Finding out healthcare
costs isn’t easy. Patients typically don’t learn them in advance. Often even the
nurses, doctors, and other medical professionals in a hospital probably don’t
know the health care costs for various procedures--billing is typically done by
a different department of the hospital.
Indeed, when one faces a
medical emergency, the patient and medical professionals are perhaps focused on
diagnosing and treating whatever health need prompts the emergency rather than
focusing on costs. Often that is the way it should be. In some cases until a
patient is properly diagnosed and treated, the total financial cost involved is
not known.
But for nonemergency
medical needs, it is often (if not always) good for patients to know in advance
approximately what the costs will be for various options and what the likely
outcomes will be.
Recent
Government Action
On November 15, 2019 the Department
of Health and Human Services (HHS) announced[1]
that “the Centers for Medicare & Medicaid Services (CMS) is issuing two
rules . . . to increase price transparency to empower patients and increase
price competition among all hospitals, group health plans, and health insurance
issuers in the in the individual and group markets.”
The HHS took action in
response to President Donald Trump’s June 24, 2019 “Executive
Order on Improving Price and Quality Transparency in American Healthcare to Put
Patients First[2].”
These step seem to be progress toward making medical care costs easier to learn in advance. Such transparency may lead to lower costs and better service.
As I stated in a March
2019 Google Blogger post[3], the greatest need for
healthcare reform is better preventive care that can enable us to live happier,
healthier, longer lives with lower medical costs. But when persons do seek
medical care, we like to get quality care at reasonable prices. More transparency
about pricing and quality can help this happen.
United
States Healthcare Costs
United States healthcare
costs are the highest in the world per capita, yet millions still lack quality
healthcare coverage.
To cite just one example
of high United States healthcare costs, a March
14, 2019 BBC article[4] notes
that U.S. retail prices for insulin and other costs of treating diabetes are
much higher than in the other countries discussed in the BBC piece.
Closing
Thoughts: Simplify Healthcare Costs?
In addition to making
prices more transparent, it could simplify things and reduce paperwork if
hospitals charged the same rate to all insurance companies, individuals, etc.,
while offering a certain amount of pro bono (free) care to the needy,
especially for emergency cases.
As it is now, often
insurance companies negotiate major discounts off the stated prices for
procedures, while persons who lack insurance and have limited funds often are
billed for the standard rates which may be double or triple what the insurance
companies negotiate. To me, this seems unreasonable. If you disagree, please
feel free to explain to me why.
Furthermore, insurance
plans often provide many pages of documentation of what’s covered and what’s
not. I’m guessing (and I admit this is not based on personal knowledge) that
medical professionals may be tempted to perform an unnecessary medical test or
procedure that is covered by a patient’s insurance to get revenue for the medical
facility and staff. In contrast medical professionals may seek to avoid
performing a procedure they find advisable due to insurance not covering it.
Ideally, we’d be better
off if we either had health insurance that covered everything, were so healthy
we needed no medical care, and/or had the funds and wisdom to pay for all our
own healthcare needs without insurance.
We don’t live in this
ideal world. But I think the Trump administration’s actions to get more
transparency in medical care is a big step in the correct direction.
However, I am writing as
an outsider. Is there something I’m missing that medical professionals and/or
insurance professionals know?
DISCLOSURE:
The author’s sisters both
work for hospitals, one as a registered nurse and the other in the accounting
area of a different hospital. But the author did not consult either of them for
information when writing this piece.
ENDNOTES:
[1] “Trump
Administration Announces Historic Price Transparency Requirements to Increase
Competition and Lower Healthcare Costs for All Americans”; U.S. Department of
Health & Human Services; November 15, 2019 press release; webpage accessed
November 23, 2019; https://www.hhs.gov/about/news/2019/11/15/trump-administration-announces-historic-price-transparency-and-lower-healthcare-costs-for-all-americans.html
[2] Donald J. Trump;
“Executive Order on Improving Price and Quality Transparency in American
Healthcare to Put Patients First”; Whitehouse.gov; June 24, 2019; webpage
accessed November 23, 2019; https://www.whitehouse.gov/presidential-actions/executive-order-improving-price-quality-transparency-american-healthcare-put-patients-first/
[3] James Edwin
Gibson; “True Healthcare Reform: Better Preventive Care;” Google Blogger; March
30, 2019; webpage accessed November 25, 2019; https://oneopinionsomeviews.blogspot.com/2019/03/true-health-care-reform-better.html
[4] Ritu Prasad; “The
human cost of insulin in America”; BBC News; March 14, 2019; webpage accessed
March 23, 2019; https://www.bbc.com/news/world-us-canada-47491964
NOTE:
This article being
submitted to Google Blogger on November 25, 2019 is virtually identical to one
the author submitted to Craft News Report, a website operated by his friend
Paul Craft, on November 24, 2019.
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