that the author may have a bias, agenda, or angle to the story.
- xyzelement 6y ago
  // Having the freedom from health care costs is more freedom for more people than the "freedom" to not pay health insurance or taxes to cover it. This is not how freedom works. Your argument is akin to saying "freedom from hearing uncomfortable opinions" benefits more people than "freedom of expression" does. On the broader level, I got to experience healthcare in the US both as a broke-ass immigrant child and as a working adult. It ranged from good to amazing in terms of availability of appointments, treatments, quality and comfort. Night and day beyond what I experienced in the USSR as a kid. So while people are shitting on the system we have, many people find it excellent and amazing and we like the freedom to continue enjoying it.
  - Trill-I-Am 6y ago
    Would the general public of other developed nations be happier if their healthcare systems were more like the US's?
fiatjaf 6y ago
This sort of thing must make some cheaper alternatives appear.
5cents 6y ago
A famous Norwegian professor of social medicine, Per Fugelli, once told a story in a talk that has stuck with me for some reason; Per was talking to a taxi driver, and the driver told him that he was having surgery on his heart valve. Per asked if he was scared , and the driver looked at him and said "No, Per, would you like to know why? Because the surgeon who will operate me has also operated the King" (the King of Norway has had several heart surgeries through ht eyears). I think it's a nice story. Unfortunately, most of his works are in Norwegian, but his last essay before dying from cancer was called Thank you, Norway - and good luck on your watch (Google Translate uses "god vakt", but I guess it is an idiomatic greeting to guards whos shift is starting) [0] - he was afraid the three pillars of the Norwegian society was somewhat threatened: justice, trust, freedom [0] https://translate.google.com/translate?sl=no&tl=en&u=https://www.aftenposten.no/meninger/kronikk/i/7rarB/takk-norge-og-god-vakt-per-fugelli https://translate.google.com/translate?sl=no&tl=en&u=https:/...
markdown 6y ago
FYI, you have a typo on the home page. > isn’t an MRI and MRI?
onlinebaba 6y ago
You all should check out https://www.sidecarhealth.com https://www.sidecarhealth.com their insurance pays 100% of the cost in cash to the care provider, thereby brining the cost of care 40% - 60% less.

447 points by ageitgey 6y ago

It would be nice to be able to see the lowest & highest prices & other stats. I can manually find the lowest price by sorting by price but I can't seem to reverse it to show the highest price first... Anyway, it seems that there are orders of magnitude differences for the same service. The service 'MRI Lumbar Spine With & Without Contrast Material' has a lowest price of $210 while the closest and highest I personally could find was ~$4109. How can there be such a large difference in price for something that, I believe, is legally & medically the same procedure?

nugget 6y ago
In 2015 I did several months of due diligence in this market - price comparison for diagnostic imaging - before concluding that it wasn't feasible to build the product we wanted to build. This new law provides the data that we were unable to access (at scale) on our own. From the data we did get our hands on, I remember seeing price differences like $200 vs $4k for the exact same procedure. The low cost provider was usually a private practice radiologist in a small shopping mall type retail location who ran a very efficient, low overhead practice. They were terrible at marketing and ran discounts for volume from certain channels. They were only open Monday to Friday from 8am to 4pm, read times could often (but not always) be slow, they handled the least complex cases and no emergencies. Cash pay up front from patients resulting in no/minimal collections. The high cost provider was usually a large University affiliated medical center who ran a less efficient, high overhead radiology department but who also, in their defense, had to handle more complex cases as well as be open 24/7 to service one or multiple emergency departments with faster read times. Lots of fighting with insurance companies for eventual reimbursement. Lots of bad debt that went to collections and had to be written down. If you pay University prices for a simple MRI you are effectively subsidizing the ED admit who needs a complex imaging procedure in the middle of the night. If consumers start to shop for MRIs the way they shop for airline tickets - which they probably should - one downstream effect will be to remove billions of dollars of "subsidies" from the most well-resourced radiology departments in the country. If I remember correctly the diagnostic imaging market was something like $150 billion/year in 2015, and probably even bigger now, i.e. plenty of potential fat to cut.
- kfarr 6y ago
  Response time / availability is not something I considered in medical service pricing before but wow it makes a lot of sense.
- wjossey 6y ago
  For folks who don’t believe in universal medical coverage, this is part of the reason why it’s so inefficient for it not to exist. The uninsured person going to the hospital at 1AM that requires an MRI because slipped a disc in their back still ends up getting that MRI. When they fail to pay that bill, which would be 5%-10% of their annual earnings, we all still pay for it. We just decided to layer in debt collection, anxiety, and depression onto the patient in lieu of cash. As someone who still considers themselves a fiscal conservative, and also believes we need true universal coverage for all Americans, this seems like a no brainer to me at this point (and I say that as someone who would have not supported this in the 00s but has evolved significantly on this issue).
  - nugget 6y ago
    My takeaway from all that research was the same. Almost everyone benefits from universal coverage but the system has to incentivize patients to shop around for the optimal balance of price, quality, and convenience. This can be accomplished with an annual deductible of a few thousand dollars perhaps capped at a % of income. Without this incentive, costs skyrocket. Price transparency is a pre-requisite without which consumers can't easily shop around, so this law is a giant leap forward in the right direction. That is the #1 most effective thing that Americans can do to reduce health care costs. #2 would be to change the standard American diet and eat healthier to reduce rates of obesity and diabetes. Almost every other proposed structural change or intervention we looked at was minimal by comparison.
    - zaphod12 6y ago
      There was an attempt at this with prescription drugs. Encourage patients to take generics by forcing a larger amount of cost onto the patients in the form of higher copays. Pharma companies realized and started giving copay vouchers (still charge insurance more, but short circuit the patient incentive). When that loophole got tighter they formed charitable foundations to give the vouchers instead. I'm not disagreeing with your points, per se. It's just amazing what entrenched interests can manage.
subhro 6y ago
> How can there be such a large difference in price for something that, I believe, is legally & medically the same procedure? I hope this never happens, but let’s say you got in a motorcycle accident and need that lumbar MRI to figure out the damage. What are going to do, get back on that wrecked motorcycle with a fucked up spine and go to that 210$ place? They do it because they can do it and get away with it.
- eldavido 6y ago
  I see this argument a lot. The trouble is that emergency care isn't what drives the majority of healthcare spend. What does is actually chronic conditions: dialysis, diabetes, autoimmune disorders, chronic weight conditions. That's what we need to worry about. And if there was a real market here, you wouldn't need to shop around because all the people that do, would enforce some level of price discipline on the market. Think about it. For any good sold at, say, Wal-Mart, say Gatorade, there are some people that want it a LOT, even NEED it, while others are more on the fence. There's only one price on the shelf and it's calculated to get a lot of people buying. So in effect, the people who are more indifferent (want it less) are actually doing a pretty significant service to the people who want it a lot, by guaranteeing the price will be set low for everyone. There's no reason something like this can't apply in healthcare.
LatteLazy 6y ago
>How can there be such a large difference in price for something that, I believe, is legally & medically the same procedure? If no one publishes their prices how do you set yours? 2 dollars? 2000 dollars? 2m dollars?
- spaetzleesser 6y ago
  I am pretty sure the providers and insurers know exactly what everyone is charging. It’s the patients that are being kept in the dark.
  - deleted 6y ago
    [deleted]
  - LatteLazy 6y ago
    Like any opaque market, bigger players will have more info, but I doubt anyone will share information as its collusion (maybe illegal) and also advantages either your negotiating opponent or your competitors...
    - mrnickel001 6y ago
      Exactly. Small payers are actually pretty hungry for this data. Generally, big payers are more privy to market rates (by paying for datasets, owning clearinghouses, etc).
  - sib 6y ago
    When I needed a similar non-emergency procedure (cervical, rather than lumbar, MRI), my neurosurgeon, at a large, university-affiliated hospital, referred me to the in-house radiology department. Within a day or two, I received a phone call from some department at my health insurance provider telling me "Hey, we see that you are going to get an MRI; did you know that you can get the exact same procedure at providers A, B, and C, for a lot lower cost?" They did this even though the hospital's radiology department was in-network. In this case, the cost difference was similar to what's noted here - about $4,000 vs $450. Since the insurance company was paying most of it, aside from my copay / share of cost, they were motivated to provide me a little transparency. To be honest, as a patient, I would have preferred to get the MRI at the hospital; their facility was nicer, cleaner, more modern, and there was better data integration for getting the results to my neurosurgeon and keeping them as part of my holistic medical record. Nonetheless, I went to the cheaper provider.
mrnickel001 6y ago
Thanks for the feedback! We'll be improving our filter/sort here in the coming days and we'll take this feedback into our plan.
- ilaksh 6y ago
  My searches so far show insane differences between insurance rates and cash rates. The cash can be 5-10x higher than what the insurance company pays. It seems like a clear case of systemic fraud to me. Am I missing something? Also I am not able to find any fundoplication or LINX (43284).
  - mrnickel001 6y ago
    Many hospitals don't discount from their list price for self pay. Medicare pays ~10% of list price. So, for example, if there is an insurance rate set at "130% medicare" (common to have a coefficient between 1 and 2), then yes, you'd still see many cash rates that are 5x insurance. However, many hospitals also listed Managed Medicaid insurance rates. These are generally 3-5% of list price & look for similar to normal insurance plans. So, what you're seeing may also be comparing a Medicaid rate to a very high cash rate. Will add 43284 & other gastro procs shortly. Thanks!

fartcannon 6y ago

Is there a Walmart for medical procedures? A jiffy-lube?

dakial1 6y ago
Come to Brazil. The best Brazilian hospital (Albert Einstein Hospital in Sao Paulo) charges 1.7k USD for a C section (my son was born recently there), while the lowest I've found in that site is 2.6K USD (don't know about the quality) and median seems to be 8K USD. I bet the other procedures have similar price differences. You can pay for the trip, get the best care (it is a really good, international level, hospital) and still have some loney left.
- pqdbr 6y ago
  And what about an MRI? This website lists rates around 2k USD, while in Brazil you can get one (in high-end modern hospitals in São Paulo) for around R$ 600 (== $120).
  - xtracto 6y ago
    MRI in Mexico cost ~$200 USD ( https://www.chopo.com.mx/zapopan/estudios/resonancia-magnetica https://www.chopo.com.mx/zapopan/estudios/resonancia-magneti... ) and is way closer than Brazil. There are laboratories even at walking distance of the USA haha ( https://www.google.com/search?tbs=lf:1,lf_ui:4&tbm=lcl&q=laboratorio+chopo+tijuana https://www.google.com/search?tbs=lf:1,lf_ui:4&tbm=lcl&q=lab... )
    - dakial1 6y ago
      Might be interesting to check how much "Medical Tourism" happens between US and other countries. This might be an interesting industry to get into. If I remember well there was a health insurance company that was promoting Medical Tourism for their clients
      - xtracto 6y ago

subhro 6y ago

This seems to be the GoodRx of medical procedures. This is tremendously helpful. How do you plan to keep the data current? Also, in the US, is a patient realistically able to say, “Hospital X is able to get my compound fracture surgery done for 65% less. Match it or I walk”, especially when insurances have negotiated rates. Or is this only useful for people with no insurance?

mrnickel001 6y ago
Hey man! This is a great comment. I work with Turquoise. We're actually building some stuff where patients can collectively bargain outside their insurance. But for now, it's most useful to people with insurance that see that one hospital down the road has a lower rate for their given insurance. (EG, the blue cross rate is better the next town over). We're going to make it easier to filter for insurance shortly. Also, very useful for cash pay.
- applecrazy 6y ago
  This is an amazing product and I congratulate you on your launch! Like the parent, I'm also really curious how you plan to update the data and also wanted to ask how you normalized the data. I ask because this space has always been interesting for me. Funny enough, I helped build almost the exact same thing at a hackathon (https://devpost.com/software/liform https://devpost.com/software/liform), but the project didn't pan out after that due to our team's lack of medical knowledge. So I'd love to learn from your experience processing this data into a usable form.

Pjki889 6y ago

The branding (design, typography) looks very similar to OneMedical.

rplnt 6y ago

Why are the prices so insane? Where do the money go? I'm from Eastern Europe so of course the prices would be different, but by an order of a magnitude at the minimum seems strange.

dnautics 6y ago
- paying for services for people who don't have/can't afford insurance. - medical malpractice insurance -> legal system - big pharma/med devices industry
- spaetzleesser 6y ago
  You should add - doctors are paid higher in the US than in another countries - billing staff overhead because of the insane insurance system - highly paid hospital administration - lots of middlemen that stay invisible because there is no price transparency - shiny new buildings that are built by friends of the hospital administration
  - excannuck 6y ago
    "billing staff overhead because of the insane insurance system" While true, I would generalize to "insane bureaucratic system" unless you want to include public "insurance" into the mix. Medicaid and Medicare aren't simple!
  - ArtDev 6y ago
    Look up the salary of your local hospital president. In my medium town of (Pop 200K) they pay him $980k per year. That is an absurd salary for a relatively small hospital!
    - therealdrag0 6y ago
      How do I look that up?
      - huitzitziltzin 6y ago

terse_malvolio 6y ago

Sometimes the cost is bigger than the cost in a different country plus the plane ticket.

dominotw 6y ago
I guess you could roll the dice and hope the for best but you will lose your ability to sue the hospital for malpractice if they mess up.
- terse_malvolio 6y ago
  Maybe there is a chance that insurance could be enabling malpractice? I'd have to get hard data on this to make a determination but I'd wager that most reputable medical professionals try to avoid malpractice regardless of country.
- BurningFrog 6y ago
  The alternative is often to not have the procedure at all.
- jasonpeacock 6y ago
  You're making a lot of assumptions here that an out-of-country hospital would be of questionable quality and not have medical malpractice laws. Just because other countries medical & legal systems are different than the US doesn't mean they are inferior.
  - learc83 6y ago
    The GP was talking about losing your ability sue for malpractice not implying that every other country has inferior medical or legal care. A country can have a fine legal system for locals that's difficult or prohibitively expensive to access for non-citizens living outside the country.
    - londons_explore 6y ago
      One of my businesses refuses to serve Americans simply because they have a habit of reaching for the legal system if they aren't happy with the service. All the Americans end up going to my competitor, who is currently in the midst of three lawsuits which will probably sink the company. Two of the lawsuits are with clients I turned away simply because they looked likely to sue! You can bet that as an American, you will pay substantially more than a local for many services simply because Americans have a reputation for this sort of stuff, and local businesses don't want to take the risk. I really wish there was some kind of certificate saying "I have never set foot in a courtroom, threatened legal action, or hired a lawyer".

forgingahead 6y ago

This was a big accomplishment of the Trump admin. Regardless of what your other opinions of his administration are, healthcare pricing transparency in the US is a very important step forward to improving the healthcare situation there. Source (one of many): https://www.reuters.com/article/us-usa-trump-drugs/white-house-says-medical-insurance-price-transparency-rule-finalized-idUSKBN27E2X0 https://www.reuters.com/article/us-usa-trump-drugs/white-hou...

ttul 6y ago
It’s too bad that all the other insane things he did will overshadow literally anything of value that he accomplished.
- the-dude 6y ago
  Could you enlighten me and name some of those things? Not things he said, but things he did according to you.
  - hedora 6y ago
    These are all well documented: https://www.indy100.com/news/donald-trump-bad-things-list-b1785865 https://www.indy100.com/news/donald-trump-bad-things-list-b1... There are 55 things on the list. There’s a mixture of things he said and things he did. As president, his words have real consequences, so drawing the line at “things he said” is strange.
    - the-dude 6y ago
      Are you serious about bringing that article/site to the table as a source to try and make your point? Or is this sarcasm?
      - zingermc 6y ago
        Don't feed the troll.

azalemeth 6y ago

I think something else that would be of interest would be doing this for drug prescriptions: compare the cost that my employer, the NHS, pay for a compound and those that Americans pay for the exact same compound. This is easy on my end at least -- prices and prescription guidance are released in the BNF / British National Formulary annually and are all made available in public. I have never understood the US system of "co-pays" and found the whole thing very confusing. For a few "popular" random examples that I think HN might have heard of: one branded Epi-Pen is £26.45; Naproxen (the NSAID painkiller) is £4.29 / 56 pack; and omeprazole (PPI used to treat gastric reflux) is £0.84 / 28 pack. A more expensive example might be the cystic fibrosis "designer drugs" lumacaftor with ivacaftor -- 112 tablets are £8000 (to be prescribed by a specialist, if the patient has the genotype to respond to it -- a total annual cost of about £26k). The US equivalent is $379,780 [1]. (NB: The price you pay as a British patient is usually £0, unless you are a working-aged and working English person -- at which point it is £9.15 per item [independent of its cost] or a fixed "all you can eat" prepayment certificate that works out at about £8.83/month -- which is what I have. Oh, and plus the taxes, of course...). [1] https://www.jmcp.org/doi/pdf/10.18553/jmcp.2018.24.10.987 https://www.jmcp.org/doi/pdf/10.18553/jmcp.2018.24.10.987

CogitoCogito 6y ago
> I have never understood the US system of "co-pays" and found the whole thing very confusing. I think you're mixing up a few things here. The co-pays are meant to make the patient directly pay some of the cost to decrease abuse of the system. There are many different structures for co-pays so saying anything general is kind of difficult, but there are reasonable arguments supporting such a system. In Sweden for example you do have to pay certain costs (which are capped) for essentially the same reason. But that has nothing to do with the fact that prices vary so widely for the same products and services. Personally I think that the US system should at a minimum require that 1. All medical products' and services' costs to published publically; 2. All costs to be non-discriminatory (meaning everyone regardless of any insurance plan or none must pay the same); 3. All costs be available prior to any services provided. In other words, there are no negotiated plans with different prices, there are no surprise bills, patients actually are able to understand costs, and real competition is actually theoretically possible. None of this would necessarily preclude an insurance plan from having co-pays, it would just make the only point of the insurance plan purely financial and open as it should be. Of course the US could just move to a single-payer government-run system, but that's a different discussion. If the goal truly is to have a market-based system, then I think my points above should be implemented.

hedora 6y ago

It would be nice if I could set my insurance plan once, and then see the cash and insured prices in the search results.

ageitgey 6y ago
This is in the works! We hope to implement this as soon as we've cross-referenced all the plans across providers.

dr_faustus 6y ago

It's always fascinating to see that even compared to prices you pay as a self-paying patient in Germany (which are already 1.5x - 2x higher than what the "public" insurances, ie. 85% of the population, pay for the same procedures), the prices in the US are about 5x to 10x higher. The standard of care seems to be quite comparable if you look at outcomes, so there must be huge inefficiences in the American system (doctors in Germany are consistently ranked as the highest paid academics, so I guess it cant be doctors' salaries alone).

emteycz 6y ago
I don't believe any medical professional in Germany has wage exceeding 150k EUR yearly after taxes - doctors in the US sometimes have multiples of that, coincidentally 5x to 10x more is not unusual.
- Redoubts 6y ago
  I’m sure German doctors don’t have oodles of student debt too.
  - emteycz 6y ago
    Yeah, that for sure.
- travisp 6y ago
  It's true that US doctors are paid more (although the gap isn't as big as it used to be). However, pay for US doctors makes up a fairly small portion of overall US medical expenditures (less than 10%). So, you could ask every doctor to work for free and not significantly change costs.
  - tfehring 6y ago
    There’s a similar (but smaller) differential for other medical professionals too. But more generally, when I’ve done high-level comparisons of medical spending between the US and Western European countries, it seems like every single cost element is more or less proportionately higher in the US. It seems like basically everyone is spending money in roughly the same proportions, including on things like doctors’ salaries - everything is just scaled up by ~40% to ~100% in the US, depending on which country you compare it to.

hehehaha 6y ago

Here’s another consideration: care quality is very disparate across the country in the US. And what’s even more frustrating is that cost is not correlated to quality. While I am a bit more critical because I’ve seen “how the sausage is made” first hand for years, this also makes it that much harder to implement universal health care in the US. Don’t think someone living in rural Wyoming should pay the same HC tax/premium as someone living right across the street from MGH.

ageitgey 6y ago
Definitely true - quality and price are only very loosely related. Right now we have care quality information on the hospital "information" page, but most people aren't finding it in the current design and we are going to re-work it so it's more visible when browsing prices.

mtalantikite 6y ago

This is great (and totally unfortunate that it needs to exist in the US), thanks for building it. One issue: it looks like the search is not respecting the zip code for me if I change it. For example, if I search for a procedure using the zip code the site auto-populates, my results are great. However, if I change the zip code to my actual neighborhood here in NYC, I'm seeing results from all over the country.

ageitgey 6y ago
Thanks, I'll take a look! If you don't mind, would you mind dropping me an email at adam@turquoise.health with the zip code you are trying?

k3liutZu 6y ago

Oh wow, so a "Tonsil Removal (Patient Under 12)" procedure has a huge price-range: $298.00 $7,830.76 $7,299.85 $10,243.23 $13,964.19 --- How are these even comparable?

theplague42 6y ago
It's probably bad data. 7k vs 13k is reasonable, but nobody is removing tonsils for $300.
- CogitoCogito 6y ago
  $300 seems low to me as well, but the order of magnitude spread isn't suprising at all. About 5 years ago I went into the ER in NYC due to extreme dehydration. They gave me some saline and sent me home a few hours later. Later I got a bill for $250 which was above my ER $150 copay so I called them up and it turned out they didn't realize I had insurance. A month later I got a "fixed" bill for $3000 to my insurance of which $150 was my responsibility. My example of a magical 12x increase given single exact same procedure coded identically, means I find a price increase of ~43x from $300 to $13,000 between different hospitals quite believable.

Abishek_Muthian 6y ago

Congratulations on the launch! Turquoise Health could be solving this need gap - 'How much will I be charged for my treatment'[1] posted on my problem validation platform. You're welcomed to explain how Turquoise Health helps solve their problem in that thread. [1]https://needgap.com/problems/122-how-much-will-i-be-charged-for-my-treatment-hospital-bills https://needgap.com/problems/122-how-much-will-i-be-charged-... (Disclaimer: It's a problem validation platform I created).

smueller1234 6y ago

Suggestion: I hope I didn't completely miss something, but the site seems to put average prices for procedures all over the place when the median price would actually be much more informative to somebody searching for a provider. Looking at a few procedures, the prices seem to have significant outliers, which exacerbates this.

ageitgey 6y ago
Thanks, we're working on figuring out the best way to represent those and maybe making them more location-specific. Even with median prices, it doesn't always make sense to show a country-wide median since there is a huge difference in price ranges between markets. A super high price in Nashville might be a super low price in Los Angeles, for example.

11thEarlOfMar 6y ago

Even I am surprised: Appendectomy: MSDRG 343: at Kaiser in Santa Clara: $56,000 Appendectomy: MSDRG 343: at Holston Valley Medical Center, TN: $4,700 Our healthcare system is even more broken than I ever imagined.

yyhhsj0521 6y ago
Too bad it is an emergency condition, otherwise people could just fly to TN for the same procedure...
- dudul 6y ago
  I used to think that, but my wife had one last year and she only got her surgery almost 2 months after the diagnosis. She was on antibiotic the whole time to reduce and control the infection. Apparently it's the new way to deal with it, since it makes the surgery much easier to perform, instead of when the patient is in pain. Anecdote aside, your point stands. Shopping, across state lines for surgery is ridiculous.
azalemeth 6y ago
For a contrast [1] from the other side of the pond, you could get by on about $3k USD (most British people have no idea about this! [2]): > RESULTS > Fifty laparoscopic appendicectomies were performed. Median operative time was 60 min. The median total operative cost of laparoscopic appendicectomy was £906. Median equipment cost for laparoscopically completed cases was £254. Median total in-patient cost was £1617 (range, £880–£3360). This compared with a mean re-imbursement of £1981 representing a [hospital] cost benefit of £233 per case (P = 0.0009). > CONCLUSIONS > Despite a liberal use of disposable equipment, laparoscopic appendicectomy can still be performed within the confines of the national tariffs. There is a considerable variation in the cost of this procedure, and it may be possible to reduce costs by more stringent use of disposable equipment and standardising recovery protocols. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2966171/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2966171/ [2] https://www.theguardian.com/society/ng-interactive/2016/feb/08/how-much-have-i-cost-the-nhs https://www.theguardian.com/society/ng-interactive/2016/feb/...
6y ago

fireeyed 6y ago

This is made possible thanks to the current administration’s CMS price transparency rule which went into effect Jan 1,2021 http://www.cms.gov/hospital-price-transparency http://www.cms.gov/hospital-price-transparency Edit: By “current” I mean the Trump administration.

apiimporter 6y ago
And by "current" administration you mean the Trump administration because people here don't like to give credit where credit is due.
- lostcolony 6y ago
  I mean, we can discuss how much credit and where it's due, but I'm pretty sure "current administration", on a given date, makes it kinda apparent?
  - ogre_codes 6y ago
    I think the idea is that the poster wants people aware that at least once in his administration Trump has done something remotely correct. Of course the fact that he did this after spending 3 years trying his damndest to gut our already mediocre public healthcare system makes it a bit of a eye roller, but you know, even a broken clock is right and all that.
    - 11thEarlOfMar 6y ago
      For completeness, a couple of other health related actions by the current administration: - 'Most Favored Nation' drug pricing. Also as of 1/1, big pharma has to charge US payers the same price as the lowest price they charge to other countries. One example cited is insulin. Apparently, the price of Insulin from the same pharma is 10% the price in Canada as it is in the US. Now that this law is enacted, that pharma has to charge the same in the US as they charge in Canada. - 'Right to Try'. Greatly reduces restrictions on terminally ill patients' access to experimental treatments. - Removed the mandate on the affordable care act. People who do not have any health insurance were liable to pay a fine. That fine was removed. - eHealth across state lines. Doctors were not permitted to see patients via video calls across state lines. During the pandemic, that restriction was removed.

echelon 6y ago

How do we disrupt the fucking debacle that is US healthcare? Would it be possible to create a subscription-based health network that was vertically integrated and provided just basic outpatient needs? Charge $9/mo or something ridiculously low and encourage everyone to check their health often and maintain healthy lifestyles? Use automation to reduce costs. Then gradually increase the scope of care. That won't help with surgery, cancer, childbirth, etc. right away, but it might create a gravitational shift that puts swaths of expensive general practitioners out of business, creating excess supply and lowering the range of what insurance covers. That might greatly reduce costs. We have to eat away at this bloated, inaccessible system somehow.

SteveCoast 6y ago
IMHO You need to make it legal to open and run a hospital (hospitals are basically local state-granted monopolies like cable companies). You make it legal to offer differential pricing. You decouple healthcare from employment. You allow employers to offer more than one insurer. Most of what we need to do is just remove the monopoly rules.

hkt 6y ago

Just came here to remind everyone that free at the point of use healthcare is great. I tried to total the cost of the care my son received when he was born, had we been American. I stopped counting at $1million. Being in the UK, I even got a few meals at the hospital canteen thrown in. Not to mention the time in nICU etc. It is horrifying that people have to compare prices and haggle for care anywhere on earth.

ageitgey 6y ago
Fun fact - I'm a cofounder of this and a US citizen, but I live in London. I agree completely with this. I spend my days working on US healthcare data and seeing how crazy it is while I use the NHS for my actual care. But the US system is tricky because while it is an huge mishmash of layers of middlemen and clearing houses taking a slice of the pie, those layers also employ a huge number of Americans across the country. It would be extraordinarily difficult (both logistically and politically) to rip all that out in one fell swoop. I feel like the only possible way to bring in socialized medicine in the US would be a gradual expansion of opt-in 'Medicare for All' or something along those lines.
- hkt 6y ago
  It doesn't seem like there's a way to do it without aggressive opposition, really. Divide and rule (taking out one rentier middleman at a time) will take decades I'd imagine. So yeah, expand and improve existing programs until they're universal and comprehensive like the NHS. Sane approach.

treeman79 6y ago

Walked into a clinic for a weekly shot. Paid 60 dollar co-pay each week. One day I asked how much go get shot without insurance. It was $15. I was paying 4x to use insurance. And insurance was getting billed on top of that.

kwhitefoot 6y ago
Did you switch to getting it without insurance?
bszupnick 6y ago
Same happened to me. A test with insurance cost $3000 with insurance. They paid $2250 leaving me with $750. I asked how much it would be without insurance and they quoted me $350.
ahepp 6y ago
My understanding is that the insurance does not actually pay the price they tell you in your explanation of benefits. So if it's any comfort, I'd guess your insurance wasn't getting billed on top of that. They probably paid $15 and pocketed your copay. Some might call this "keeping two sets of books", but apparently it's par for the course here in the glorious USA. Up until recently [0], it was common for insurers to have rules preventing health care providers from telling you when it was cheaper to pay cash. [0] https://www.aarp.org/health/drugs-supplements/info-2018/gag-rules-pharmacists/ https://www.aarp.org/health/drugs-supplements/info-2018/gag-...
three_seagrass 6y ago
If it's any consolation, the insured patient payments are subsidizing the non-insured cash cost.

ketanmaheshwari 6y ago

Looking at some of the prices, I can't help but think how great an incentive it is to be healthy in the US. "Health is wealth" if it applies anywhere it is in the US. I have taken extra measures to ensure that myself and my family are healthy in the last year and with a tax-free HSA account that is invested into ETFs, I am literally printing dollars just by following basic principles of being healthy.

originalvichy 6y ago
Health privilege becomes a thing when access to healthcare becomes a barrier. I know the word ”privilege” is quite radioactive. I was sick often as a kid and after finding a diagnosis I’ve been performing well among my age peers. Thank you Finnish healthcare. Couldn’t imagine how much it sets you back cognitively to have health issues as well as financial issues burdening your mind 24/7. Completely avoidable pain and suffering purely for profit.
- ketanmaheshwari 6y ago
  Agreed. I was just looking at the positive aspect of it.

zirkonit 6y ago

Cardiac valve procedure at Kaiser Foundation Hospital - Redwood City Medical Center - $458,254.00 cash price. Oh my. I get it that it's an expensive procedure, but OH MY.

huitzitziltzin 6y ago
Kaiser might be a weird outlier. IT is a very different kind of organization (vertically integrated - physicians/insurers/hospitals). It might be that the price is that insane elsewhere, but Kaiser may not be the best way to judge.

baskire 6y ago

Having hospitals compete on price will bring healthcare costs down. Just like how we can choose between generics and name brands. Great job!

voicedYoda 6y ago

Looks interesting. How is this different than test claim submissions available from Eligible, Waystar, PokitDoc, etc? And are you licensing out cpt codes from the ama? IMHO the AMA and their copyright of CPT codes is the biggest setback to progressive change, transparency, and adaptive change in tech... Payers and well funded companies can afford licensing, otherwise they will strangle you with lock down...

yding 6y ago

Very cool! We've been working an app that is looking for this exact type of data. Do you have an API or plans for making an API for this?

ageitgey 6y ago
We do have plans for an api, but we are currently working out the model for it - feel free to get in touch via the site and let us know you are interested and what you might want to do with it.
- yding 6y ago
  Thank you. Just did.

duffpkg 6y ago

One important piece of context here is that these rates are negotiated as part of a contract bundle where an insurer is bringing a pool of patients to the facility. Prices can vary widely procedure to procedure because they are associated with over or under representation of certain factors within that pool. For example, grossly simplified, I might have a particular service line, hip replacements (an ortho program). The insurer whose patient population is going to 'keep the lights on' in that service line is going to see a very different rate per service than a different insurer who rarely has patients that need it. Nothing about these prices shown are really reflective of the costs of doing the procedure such as pricing in a retail store. I do think this transparency initiative will result in more consistent costs but not necessarily net lower costs. Comparisons to other countries that are smaller than the united states are somewhat apples to oranges. There are a lot of factors that are glossed over when someone says "costs are 5x higher in the US than my country" including real estate, energy subsidy, and so on. Its a deep well.

brundolf 6y ago

I had this exact idea ~6 months ago but didn't know where to begin. I'm sincerely glad someone else built it. We're in such desperate need of justice when it comes to U.S. healthcare and this is a really good first step in holding the system just a little bit more accountable.

curiousllama 6y ago

Great solution. I hope this will make asking about costs at the hospital more normal! I once went to a doctor for vaccinations before traveling. The nurse said "You need X, I recommend Y, and the CDC recommends Z." I responded "great, let's get X right now. Not sure about Y or Z - how much do they cost?" The question just didn't compute. No matter how I phrased it ("just want to price compare" ... "there's a bunch of travel clinics and I'm trying to get this cheaply" etc), I couldn't make myself understood. The NP ended up coming in to give me their "anti-vax" spiel. I had walked in to a hospital wanting a vaccine, and asking about costs was so foreign to them that they thought the only reason I could hesitate to get a vaccine was anti-vax sentiment. All this to say - this tool is very much needed, and has the potential to do a lot of good!

deleted 6y ago

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ummonk 6y ago

And of course the FTC doesn’t care about the blatant anticompetitive behavior by hospitals.

huitzitziltzin 6y ago
Where do you get that from? The FTC has challenged a lot of hospital mergers. They are not always successful, but they do challenge them. Source: healthcare/competition economist.

SteveCoast 6y ago

A number of people, including me, have been building similar things, see http://price.hospital http://price.hospital The problem seems to be figuring out a revenue model, and translating all the medical terms in to human.

egillie 6y ago
Same, I've been mapping out CA average prices at http://hospitalprices-env.eba-r2yhwdcw.us-west-1.elasticbeanstalk.com/common-procedures/ http://hospitalprices-env.eba-r2yhwdcw.us-west-1.elasticbean... Comparing just the price of a hip replacement is difficult, because there are so many other services that will bundled in with a hip replacement (anesthesia etc) that may not be represented in the service price alone. The "average cost by diagnosis code a patient comes in with" transparency requirement is an attempt at solving that, but doesn't differentiate between insurance plans. Also, I love OpenStreetMap, thanks for your work on that!
- technics256 6y ago
  Are you scraping this or just visiting each site manually and getting the machine readable data? Cool stuff!!
  - egillie 6y ago
    California collected all of their hospitals' data at https://oshpd.ca.gov/data-and-reports/cost-transparency/hospital-chargemasters/ https://oshpd.ca.gov/data-and-reports/cost-transparency/hosp... The average prices for common procedures is on the 1045 sheet I have my gripes with California but I love that they did this
    - technics256 6y ago
      Woah, I'm a CA resident and also surprised and happy. Are you seeing a lot of non-compliance?
      - 6y ago

dubcanada 6y ago

How accurate is this? Some of the threads point out extremes between different hospitals, is that because X hospital does more stuff then Y, and Y charges you the same as X it's just a bunch of hidden/extra stuff that isn't billed as "MSDRG 343"? Or is it because the hospital like any business can charge you what ever you want and may charge more or less depending on the neighbourhood, rent, etc?

ageitgey 6y ago
I think part of it is that there is a huge difference in cost between some facilities. But another part of it is that a lot of hospitals don't really know what they charge. They had to scramble and hire consultants to come up with these numbers to meet the deadline and the numbers will probably get more accurate and vary less over time as hospitals get better used to working with prices out in the public.

zachmu 6y ago

We're running a $10,000 bounty to assemble this information into a queryable database: https://www.dolthub.com/repositories/dolthub/hospital-price-transparency/bounties/00000000-0000-0000-0000-000000000001 https://www.dolthub.com/repositories/dolthub/hospital-price-... You get paid based on the percentage of rows you contribute to the dataset. So if you fill in 20% of the rows, you get $2,000. More details here: https://dolthub.awsdev.ld-corp.com/blog/2021-01-14-hopsital-prices-bounty/ https://dolthub.awsdev.ld-corp.com/blog/2021-01-14-hopsital-...

egillie 6y ago
This is amazing! Will the data be public after it's assembled?
- zachmu 6y ago
  Yes. It's public now, just incomplete.

stevofolife 6y ago

Can someone explain why US medical costs are so absurd? Why is it the way it is?

rohanagarwal94 6y ago

Hope this was available for India

4ec0755f5522 6y ago

I just read an article about quiet / dream jobs (park ranger etc.) In it, every single person has a side gig(s) or is otherwise making decisions on their careers based on medical coverage. Every one of them! One of the people says most people leave when they turn 26 because they can't stay on their parents' health insurance. What?! > And like other dream jobs I learned about, it’s not enough to survive on: During > off-seasons, Krumbholz also works as a substitute teacher and an aquarium dolphin > tank cleaner; since being on university health insurance would mean she’d constantly > lose it during the off-season, Krumbholz decided to stay on the state exchange > instead. The idea that health care is tied to your employer, and your employment status, is so unacceptably broken. I've never heard of anything so broken in terms of the obvious social and economic harm a bad policy is creating. Having the freedom from health care costs is more freedom for more people than the "freedom" to not pay health insurance or taxes to cover it.

peytn 6y ago
That sounds extreme. Without taking sides, I suggest another possibility is that the author may have a bias, agenda, or angle to the story.
xyzelement 6y ago
// Having the freedom from health care costs is more freedom for more people than the "freedom" to not pay health insurance or taxes to cover it. This is not how freedom works. Your argument is akin to saying "freedom from hearing uncomfortable opinions" benefits more people than "freedom of expression" does. On the broader level, I got to experience healthcare in the US both as a broke-ass immigrant child and as a working adult. It ranged from good to amazing in terms of availability of appointments, treatments, quality and comfort. Night and day beyond what I experienced in the USSR as a kid. So while people are shitting on the system we have, many people find it excellent and amazing and we like the freedom to continue enjoying it.
- Trill-I-Am 6y ago
  Would the general public of other developed nations be happier if their healthcare systems were more like the US's?

fiatjaf 6y ago

This sort of thing must make some cheaper alternatives appear.

5cents 6y ago

A famous Norwegian professor of social medicine, Per Fugelli, once told a story in a talk that has stuck with me for some reason; Per was talking to a taxi driver, and the driver told him that he was having surgery on his heart valve. Per asked if he was scared , and the driver looked at him and said "No, Per, would you like to know why? Because the surgeon who will operate me has also operated the King" (the King of Norway has had several heart surgeries through ht eyears). I think it's a nice story. Unfortunately, most of his works are in Norwegian, but his last essay before dying from cancer was called Thank you, Norway - and good luck on your watch (Google Translate uses "god vakt", but I guess it is an idiomatic greeting to guards whos shift is starting) [0] - he was afraid the three pillars of the Norwegian society was somewhat threatened: justice, trust, freedom [0] https://translate.google.com/translate?sl=no&tl=en&u=https://www.aftenposten.no/meninger/kronikk/i/7rarB/takk-norge-og-god-vakt-per-fugelli https://translate.google.com/translate?sl=no&tl=en&u=https:/...

markdown 6y ago

FYI, you have a typo on the home page. > isn’t an MRI and MRI?

onlinebaba 6y ago

You all should check out https://www.sidecarhealth.com https://www.sidecarhealth.com their insurance pays 100% of the cost in cash to the care provider, thereby brining the cost of care 40% - 60% less.