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Cost of Care: What you Need to Know

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One of the most perplexing issues in healthcare today for US consumers is our cost of care, and what we are getting for those dollars. Although we have always believed that we have the best healthcare in the world, a close look at our system, reveals that we are paying more, getting less, and what we pay is not equal on several counts.

The Commonwealth Fund in a study in June 2014, in conjunction with several healthcare research organizations, conducted a study where their findings reinforce the poor performance of the US in health rankings as compared with other countries. This research revealed that in access to care, equity of care, and health care quality we have a long way to go.

Access to care: People in the U.S. have the hardest time affording the health care they need. The U.S. ranks last on every measure of cost-related access. More than one-third (37%) of U.S. adults reported forgoing a recommended test, treatment or follow-up care because of cost.

Equity: The U.S. ranks last. About four of 10 (39%) adults with below-average incomes in the U.S. reported a medical problem but did not visit a doctor in the past year because of costs, compared with less than one of 10 in the U.K., Sweden, Canada, and Norway. There were also large discrepancies between the length of time U.S. adults wait for treatments and procedures as compared with other countries.

Health care quality: The U.S ranks in the middle. On two of four measures of quality—effective care and patient-centered care—the U.S. ranks near the top (3rd and 4th of 11 countries, respectively), but it does not perform as well providing safe or coordinated care.

We spend approximately two-and-a-half more dollars than most developed nations in the world for health care, including: Germany, France, Sweden and the United Kingdom. Additionally, price inequities that the US consumer would never tolerate in other industries, are standard in healthcare. For example there is a huge disparity (can be many thousands of dollars) in the cost of procedures such as colonoscopies, endoscopies, MRIs.

New York Times columnist Elizabeth Rosenthal has written about how one woman’s colonoscopy at a surgical center near her home on Long Island resulted in a bill of $6,385, while in Keene NH the cost of the same colonoscopy was billed at $7,563.56. A patient in Chappaqua, N.Y. received a bill for $9,142.84 for this procedure and in Durham, N.C., the charges for a patient came to $19,438.” MS Rosenthal points out that “In many other developed countries, a basic colonoscopy costs just a few hundred dollars and certainly well under $1,000.”

In the same article, Ms. Rosenthal also reported that:
• The average cost of a hip replacement in the U.S. is over $40,000. In Spain that same surgery is @$7,000.
• The average price of an MRI in the US is $1,000 and in the Netherlands the price is approximately $300.
• An Angiogram in the US costs approximately $914 while in Canada that procedure costs $35.00.

So why are we paying so much more and coming out with a lower standard of health care? We are talking about two related issues:

1. The extremely high cost and lower quality of care in the United States compared to our international colleagues and what an individual consumer can do about this.

2. The disparity in the cost of the same procedure within the US system, which is even more shocking when compared with the cost of these procedures in countries outside the US.

Obamacare tried to address the issue of our poor performance by finally providing insurance to the millions of uninsured Americans, (approximately 15% of the population) who had no access to healthcare. Unfortunately Obamacare has had enormous problems getting the uninsured signed up for coverage, finding enough medical providers to address the needs of this population and working out the kinks and legal obstacles to providing healthcare for everyone. These issues are far from resolved and the solutions are compounded by the high cost of care that impacts everyone.

Among the elements that are preventing the US healthcare system from reducing disparities in costs of care are:
• Diversity in insurance benefit structures.
• Lack of standards in price information.
• Legal impediments including contractual deals between provider institutions and payers.
• Consumer confusion and inaction

When the doctor tells you that you need an MRI and suggests a clinic where the procedure can be done, are you thinking about what this will cost and where you can find a less expensive option, or are you focused on why you need the MRI and what the results will be, i.e. what is wrong with me? With most of us the cost of the procedure does not hit our radar until the bill comes in.

Is this is going to change as the cost of care continues to rise and much of that cost comes directly out of our pockets? Part of the problem lies in the lack of oversight in the healthcare industry, leaving doctors and hospitals to configure care as they find convenient and basically charge what they deem appropriate or what they are allowed under the arrangements they have negotiated with payers.

In another recent New York Times article, also by Elizabeth Rosenthal, there is the story of a 37-year-old man who required neck surgery for herniated disks. Prior to the surgery he secured all of the necessary consent forms, and clearances from his insurer. Thus, he was prepared when the bills started arriving. He was blindsided, however, by a $117,000 bill from an “assistant surgeon,” who he did not know would be a part of the surgical team.

According to Ms. Rosenthal, “In operating rooms and on hospital wards across the country, an increasingly common practice is to bring in assistants, consultants and other hospital employees In operating rooms and on hospital wards across the country, physicians and other health providers typically help one another in patient care. But in an increasingly common practice that some medical experts call drive-by doctoring, assistants, consultants and other hospital employees are charging patients or their insurer’s hefty fees. They may be called in when the need for them is questionable. And patients usually do not realize they have been involved or are charging until the bill arrives.”

Today, when the smallest detail about a patient/physician encounter can be recorded and put into the health record, cost of care data is strikingly missing. As a result much confusion, misunderstanding and anxiety ensues. Additionally when cost of care becomes apparent, many patients opt out of procedures and treatments that they realize they cannot afford. Ultimately many of these same patients end up in the emergency room with conditions that have compounded over time, and the cost of care increases for everyone.

To say that the entire system needs to be revamped would not be an exaggeration. Transparency in health care costs is the responsibility of provider and payer organizations who need to reveal the cost of care to patients and provide options that are affordable. Nothing will change, until patients take a stand, challenge the system, demand to know what they will pay for health care and advocate for care that is equitable and equal.

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