Numerous sources have shown that hospital prices are the largest driver of medical inflation. If you ever have visited an emergency room without insurance, the fees are absurd and the methods used to justify the prices and the bills border on fraud as discussed in a recent article in the NY Times. In the article, it mentions that although her insurance was billed, they paid the negotiated amounts for the various facility fees, trauma fees and attending doctor charges that were absurd. Imagine not having an insurance company available to discount those fees. Lower healthcare costs will need a shift in how we practice healthcare, train doctors and charge for the services that are provided.
The current ala carte free for all is difficult enough for us to understand. The medical bill for hospital-based services we later receive may contain tests, procedures, and doctors who we never remember seeing. How do insurance companies make sense of this and keep medical billing honest? Ultimately, the healthcare system has become so complex, aided by drug and insurance interests that unless we simplify it, there can be no meaningful reform in healthcare costs. Companies who self insure such as Walmart are even incentivizing their employees to go to other countries such as Mexico to have a procedure done to reduce costs.
Would publishing a list of all the exorbitant fees for the public to see change anything? People visit the ER out of fear when a seemingly life-threatening health problem occurs. They also visit when they are deathly ill, or when they need stitches or fracture a bone. Others are delivered to the ER by ambulance when they are incapacitated by an accident, stroke or some other event.
A few years ago, I reported on a surgery center in Oklahoma that published their charges for different conditions. Many of these procedures were not elective surgeries, so theoretically, a rational person could shop for the best deal if they took the time to do so. There is also a web site called the Healthcare Bluebook that helps people shop for procedures and allows them to somewhat compare prices.
For consumers, a straightforward pricing model makes sense. I am not sure that having hospitals reveal their ala carte prices will get us there. Perhaps, a pay one price for a condition model will make more sense for everyone but I am not sure the hospital conglomerates will allow this to happen, since they have a strong lobby in congress.
Check out the NY Times article on this below
To Lower Costs, Trump to Force Hospitals to Reveal Price of Care
A proposed federal rule would make hospitals list the prices they negotiate with insurers, allowing consumers to seek better deals for care.
By Reed Abelson Nov. 15, 2019
The Trump administration on Friday announced it would begin forcing hospitals to publicly disclose the discounted prices they negotiate with insurance companies, a potentially bold move to help people shop for better deals on a range of medical services, from hip replacements to brain scans.
“For decades, hospitals, insurance companies, lobbyists and special interests have hidden prices from consumers, so they could drive up costs for you, and you had no idea what was happening,” President Trump said Friday afternoon in the White House’s Roosevelt Room. “You’d get bills that were unbelievable and you’d have no idea why.”
Patients, he said, have “been ripped off for years.”