|Quoting DocLightning (Reply 1):|
One hospital was charging $7 for an alcohol pad that costs 1¢. Why someone isn't in jail over that is beyond me.
How much does it cost for the hospital to apply that pad? Salary for the nurses, the nurses assistants, the doctors, the orderlies, the insurance, etc? You know, the overhead for operating a hospital.
I'm not saying that $7 is the right number, but, I really don't think $.01 is the right number either.
The blame for this falls squarely on the shoulders of the insurance companies, the medical provider industry and the consumer. How's that for a broad net?
The insurance companies have leveraged their market power to "force" providers to accept negotiated rates. Don't accept our rates: you're out of network. I'm going to guess that these rates, sometimes, don't cover the actual costs of the service, nor provide for an adequate profit for the hospital and its investors.
The medical providers will charge what, amounts to, confiscatory fees for services provided to non-insurance patients. They know they won't get a bunch of that money. They know they'll get only a fraction of it, in many cases. So, they get to write-off the loss or petition the government (state and/or federal) for relief.
What about us? Show of hands: how many of us actually shop for our non-emergency medical care? Elective surgeries? Or, do we just talk to our doctor, get them to set it up, clear it with the insurance folks and have it done?
I tried to shop around when I had a vasectomy and then again when I had a partial mastoidectomy (cholesteatoma). And, it was darn near impossible to nail the providers down on a price. And, understandably so. Way too many variables. Yeah, my insurance company's website had some information about common and customary charges, but, is that the negotiated rate or the rate the provider would charge if there weren't all the external factors?
I called the hospital where my surgery was to be performed and asked if someone could tell me what the basic per hour cost was for the use of an operating room? I'm sure that the person looked at the phone like I was some kind of three-eyed, purple question-asking monster. What I found out was that, first, they charge per minute and second, until a surgery is booked and the insurance, including Medicaid/Care is, checked, they would be unable to give me a basic rate. My mastoidectomy ran about $175/min for what turned out to be a 5 hour (300 minute) surgery. If I think about it, I'll see if I can find the detailed billing and see what the "insurance write-off" was.
It seems to me that those of us with insurance don't seem to care very much about how much a procedure costs. We are disassociated from the actual cost, the charged cost and the actual payment to the provider (except for some co-insurance or co-pay or deductible). I really can't think of any other industry where this is the case.
And, short of scrapping the whole system and starting from the beginning, I don't know how to fix it or if it can be fixed.
I can tell you that putting more people under an insurance umbrella where even more folks are disassociated from the true costs, isn't going to help. Neither is shutting them away from healthcare.
I found that when we went to an HSA type insurance, we are a lot more careful about our medical spending. I had a conversation with my doctor about his rates and compared them to other providers...again, a lot of those guys were unwilling..or in some cases...unable to provide me with a rate schedule, except in very broad terms.
Have you guys noticed that a lot of practices, at least in this area, have started to affiliate themselves, and taking on the name, of large medical providers? Baptist Health and Norton's are big here. More and more general practices are affiliating themselves with one of these two corporations? Why?
My guess is because the bigger medical provider networks (corporations) have been pushing back against the insurers and demanding higher negotiated rates to more accurately reflect the level of service provided. It's the market trying to exert itself in a highly regulated and irregular market. It may reach balance, but I'm afraid there are too many external forces involved for the medical market to find balance anytime soon.
Ken, you call it a game or games, I call it medical providers adapting to external costs and factors that they have little or no control over.
[Edited 2013-05-10 06:03:29]
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