5 ms·

> the purchaser does not know the price of something at the point of purchase. This is only solvable for the cases where what needs to be done is completely kn

> the purchaser does not know the price of something at the point of purchase. This is only solvable for the cases where what needs to be done is completely known and certain in advance. Which for very complex human biological systems would not be the majority of cases, unless providers decide to only deal with health issues that fit that criteria and send everybody else to someone else. I think the problem of not being able to accurately predict the required care is an intrinsic part of health care. Some of it actually is taken care of in some way, for example, if you go to ER they will only fix any immediate urgent issues and then send you home. Or, they send you home after n days in the hospital no matter what (example links: https://www.ombudsman.org.uk/sites/default/files/page/A%20report%20of%20investigations%20into%20unsafe%20discharge%20from%20hospital.pdf https://www.ombudsman.org.uk/sites/default/files/page/A%20re... or https://pubmed.ncbi.nlm.nih.gov/12568426/ https://pubmed.ncbi.nlm.nih.gov/12568426/). > When consumers are informed and can force suppliers to compete with each other, Uhm... how do you imagine this would happen? Genetical engineering so all humans become standardized clones with identical completely predictable issues? I think you severely underestimate the inherent unpredictability. Simple stuff like teeth cleaning can be a price known in advance, or coming in only to renew a prescription for a known health problem, but many, most?, of the "real" issues are not. OR, what would happen if you enforce this is that the MDs would be forced to press the cases into the pattern. They may think they should order an additional test or imaging procedure after actually looking at the patient, but since it's not in the pre-approved plan it would not get paid, so they don't, only things that were known before any doctor looked at the person get treated and only using the predicted methods.

lelanthran 4y ago
The majority of healthcare is for routine and known in advance procedures, not for emergency or exploratory procedures. Sure, the GP might want to order tests, but the cost of the test will be known in advance, the cost of the consultation was already known by the patient. The patient can tdecide which radiologist they want, using price as a criteria if they want to. The existing method is basically "you can only know what the cost is after you owe it to us", which is, frankly, insane. It allows the sellers to set a price that the ma let cannot bear, which results in secondary markets that provide insurance and skim even more off the top.
- nosianu 4y ago
  > The majority of healthcare is for routine and known in advance procedures Yes what kind of procedure is needed often is known in advance. The details often only emerge after it's been started though. Just because it's routine does not at all mean it's all predictably-in-advance the same throughout, except for really basic stuff, which in turn is unlikely to be the big cost driver.
  - lelanthran 4y ago
    > Yes what kind of procedure is needed often is known in advance. The details often only emerge after it's been started though. Just because it's routine does not at all mean it's all predictably-in-advance the same throughout, except for really basic stuff, which in turn is unlikely to be the big cost driver. I dunno that I'd call a broken leg "really basic stuff". This is what I responded to and what I quoted in my original post: > "Here is the cash price. We won't know your HDHP insurance price until after we bill them, which could be good for you or could be bad." So, yeah, the supplier currently knows in advance what it costs to fix a broken leg. There is no reason for the price of more mundane medical care to be opaque at all.
Joeri 4y ago
When you take your car in for repair, you also can’t know for sure what the cost will be, because cars are complex systems and every car is unique in its own way. But if the garage overcharges you then you will figure this out and you will not go there again. In the US healthcare system because of the lack of price transparency it seems to be impossible to know which hospital or doctor overcharges, and so a free market cannot arise. It is not even possible for a competitor to advertise better prices, because there is no practical way to check that their prices are indeed better.
- nosianu 4y ago
  I'm not sure cars as an example work for health care. Each model has orders of magnitude less complexity, it's not living tissue, and variability within a model is very small. And it's all logically engineered instead of the mess that is biological systems (I have a small bit of background in life sciences - only studies, not work). But that's only an aside that I don't want to concentrate on. > a free market cannot arise A free market is not the best model I think, because even if you had perfect price transparency, people don't have nearly enough knowledge to evaluate the suggestions of doctors. Sure, they will select one the like more, but base don superficial information, not based on actual medical knowledge. For some truly "free market" you really want easily comparable and quite equal things to shop for. Medicine is too individual. Yes I know the desired model is you go in with your list of symptoms, get a few tests based on it, then an algorithm, right now in an MDs head, selects the appropriate treatment - time for the next patient in the overcrowded waiting area. It seems to me, and I had personal experiences with this model's limitations too, that there is a lot of dissatisfaction with this model not least with burned out medical professionals. But it sure is something the business-minds like, you can optimize processes and manage the heck out of such a system beautifully. I - German (but I lived in the US for a decade and also had a bit of regular contact with various health providers, such as Stanford hospital or a Berkeley orthodontist for minor - and predictable, as you say - stuff like straightening teeth and hypo-sensitization) - am certainly not against a free-market component. I grew up in the GDR and we had a small bit of it even there! As a child my parents and grand parents actually did shop around for some specialists for some very reasonable amount of money, for my eyes for example (it worked out great, I stopped needing glasses as a late teenager, I ran around with one side of the glasses covered for a few years very early in childhood, for example, to strengthen one eye). I think a little bit of that helps to reward those who care a bit more about their health and go about looking for solutions to problems more diligently and intelligently than others who just go with the flow. But I think this works best in small doses, not with the entire system set up this way.

lelanthran 4y ago

The majority of healthcare is for routine and known in advance procedures, not for emergency or exploratory procedures. Sure, the GP might want to order tests, but the cost of the test will be known in advance, the cost of the consultation was already known by the patient. The patient can tdecide which radiologist they want, using price as a criteria if they want to. The existing method is basically "you can only know what the cost is after you owe it to us", which is, frankly, insane. It allows the sellers to set a price that the ma let cannot bear, which results in secondary markets that provide insurance and skim even more off the top.

nosianu 4y ago
> The majority of healthcare is for routine and known in advance procedures Yes what kind of procedure is needed often is known in advance. The details often only emerge after it's been started though. Just because it's routine does not at all mean it's all predictably-in-advance the same throughout, except for really basic stuff, which in turn is unlikely to be the big cost driver.
- lelanthran 4y ago
  > Yes what kind of procedure is needed often is known in advance. The details often only emerge after it's been started though. Just because it's routine does not at all mean it's all predictably-in-advance the same throughout, except for really basic stuff, which in turn is unlikely to be the big cost driver. I dunno that I'd call a broken leg "really basic stuff". This is what I responded to and what I quoted in my original post: > "Here is the cash price. We won't know your HDHP insurance price until after we bill them, which could be good for you or could be bad." So, yeah, the supplier currently knows in advance what it costs to fix a broken leg. There is no reason for the price of more mundane medical care to be opaque at all.

Joeri 4y ago

When you take your car in for repair, you also can’t know for sure what the cost will be, because cars are complex systems and every car is unique in its own way. But if the garage overcharges you then you will figure this out and you will not go there again. In the US healthcare system because of the lack of price transparency it seems to be impossible to know which hospital or doctor overcharges, and so a free market cannot arise. It is not even possible for a competitor to advertise better prices, because there is no practical way to check that their prices are indeed better.

nosianu 4y ago
I'm not sure cars as an example work for health care. Each model has orders of magnitude less complexity, it's not living tissue, and variability within a model is very small. And it's all logically engineered instead of the mess that is biological systems (I have a small bit of background in life sciences - only studies, not work). But that's only an aside that I don't want to concentrate on. > a free market cannot arise A free market is not the best model I think, because even if you had perfect price transparency, people don't have nearly enough knowledge to evaluate the suggestions of doctors. Sure, they will select one the like more, but base don superficial information, not based on actual medical knowledge. For some truly "free market" you really want easily comparable and quite equal things to shop for. Medicine is too individual. Yes I know the desired model is you go in with your list of symptoms, get a few tests based on it, then an algorithm, right now in an MDs head, selects the appropriate treatment - time for the next patient in the overcrowded waiting area. It seems to me, and I had personal experiences with this model's limitations too, that there is a lot of dissatisfaction with this model not least with burned out medical professionals. But it sure is something the business-minds like, you can optimize processes and manage the heck out of such a system beautifully. I - German (but I lived in the US for a decade and also had a bit of regular contact with various health providers, such as Stanford hospital or a Berkeley orthodontist for minor - and predictable, as you say - stuff like straightening teeth and hypo-sensitization) - am certainly not against a free-market component. I grew up in the GDR and we had a small bit of it even there! As a child my parents and grand parents actually did shop around for some specialists for some very reasonable amount of money, for my eyes for example (it worked out great, I stopped needing glasses as a late teenager, I ran around with one side of the glasses covered for a few years very early in childhood, for example, to strengthen one eye). I think a little bit of that helps to reward those who care a bit more about their health and go about looking for solutions to problems more diligently and intelligently than others who just go with the flow. But I think this works best in small doses, not with the entire system set up this way.