8 ms·

This is a red herring. It is not surprising that the cost of care can vary wildly when the customer cannot possibly know the cost of care before purchasing it.

• DannoHung 14y ago
  How shall emergency rooms operate? Also, how shall people make an initial determination on care when no diagnostics have yet to be performed?
  • mseebach 14y ago
    > How shall emergency rooms operate? Not all emergency room decision-making happen with blood pumping out of your pulmonary artery. There are parents who take their babies to ERs, and through repeat business decide to like one better (maybe because it's cheaper, maybe because it's a bit more expensive, but never have any waiting time) than the other. There are consumer reporters who will look into why one hospital is cheaper than the other. Smart phone "Yelp for hospitals". EDIT: Forgot the conclusion: This will drive down prices in the general case, which will also result in lower prices for the emergency case, even if in an emergency you don't have the luxury of calmly evaluating all the options. > Also, how shall people make an initial determination on care when no diagnostics have yet to be performed? The same way you decide which restaurant to go to before you know exactly which dish to have: Ranking by a general cost/quality scale.
    • bicknergseng 14y ago
      I wouldn't bank on free markets fixing emergency room problems. While anecdotally some parents may choose to take their children to one hospital or another, I doubt this is a statistical norm. I imagine most people choose the nearest emergency room for most emergencies, and hold off for an appointment with a doctor otherwise. Sometimes, it's just a baby with colic. But sometimes (increasingly in a country with a serious obesity problem) it's a heart attack, and no one is going to drive their dad 45 minutes to the cheap hospital when the one that will save his life is 10 minutes away. Because of this I don't think hospitals have any incentive to drive down ER costs. But maybe I'm projecting, since my experience with ERs tends to be "Oh shit... get me to a hospital now Google Maps" rather than "I should Yelp some reviews of hospitals, because I have time."
      • mseebach 14y ago
        Of course it's hard to predict what will happen. But right now, nobody has an incentive to even check, so obviously it doesn't happen. Some people will live 10 minutes from one ER and 45 from the next. But some will live 25 from one and 30 from another. Or have three within 15 minutes (ie. short enough that they're equidistant for "the baby has colic"). Some will have more time than money and drive 45 minutes if it means saving $20. But there's another factor in free markets you're not accounting for: new entrants. If an ER charges high rates because they're the only player in the area, someone could set up a competing ER and charge less.
        • ryguytilidie 14y ago
          I love how easy everyone always makes this sound. Yeah, just setup a hospital near the other hospital and make your prices lower. I'm sure they wouldn't respond by lowering costs until I'm driven out of the market and then immediately raise them again.
          • cmbaus 14y ago
            And amazingly we still have businesses that compete and don't price all their competitors out of business. So I don't think this is an obvious conclusion.
            • rdw 14y ago
              The reason that this is so is because of regulations.
              • webXL 14y ago
                Or it could actually have nothing to do with regulations. Something called imperfect competition: very few people want and sell the exact same thing. That makes it very difficult to sell superior products at lower cost.
              • anonymoushn 14y ago
  • pfranz 14y ago
    Doctors have no idea how much a procedure or test cost (and they don't care or want that burden)--that stuff is generally insulated by insurance. In my experience, they are vaguely aware of the price of different prescriptions (after insurance) because that directly affects the patient. The economic forces are all out of whack. I'm not blaming doctors--the information should be more easily available to them to provide to the patient. I'm not in the medical industry (but my g/f was seeking out her own insurance recently), but I would guess that the ER would work similar to a car mechanic. Where the paperwork you're already signing upfront includes a flat price you're paying for diagnostics. Then after the diagnostics (or possibly at the same time you signed the diagnostic paperwork), you agree to a price range for treatment/tests. It would itemize the fixed costs and estimate the variables. If things go outside of that range, there's an amendment. You walk home with the bill.
  • DanBC 14y ago
    "Each blood test: cost $X" "Each x-ray: cost $Y" etc etc. That way patients can ask the doctors if the tests are actually needed. You're right that emergency care becomes a lot more complicated.
    • zecho 14y ago
      In actuality, it would be: "Each blood test paid by insurance company $A costs $X, Each blood test paid by insurance company $B costs $Y." Etc. I really think a big part of the problem in healthcare pricing is insurance company policies regarding networks and guaranteed volume. Your auto insurance doesn't demand you use a certain body shop, why should your health insurance? Here's a practical example that recently came up for me. My wife is a nurse at a few clinics. At one clinic, she's got health insurance and that clinic provides IUDs via their hospital, which she wanted to get. At this clinic, the price billed to her insurance would be $4700. At another clinic she works at, she could get the same IUD brand and procedure for $600. When she asked her insurance about it, they said they would pay 100% of $4700 in-network but 60% of $600 out-of-network. Obviously, being selfish, she decided to let the company eat the $4100 they would otherwise save so that she would pay $0 instead of $240.
      • tsotha 14y ago
        Because that $4700 isn't the cost the insurance company is paying. The real reason you can't go without insurance in the US is they're negotiating steep discounts - where I live it's supposed to average 80%. It may well be they paid less than $600 for a procedure that lists at $4100. And of course the government numbers don't take this into account, so what they've published is pretty much worthless.
        • zecho 14y ago
          I doubt it. That $4700 is what was listed in the insurance packet, then again in the bill along with a few other minor expenses incurred during the procedure, and finally paid for by insurance in a later notice to us. The 100% is because of ACA requirements. I don't disagree with you that insurance companies negotiate different discounts, though, which is what I was trying to get at in my post regarding pricing.
• flatline 14y ago
  The customer generally cannot even know the cost of care after purchasing it. Not only is the issue muddled by insurance companies' negotiated rates, but the line item prices on doctors and insurance statements are almost complete nonsense. Really they just say what broad category the care fell under for record and insurance purposes, and there is no way to tell if you have, for instance, been double billed for a procedure. The only times I've been able to clearly tell what I paid for was when going to a specialist for a very specific procedure.
• Vivtek 14y ago
  No, it's not a red herring. It's two different problems with the same industry.
• grey-area 14y ago
  It is not surprising that the cost of care can vary wildly when the customer cannot possibly know the cost of care before purchasing it. Even the healthcare professionals can't estimate the price of care before providing it, because it depends on the outcome of things like surgery and reaction to treatments which cannot be predicted. So there's no way to tell the patient beforehand that their care will cost x amount. In addition to this the customer often doesn't know what they want and has no basis for making an informed choice before seeing a doctor. This is fundamentally different than (for example) selling products in a supermarket where costs are known up front, shops can vary prices and quality, and people can shop around. So the benefits of patient choice of hospital and treatment etc are questionable. Other countries spend far less using a single-payer system with comparable or better outcomes than the US according to the statistics on life expectancy and expenditure per capita on healthcare, so IMHO the US should have more and better regulation of the healthcare market, not less. Cutting out the insurance companies completely would be a good start, as at present they run a racket extracting billions from the US tax payer for questionable results.
  • wfunction 14y ago
    > So there's no way to tell the patient beforehand that their care will cost x amount. I call B.S. -- unless you're calling B.S. on the data. There's something called "estimation" which comes in very handy when you don't know something with certainty. If you have absolutely no idea, then you just guess the average cost for each patient with a similar background, with a disclaimer that it may not be accurate. Problem solved, unless you don't want to do it because then it'll prevent you from ramping up the prices unnecessarily later.
    • jaynos 14y ago
      Tell me my surgery will cost $100,000 at hospital X and $200,000 at hospital Y (both of which are close to me and staffed with competent employees). It won't influence my decision as long as my insurance company doesn't care. I'll pick based on the doctor and the insurance company can negotiate either bill (down to a very similar level, I presume). If I don't have insurance, I may be swayed by the $100,000 price, but either way they'll have to sue me to get all of the money that they ask for.
• warfangle 14y ago
  And why should healthcare cost money? That's pinning quality of health to how much money you make. And that's just plain immoral.
  • anonymoushn 14y ago
    Well, let's look at the alternatives. If we don't want people to have to pay for the services they use, we can let people enslave doctors. Or, we can steal from every citizen in the whole country and use the resulting money to pay the doctor. This second option would be called "single payer," and it is my preferred policy, but it does not seem to be obviously morally different from enslaving doctors or obviously morally preferable to requiring people to pay for the services they use.
    • wpietri 14y ago
      Or, and I'm going out on a limb here, and we could have a thing called a "democracy", where we jointly decide to pay for health care for everybody. And then we could come up with some sort of system for sharing out the costs of the joint project in a more-or-less equitable fashion.
      • anonymoushn 14y ago
        Right, this is what I proposed. We should democratically agree to use the threat of violence to steal money from everyone to pay for medical services for everyone.
        • wpietri 14y ago
          Theft implies unwillingness. So sure, in the sense that paying your share of a group meal you ordered is theft, yes.
        • summerdown2 14y ago
          More like: we agree together to set up a society, then people in it have to follow the rules. If you don't like that, there are rules that let you change the rules.