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Doctors, Hospitals, Patients, Who’s Minding the Store?

A few weeks ago, I wrote a blog post about the cost of health care. My key point was that until there are significant changes in the health delivery system, there will not be reductions in the cost of care – not for patients, not for the overall system.

Just this week, an article, published in the  Archives of Internal Medicine, and reported by the Associated Press, indicated that patients could pay as much for having their appendix removed as they might pay for a refrigerator or a small home! The study involved  19,368 California patients, ages 18-59, from hospitals throughout the state. To get the fairest comparison, the researchers included only uncomplicated cases with hospital stays of less than four days.   The disparaties in patients’ bills for this surgery ranged from $1,500 to $180,000 with an average of $33,000. The range could be partially explained by the fact that some patients had multiple issues, longer hospital stays, and more costly procedures. However, there is  no realistic reason why there should be such a huge range.

There are many other disconnects in our health care system that account for  the  erratic  pricing of tests and procedures, with no real  justification.  One of the most egregious practices that elevates the cost of care  is continued inflation of tests and procedures by hospitals, that is passed along to insured consumers. The reason we are given, is that everyone must help cover the uninsured. It is a fact that hospitals that receive reimbursements from CMS for Medicare andMedicaid services must provide care to all, insured and uninsured.  The question is whether the funds that are needed to care for the uninsured should be carried on the backs of everyone else? Compounding that situation  is the fact that the bills issued to individuals who are uninsured are often considerably higher for the same procedure as the bills issued to insured individuals who fall under the negotiated contracts between hospitals and insurers. This is a  particularly outrageous and convoluted practice that needs to be addressed. There is also the issue regarding many of the urban teaching hospitals that are considered not-for-profit; pay no income property or sales tax, and  are amassing, in their investment portfolios, billions of dollars, while continuing  to pass along these high costs.  This saddles many patients with excessive charges, and ultimately with bills that they cannot pay, at the same time that employers are footing a smaller portion of health care costs.  It is easy to see why the patient who suddenly faces a catastrohic illness can also face bankruptcy.

A new model of paying providers, Global Payments, might help to control health care costs by eliminating the  fee for service payment plans that encourage providers to order more rather than fewer tests and procedures.  Under Global Payments, the provider is given a fixed amount of money for the care that a patient receives in a given time period, such as a month or a year.  Although Global Payments will control some costs, whether this will benefit the patient and result in fewer co-payments or reduced costs for tests and procedures is questionable.

So how can e-patients fight this system?  They must stop allowing themselves to be victims that are on the receiving end of whatever the doctor orders and the system charges.  Instead, they must become full participants working with their physicians collaboratively to discuss treatment options and costs.  They must  engage in comparative shopping so they become educated about health care pricing and  can use their purchasing power to force the system to become accountable.  Finally, they must make wise choices about their care, and understand that they are dealing with a system that is full of loopholes and greed on the part of too many  providers, insurers, pharma companies and medical suppliers who, for too long, have been  more concerned with their bottom line than with patient care.

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