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Equally important, providers aren't bringing distinct care bundles to market with easily comprehensible price tags. You’ve often got to figure out which CPT code(s) are relevant to your situation and try to work through which additional fees might get tacked on in various circumstances and settings. Sometimes that’s not too hard, sometimes it’s very hard.
Thanks for your thoughts on this.
Where's the most obvious direction to go from here (e.g., legislatively)?
A March 2019 online search for the average price of a routine vaginal delivery in Denver, Colorado, yielded a widely disparate set of answers, ranging from a little more than $6,600 to nearly $13,600 (Exhibit 1).
As the state’s appointed manager of the all-payer claims database, the Center for Improving Value in Health Care (CIVHC) should have the most reliable pricing information, and yet its estimate differs from the average price listed on the state’s Division of Insurance website. Less surprisingly, it also differs from the prices of the three better known national public sites—Guroo (managed by the Health Care Cost Institute), Healthcare Bluebook, and Fair Health—because each uses its own method for determining which services should be included in the episode of care. And looking up this same information on any of the websites of hospitals in Denver (which, as of January 2019, are compelled to list prices) can lead to even more confusion because the prices reflect charges, instead of amounts paid by insurers, which are reflected in Exhibit 1.
Section 3003 of the Affordable Care Act called on the Centers for Medicare and Medicaid Services (CMS) to create episode definitions and an associated “grouping logic” that could be used for a variety of purposes, including assessing the performance of providers. In 2016, that work was completed, following years of development, rigorous testing and vetting, continuous work with medical specialty societies and experts to define and refine the episodes, and the application of the definitions and grouping logic to some CMS performance reporting efforts. In December 2018, CMS made the entire work product available as a public good that can be used for any purpose, including to improve price transparency for episodes of care.
Quick anecdote.
It highlights this problem in some detail and points to a potential path forward provided by--what else?--the ACA.It highlights this problem in some detail and points to a potential path forward provided by--what else?--the ACA.]
The U.S. isn’t very competitive with other countries when it comes to taking care of its workers, according to a new report from Glassdoor.
Conducted in cooperation with London-based Llewellyn Consulting, the report, “Which Countries in Europe Offer Fairest Paid Leave and Unemployment Benefits?” shows a sharp divide between American workplace benefits and those offered in 14 European countries.
“In the U.S., workplace benefits like unemployment, maternity/paternity leave, and paid time off are part of the total compensation pie negotiated between employer and employee,” said Glassdoor’s chief economist Andrew Chamberlain in a statement. “In most cases, the responsibility to provide these necessary social benefits to workers falls to U.S. employers rather than the government.” This is in contrast to social policy across Europe, Chamberlain observed, which generally results in far more generous benefits than what is typical in the U.S.
With unemployment at historic lows, the general sentiment among workers is that they can find another, better job elsewhere, particularly among millennials, 44% of whom Deloitte found would leave their employers in the next two years. Benefits could make the difference between a talented employee staying or leaving to find a better package elsewhere.
A separate Glassdoor survey found that 79% of U.S. employees report they would prefer new or additional benefits instead of a pay raise, and more than half (57%) of people said benefits such as health insurance, paid vacation, paid sick days, and a retirement plan–some of which are mandated in European countries–are among their top considerations before accepting a job.
Using the United States as a benchmark, this study compared of benefits in six key areas:
Paid maternity leave
Paid paternity leave
General parental leave
Paid holiday allowances
Paid sick leave
Unemployment benefits
Data from the OCED Family Database of all parental leave policies was analyzed for 14 countries including Denmark, France, Spain, Netherlands, Sweden, Finland, Italy, Norway, Austria, Belgium, Germany, the U.K., Switzerland, Ireland, and the U.S.
It’s important to note that Glassdoor analyzed the U.S.’s parental leave policy as stipulated under the Family and Medical Leave Act (FMLA), which also allows unpaid leave for reasons other than childbirth, such as caring for sick children, spouses, or elderly parents. This was reclassified as “general parental leave” rather than “maternity leave” or “paternity leave.”
There are differences from country to country based on government regulatory mandates, but those that ranked as the most generous are Denmark, France, and Spain, while the U.K., Switzerland, and Ireland are among the least generous. The U.S. brings up the rear in nine of the 12 areas ranked as well as an overall aggregate score of .03 for its benefits (or lack thereof). For comparison, Denmark scored a 7.8 and France came in second with a 7.2.
Paid parental leave is now a hot-button issue as businesses of all sizes are scrambling to offer what the U.S. government doesn’t. Under the FMLA, new parents (birth mothers, birth fathers, and new adoptive parents) are entitled to 12 weeks of unpaid parental leave. Working mothers in the U.S. may take short-term disability benefits offered at the state level, such as in California and New Jersey.
But in reality people don't shop for appendectomies.
Have you read the posts in this thread, including the links provided? Insurance companies have provided tools for checking prices and a vast majority of people don't use them. Greenbeard cited sources explaining why health care is not actually shopped for and a great deal of the expensive stuff basically cannot be shopped for (with explanations as to why that is).
“For example, a hospital stay costs an average of $1,825 in Spain, $5,004 in Germany and an average of $15,734 in the U.S. An appendectomy ranges from an average of $1,030 in Argentina, to $5,509 in Chile, to an average of $13,003 in the U.S.
The cost is so modest I don't mind at all calling upon my doctor for the slightest question.
I just want to commend you for spending the time and effort to look into that and not falling into the all too common tendency to get every test available. Overuse of medical technology is one of the reasons why our health care system is so expensive.Quick anecdote. A few months back our 5-year old had white streaks and a very sore throat, and I suspected strep. I took him to the doctor ($35 copay) to find out if it was indeed strep, in which case he'd get antibiotics so that he could return to school sooner, or find out it was viral in which case he could return to school. Doctor swab tests on site and determine's it's not strep, but says by company policy they send swabs to a second round of testing just to be sure. I asked what the rate of false-negative for on-site testing was and he said significantly less than 1%. I asked how much this all costs and he said he had no idea, and that it depends on insurance. I didn't question him further and we left.
But on the way home I asked my wife to get onto the health system's website to find out the billable rate for the strep culture lab test, and found out it was either $280 or $560, depending on which was ordered. Being well within our deductible, that would be all our cost. I called back and demanded they cancel that order.
My reaction to all this was that, first of all, billing $280 to $560 to double-check a usually non-lethal childhood illness seems medically unnecessary to me. Second, doctors should know or be able to easily check the cost of what they're recommending so that the cost vs. benefit can be discussed with patients.
But then more recently I started thinking about health care price transparency in general and trying to understand why there isn't better transparency and what the arguments are for and against.
I ran across evidence (Characterizing Health Plan Price Estimator Tools: Findings From a National Survey) that not only to health plans and, in many cases, provider systems, make cost information available, but extremely few seem to be looking or caring. As few as 2% use web-based tools for determining health care costs.
This gets me thinking, there was really no reason why I couldn't have determined in advance the cost or potential costs of the strep testing before taking my kid to the doctor. If I had known, I might have gone in to the doctor and said "I want an on-site strep test but I do not consent to any additional follow-up or secondary testing." That might piss some doctors off to have patients coming in demanding specific things and refusing others, but that is what I should have done. I cannot abdicate all responsibility for situations like the one I encountered and "blame the system" when the system avails the information to me and I choose not to look.
If a vast majority of Americans aren't even interested in the cost of health care even when it's made available to them, then by default we are entrusting the entire responsibility for controlling health care costs onto a combination of government and insurance companies, because we refuse to take responsibility for ourselves as patients. Consumers determining exactly what they want and are willing to pay for is the most organic and effective form of cost control there is, and collectively we're refusing to do it.
I'd be interested to hear from people what they specifically think would be necessary and effective at incorporating more patient-driven cost control into our health care system.
I just want to commend you for spending the time and effort to look into that and not falling into the all too common tendency to get every test available. Overuse of medical technology is one of the reasons why our health care system is so expensive.
I am a bit in awe that you had the presence of mind to ask about the false negative rates for the first test. I don't think it's realistic to place that burden on the average health care consumer. That burden should be on those who actually have the background information to make those decisions (ie. The medical professionals). Unfortunately, our system encourages them to NOT forgo tests that have marginal benefits but not so marginal costs.That's the most important thing that cost-sharing (having deductibles, copays, coinsurance) accomplishes, is the patient's desire to refuse questionably necessary tests, labs, and other cover-your-ass procedures that providers are very often all too willing to fling at patients. And this is one of the big problems I see with a lot of the recent idealistic campaign fodder versions of single payer I've seen proposed recently, which make silly promises like eliminating all cost-sharing.
I just want to commend you for spending the time and effort to look into that and not falling into the all too common tendency to get every test available. Overuse of medical technology is one of the reasons why our health care system is so expensive.
Cancer Kills More-and Costs More--in U.S. than in Europe - Scientific ...Yep.. its also why we are much more likely to survive cancer than other countries..
there is a tradeoff.
Cancer Kills More-and Costs More--in U.S. than in Europe - Scientific ...
404 - Scientific American Blog Network...
Jun 8, 2015 - A new study shows that the U.S. spends far more than Europe on cancer care but has a higher mortality rate for lung cancer, the leading killer.
No, it's notYep.. its also why we are much more likely to survive cancer than other countries..
there is a tradeoff.
No, it's not
Overuse, by definition, doesn't increase cancer survival rates
dear we call all find 1000 links to make us look right. Do you understand??
That's the most important thing that cost-sharing (having deductibles, copays, coinsurance) accomplishes, is the patient's desire to refuse questionably necessary tests, labs, and other cover-your-ass procedures that providers are very often all too willing to fling at patients. And this is one of the big problems I see with a lot of the recent idealistic campaign fodder versions of single payer I've seen proposed recently, which make silly promises like eliminating all cost-sharing.
But the ‘billable rate’ is not the cost.
The cost would have been a small fraction of that.
Lab charges are especially crazy in terms of the differential.
I learned this while fighting a routine lipid panel charge because my insurer thought my wife was also covered by her employers insurer. It went to collections, and the $600+ charge that I literally spent several hours on resolving was finally paid by the insurer for the contracted price of $24.
That’s the point where I knew the US health care system just MIGHT not be the best in the world,
Why do you think any other system doesn't have that?
Most other systems are combined private with public.. with varying public contracted rates. That's why an provider would charge 600 because for some insurers.. would reimburse 24 dollars.. some 70.. some 250... etc..
Right. It’s a bad system, like I said.
Quick anecdote. A few months back our 5-year old had white streaks and a very sore throat, and I suspected strep. I took him to the doctor ($35 copay) to find out if it was indeed strep, in which case he'd get antibiotics so that he could return to school sooner, or find out it was viral in which case he could return to school. Doctor swab tests on site and determine's it's not strep, but says by company policy they send swabs to a second round of testing just to be sure. I asked what the rate of false-negative for on-site testing was and he said significantly less than 1%. I asked how much this all costs and he said he had no idea, and that it depends on insurance. I didn't question him further and we left.
But on the way home I asked my wife to get onto the health system's website to find out the billable rate for the strep culture lab test, and found out it was either $280 or $560, depending on which was ordered. Being well within our deductible, that would be all our cost. I called back and demanded they cancel that order.
My reaction to all this was that, first of all, billing $280 to $560 to double-check a usually non-lethal childhood illness seems medically unnecessary to me. Second, doctors should know or be able to easily check the cost of what they're recommending so that the cost vs. benefit can be discussed with patients.
But then more recently I started thinking about health care price transparency in general and trying to understand why there isn't better transparency and what the arguments are for and against.
I ran across evidence (Characterizing Health Plan Price Estimator Tools: Findings From a National Survey) that not only to health plans and, in many cases, provider systems, make cost information available, but extremely few seem to be looking or caring. As few as 2% use web-based tools for determining health care costs.
This gets me thinking, there was really no reason why I couldn't have determined in advance the cost or potential costs of the strep testing before taking my kid to the doctor. If I had known, I might have gone in to the doctor and said "I want an on-site strep test but I do not consent to any additional follow-up or secondary testing." That might piss some doctors off to have patients coming in demanding specific things and refusing others, but that is what I should have done. I cannot abdicate all responsibility for situations like the one I encountered and "blame the system" when the system avails the information to me and I choose not to look.
If a vast majority of Americans aren't even interested in the cost of health care even when it's made available to them, then by default we are entrusting the entire responsibility for controlling health care costs onto a combination of government and insurance companies, because we refuse to take responsibility for ourselves as patients. Consumers determining exactly what they want and are willing to pay for is the most organic and effective form of cost control there is, and collectively we're refusing to do it.
I'd be interested to hear from people what they specifically think would be necessary and effective at incorporating more patient-driven cost control into our health care system.
You just made a great argument for universal healthcare. I don't get billed for anything in England; not by the doctor or hospital, not for ops-major or minor, not for ambulances, not for prescriptions. Come to England, we''ll fix you for free
yes, the only good system is capitalism because it forces medical providers to compete on basis of price and quality. No more $25 aspirins when you're in the hospital !
You just made a great argument for universal healthcare. I don't get billed for anything in England; not by the doctor or hospital, not for ops-major or minor, not for ambulances, not for prescriptions. Come to England, we''ll fix you for free
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