A new article in Consumer Reports begins:
If gas stations worked like health care, you wouldn’t find out until the pump switched off whether you paid $3 or $30 a gallon. If clothes shopping worked like health care, you might pay $80 for a pair of jeans at your local boutique and $400 for the identical pair at the nearest department store—and the clothes wouldn’t have price tags on them.
“Why can’t you or I as a consumer ask what it’s going to cost and be met with something other than a blank stare?” asks Will Fox, a principal with Milliman, a national health actuarial consulting firm. The answer, he says, is that neither providers nor health insurers really want consumers to have that information.
Here’s why: The contracted prices that health plans negotiate with providers in their networks have little or nothing to do with the actual quality of services provided and everything to do with the relative bargaining power of the providers.
Here’s what this system means for consumers:
- Not even staying within your plan’s network will guarantee you low prices. Providers who have a lot of market clout, such as a prestigious university hospital, may command prices several times higher than providers who don’t.
- It may be difficult, if not impossible, to find out the price of health care ahead of time, especially for complex services such as elective surgery. That’s a special problem for people with high-deductible plans, who may be responsible for the first $5,000 or even $10,000 of their health expenses every year.
- If you go out of network, whether on purpose or involuntarily, you may be hit with a five-figure bill that your insurance company isn’t obligated to pay.
- There are ways to protect yourself against being blindsided by a huge bill. But they’re often not easy and don’t always work.
And it includes this table:
Opinions on other issues in news, journals, PR, advertising, marketing
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
Comments (6)
Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.
Charles Lehmann
June 3, 2012 at 12:42 pmMRI’s have been around for over 40 years. The problem in medicine is frequently you have to get worse before diagnostic tests reveal what’s wrong. Older MRI’s sometimes require a repeat study but the newer MRI’s identify the problem on the first exam. That machine costs more and improve patient outcomes which warrants higher insurance reimbursement. Otherwise diagnostic facilities would not have motivation to modernize their equipment.
Charles Lehmann
June 3, 2012 at 12:56 pmThe above matrix would be fine if all surgeons had identical skills. Medicine is not like changing an oil filter in a car. The practice of medicine is not just a science but an art. The skill and experience of a surgeon results in an assessment that helps the patient choose the procedure that is best for the patient with the best risk reward ratio for the outcome the patient seeks.
Rob Midwest
June 5, 2012 at 9:25 pmThere are NO objective measures to assess MRI’s, surgeons, or any other Medical Services, except lab tests. How do you measure “quality” of a surgeon? Nortin Hadler and Otis Brawley’s books about treating what does not need to be treated are critical to read. Type 2 Malpractice as Hadler calls it, doing well what should not have been done in the first place. Consumer Reports is absolutely correct. Medical Services should be quantifiable and should have known outcomes and known prices ahead of time. Why would someone pay $100,000 for a procedure that can’t be evaluated or the outcome known? Doctors supposedly use ‘science’ to produce results. Where are the results to measure doctors services?
Our Comments Policy
But before leaving a comment, please review these notes about our policy.
You are responsible for any comments you leave on this site.
This site is primarily a forum for discussion about the quality (or lack thereof) in journalism or other media messages (advertising, marketing, public relations, medical journals, etc.) It is not intended to be a forum for definitive discussions about medicine or science.
We will delete comments that include personal attacks, unfounded allegations, unverified claims, product pitches, profanity or any from anyone who does not list a full name and a functioning email address. We will also end any thread of repetitive comments. We don”t give medical advice so we won”t respond to questions asking for it.
We don”t have sufficient staffing to contact each commenter who left such a message. If you have a question about why your comment was edited or removed, you can email us at feedback@healthnewsreview.org.
There has been a recent burst of attention to troubles with many comments left on science and science news/communication websites. Read “Online science comments: trolls, trash and treasure.”
The authors of the Retraction Watch comments policy urge commenters:
We”re also concerned about anonymous comments. We ask that all commenters leave their full name and provide an actual email address in case we feel we need to contact them. We may delete any comment left by someone who does not leave their name and a legitimate email address.
And, as noted, product pitches of any sort – pushing treatments, tests, products, procedures, physicians, medical centers, books, websites – are likely to be deleted. We don”t accept advertising on this site and are not going to give it away free.
The ability to leave comments expires after a certain period of time. So you may find that you’re unable to leave a comment on an article that is more than a few months old.
You might also like