18 ms·
Open source hospital price database
- Solvency 3y agoDarn. I really want to sort this by highest price to lowest, but it times out.
- deleted 3y ago[deleted]
- timsehn 3y agoIf you clone the database locally it will work. It takes a long time to clone though.
- alecst 3y agoI meant to submit this from my work account and not my personal one, but oh well. I helped make this. AMA or email me at alec@doltub.com.
- adunsulag 3y agoWhat the is the code you are using in your data. Is it SNOMED? CPT4? Something else?
- tdstein 3y agoCDM codes and REV codes are listed, both of which are a different coding system than SNOMED or CPT, specifically built for billing purposes. https://en.m.wikipedia.org/wiki/Chargemaster https://en.m.wikipedia.org/wiki/Chargemaster
- alecst 3y agoWe're gotta work with whatever the hospitals give us. The most common codes we see are CPT/HCPCS codes (coupled with revenue codes), or DRG codes. When the hospital provides any one of REV, CPT, HCPCS, MS-DRG, APR-DRG, APC, NDC, or EAPG, we break them out into their own columns. We keep all the code metadata -- that is, we leave the code strings mostly intact, and then extract the code itself into a separate column. This preserves things like "CPT4" or whatever, as a string, but we do not have a way yet of splitting CPT codes into multiple subtypes. So we haven't lost any data, but we haven't totally figured out how to query it perfectly well either.
- throwaway918243 3y agoCan you share how are the data collected?
- alecst 3y agoSure. We get it via pull requests: https://www.dolthub.com/repositories/dolthub/transparency-in-pricing/pulls?refName=main https://www.dolthub.com/repositories/dolthub/transparency-in...
- throwaway8689 3y agoIf you are curious to compare with a foreign single payer system, England's NHS tariff is published at https://www.england.nhs.uk/pay-syst/national-tariff/national-tariff-payment-system/ https://www.england.nhs.uk/pay-syst/national-tariff/national...
- Faaak 3y agoAnd for Switzerland, which has a somewhat private (although regulated), but mandatory healthcare: for example https://browser.tartools.ch/#/tarmed_kvg/data/L/37.0700 https://browser.tartools.ch/#/tarmed_kvg/data/L/37.0700 (the real data is an MBD file, but less readable)
- nhinck2 3y ago13k vs 35k for a defib implantation, yikes.
- lannisterstark 3y agoI mean, it's just the 'cost.' Not necessarily the 'cost to the patient.' I understand that it's helpful to see for people who are under/uninsured, but for most of the people it'll just max out at out of pocket/annual deductible max (which for example is like $250 per annum for me). Further, what hospitals charge to insurance is not necessarily the rate insurance pays either. My counselor charges my insurance $400 an hour, but insurance negotiates it to like $80, of which I pay $0. The counseling office charges people who do not have insurance like $96 per session. What hospitals charge is not necessarily cost to patient is all I'm saying.
- rqtwteye 3y ago"What hospitals charge is not necessarily cost to patient is all I'm saying." It is cost to the patient in the form of ever rising insurance premiums and deductibles (mine is $3000 and a lot of people have even higher deductibles). Your counselor example also shows the insanity of US healthcare pricing. $400 vs $80 vs $96. How is anybody supposed to make economical decisions with such crazy pricing differences? There should be a regulation that providers charge the same price for the same procedure, no matter if they are insured or not or what insurance they have.
- tomrod 3y agoSo glad to see Dolthub got their DB up and running! We spoke a few times early in your process for insurance, looking forward to seeing that land.
- timsehn 3y agoThe insurance database (transparency in coverage) is here (also open data): https://www.dolthub.com/repositories/dolthub/transparency-in-coverage https://www.dolthub.com/repositories/dolthub/transparency-in...
- hathawsh 3y agoHmm, that URL (https://www.dolthub.com/repositories/dolthub/transparency-in-coverage https://www.dolthub.com/repositories/dolthub/transparency-in...) is giving a 404.
- thumbuddy 3y agoThis is awesome. Lot of social good here. Kudos to you
- deleted 3y ago[deleted]
- hathawsh 3y agoRelated: I'd love an app or web site that lets me type in a medical procedure needed by someone close to me. After an AI chat conversation where I clarify the procedure and list any possible complications I'm aware of, the app would use databases (such as the database linked to this thread) to give me a list of estimated pricing nearby (and far away, if the prices are high.) All estimates would give a range (for example, $3500 +/- $1500.) Does such a thing exist? It seems possible with 2023 tech, although it probably needs to know health insurance details to do its job well. I think millions of US citizens would subscribe.
- thallium205 3y agoCMS publishes all their rates which is where almost all pricing is based off of (typically some multiple).
- bardworx 3y agoOnly issue is that you cannot get a bundled price. For example, you know what a colonoscopy costs but only the procedure and not all the addition care that may come with it. At least from my understanding.
- breadwinner 3y ago> I think millions of US citizens would subscribe. And why would millions of US citizens be interested in such a service? If they have insurance, insurance pays most of the costs. And this is the reason medical costs are on an upward spiral in the US: consumers are not incentivized to shop around.
- wnolens 3y agoMany many people have high deductible plans, or need to use out of network providers. We cannot shop around as it is.
- hathawsh 3y agoA lot of US citizens have moved to "high deductible" health insurance plans, which means they pay for most medical procedures up to some yearly maximum (such as $10k.) The advantage is the monthly premium is significantly less. Those people are very incentivized to shop around.
- andrewstuart 3y agoA friend just went to hospital in Queensland, Aus with pain in his hand. The booked him in to stay the night and did surgery the next day and he stayed for two more days then went home. Without a bill. Thank goodness for Australia's healthcare system. It's far from perfect, but when it works, it really works well.
- peteradio 3y ago3 days in hospital bed for hand surgery?!
- andrewstuart 3y agoHe arrived around lunchtime, had to wait 9 hours or so to be seen, they scheduled him for surgery the next day and booked him in that night, then two days post surgery (general anesthetic) to keep an eye on him. I'm not a doctor, don't know the details.
- zapdrive 3y ago9 hours to be seen? I thought only Canada was fucked up. I think all the countries with "free" healthcare end up with having absurd waiting times. I had some issue with harmones and the family physician referred me to endocrinologist. I called his office and guess what? There was a 6 month waiting period. They gave me an appointment 6 months away. Luckily I was traveling to Mexico in a couple weeks. I saw an endocrinologist there (no appointment, just walk in). He told me if i had waited 6 months, it would have taken a drastic irreparable toll on my health.
- warent 3y agoI think all the countries with "free" healthcare end up with having absurd waiting times The irony is that we also have absurd wait times in the USA for our paid healthcare. At least other countries get it for free. This is such a common trope that the USA tradeoff is that we pay to get higher quality expedited care, but it's just not true
- tempnow987 3y agoSome timeouts filtering by hospital for me: 'SELECT * FROM `rate` where hospital_id = "XXXXXX" ORDER BY `hospital_id` ASC, `row_id` ASC LIMIT 200;'
- TX81Z 3y ago[flagged]
- yboris 3y agoLife hack: whenever you're about to use the word "just", pause and think. Saying "just" implies the thing you're commenting on is somehow simple, and isn't much effort. If anyone had trouble doing the thing that you can "just", will likely not feel great hearing it. Are you suggesting getting the Medicare data is easy, and it's also easy to browse? If so, could you link us to the alternative / better resource?
- MPSimmons 3y agoIf you just want to see the prices with the things, this is a more abbreviated query: SELECT `hospital_id`, `row_id`, `line_type`, `description`, `payer_category`, `payer_name`, `standard_charge` FROM `rate` Adding an 'order by' clause makes the query time out. "CC" in many of the descriptions seems to mean "complications and comorbidity". "MCC" is Major Complication or Comorbidity. Some other abbreviations can be looked up here: https://www.asha.org/practice-portal/professional-issues/documentation-in-health-care/common-medical-abbreviations/ https://www.asha.org/practice-portal/professional-issues/doc...
- pessimizer 3y agoI think it's important that people around the world can see this, know that we suffer, and feel proud of their own countries' health systems.
- ponector 3y agoIn Poland I pay mandatory health insurance, it is 9% of my income. Instead they provide healthcare with queues up to few years for non life treating conditions. Also common story is there could be up to 6 months between diagnosis of cancer and start of the treatment. Would you like to pay such healthcare tax?
- dopa42365 3y agoThat has probably more to do with Poland being overall piss poor compared to the countries that always rank top on health care things (like Norway) rather than how you're paying for it.
- ponector 3y agoLong queues are common for countries with public healthcare. The big difference with private - you can choose how much do you pay and what you'll get. With public you get poor experience no matter how much you pay. And sum is not limited: more you earn more you pay :(
- Frondo 3y agoAs someone who just tried to schedule an appointment with a new PCP and being told my first available appointment would be in August, I'm not at all sold on the idea that long queues are unique to public health care systems. I'm not sure what kind of health insurance I could buy in the US that would give me short queues. Lower deductible, more ancillary services, sure, but what's the plan that says "no more than a week to schedule any kind of appointment you need"?
- agravier 3y agoPublic healthcare can also suck balls indeed, but to compare the same things, I would rather pay for well-functioning public healthcare than for well-functioning private healthcare. The other insurer's incentives (max profit) are just less likely to be aligned with mine (good health) in the private system.
- iLoveOncall 3y agoHere is a full export of the same database for France and other civilized countries: 0
- Ichthypresbyter 3y agoHaving universal healthcare 100% free at the point of use is unusual. French people, like most Europeans, do pay out of pocket for healthcare, it's just heavily subsidized and regulated.
- peschu 3y agoI am surprised that there is no central catalog in the us. In europe(DACH) there is something called "drg" for example. For example here(switzerland) https://www.bag.admin.ch/bag/en/home/versicherungen/krankenversicherung/krankenversicherung-leistungen-tarife/Spitalbehandlung/Tarifsystem-SwissDRG.html https://www.bag.admin.ch/bag/en/home/versicherungen/krankenv... (Hard to find ressources in english) The system is different because it's designed to have a pricing system with health insurances and also far away from perfect. But the treatments etc are standardized.
- qwytw 3y agoBut that's objectively false. Unless you have supplementary (ussually employer provided) insurance you have to pay a portion of the fee for every visit or procedure. France is one of the worst countries you could have picked... lol.
- nojito 3y agoHospital charges don't matter the real information is in the Payor Transparency data which is magnitudes larger than this dataset.
- orbz 3y agoAlso magnitudes off in accuracy sadly. I’ve known a few groups who’ve tried to reconcile it against actual charges and you might as well just use a random number generator.
- avs733 3y agoA group of students I mentor have been working on the reverse version of this startup actually...towards this very idea. They are trying to figure out how to have people submit their bills and gather actual billing data and compare what actually happens with what is claimed. Gives them a better data set for comparison and evaluation and to spot 'oddities'. I imagine health insurance does the same thing...but its opaque and invisible to consumers.
- cvccvroomvroom 3y agoIt doesn't matter how much it costs because there is no such thing in America as informed consumer consent. If you're unconscious, they will treat you, bill you, and you become liable for an arbitrary debt. The Founding Fathers revolted for this type of arbitrary taxation but too many modern Americans are too docile and accepting of mistreatment and exploitation. I met a woman in a coffee shop in Redding CA who was about to defend her home, clothing, and means of transportation from creditors who forced her into bankruptcy while she was dying of stage IV cancer. This is the state of healthcare as a business first in America.
- colordrops 3y agoThe problem is that people grow up with this ridiculous state of affairs, among many others, so there is no point of reference, and even when a moment of clarity hits that something might be wrong, there is a sense of hopelessness that nothing can be done because everyone else is still half-alseep.
- tonightstoast 3y agoI went to get a standard STD panel at an urgent care a few weeks back. I asked how much it would be beforehand (since I don't have insurance). The front desk person said "between $100 and $200". I left and paid $340 - which pissed me off but whatever. Then, the following week, I received a bill from the lab testing for $380. That infuriated me. In total I spent $720 after being initially quoted max $200. I tried to fight it but medical billing places remind me of the South Park episode about Cable Companies (where they're rubbing their nipples as the callers describe how they're being exploited). Truly an asinine system.
- cvccvroomvroom 3y agoYou have to demand a coded bill ahead to time or you must refuse treatment. If it's not in writing, then there's no evidence. If they refuse, then you have to be willing to walk away. Also, pay by check including the phrase "payment in full".
- 3y ago
- ankrgyl 3y agoI'm not super familiar with Dolt's SQL implementation, but I'm surprised that a simple `count(*)` query timed out: https://www.dolthub.com/repositories/dolthub/transparency-in-pricing/query/main?active=Tables&q=SELECT+COUNT%28*%29%0AFROM+%60rate%60%3B%0A https://www.dolthub.com/repositories/dolthub/transparency-in...
- timsehn 3y agoQueries on DoltHub need to go to S3 to fetch all the chunks. This only works for databases < 1GB generally. You will get much better performance if you clone the database locally.
- jacky1234 3y ago[flagged]
- jacky1234 3y ago[flagged]
- kumarski 3y ago[flagged]
- coffeeshopgoth 3y agoThis is awesome. As someone who lives in the U.S, had a heart attack (double bypass), and a week hospital stay...I want to see if $298,000 was the right price.
- geomark 3y agoTry this for a comparison https://www.bangkokhospital.com/en/page/cardiovascular-surgery https://www.bangkokhospital.com/en/page/cardiovascular-surge... Looks like about 1/10 the cost. As good or better medical care as any hospital in the world, with much nicer facilities and warmth in their care. No good if it's an emergency, but great if you can plan ahead.
- throwaway918243 3y agoIs the data US only? I wonder if there is a global version? On quick glance didn't find the provenance of the data. Would you mind sharing how the data is collected? I'm working with an asian insurer to bring price transparency to the public. If there is a trustable global database would benefit the world hugely. There are, for example, non urgent medical procedures that people can undergo in different countries
- alecst 3y agoThe data is collected by a team of scrapers, and the rows can be checked against the source files listed in the `hospital` table.
- car 3y agoHey billing geeks, I have had this idea to compare US prices to the ones listed in the German GOÄ, which is the central price catalog negotiated with German health insurers. It is binding for German doctors participating in the public healthcare system (Kassenärzte; Kasse = insurance carrier). This is somewhat analogous to medicare pricing I believe. If this were at all possible, and I don't have high hopes looking at the obfuscation in the published US hospital pricing data, it would shine a light on the insane pricing insurers in the US get away with. Being able to quantify would allow to direct comparison, and hopefully convince some people to vote for the right party to change the greed and human suffering we currently have to put up with. Edit: Here a PDF of the GOÄ [0]. It has multiple pricing as well, which is used when a private insurance carrier pays. Private insurance can be used as well, giving preferred access and treatment. [0]https://www.pvs-bremen.de/fileadmin/user_upload/redakteure/pvs-bremen/dokumente/GOAE.pdf https://www.pvs-bremen.de/fileadmin/user_upload/redakteure/p...
- c00lio 3y ago> Private insurance can be used as well, giving preferred access and treatment. Well, actually, the contracts doctors have with the public insurance carriers forbid giving preferred access. So handing out earlier appointments to privately insured people is verboten. But no doctor obeys this, and punishment is practically nonexistent. Differences in offered treatments are allowed, the catalogue that private insurance pays for is usually larger.
- nradov 3y agoUS commercial medical insurers don't "get away with" pricing. They negotiate treatment prices with providers, who constantly try to raise prices. The most common way to handle pricing is as a multiple of whatever Medicare set. So if Medicare agreed to pay $20 (just making up a number) for CPT code 71045 (chest x-ray) then a commercial insurer might agree to pay 1.5× of that. The out of pocket amounts paid by plan members for insurance premiums and co-pays on employer sponsored group plans are largely under employer control (within limits imposed by the Affordable Care Act). There's nothing stopping your employer from giving you free insurance with $0 co-pays.
- 3y ago