How much do you spend on your health care? Good luck finding out – Monterey Herald


The prices for medical procedures in the United States are considerably higher than in any other country. The average MRI in the United States is around $ 1,120 and in some hospitals it is well over $ 3,000. Not only are the prices high, they are also very variable. The average cost of a hip replacement in the United States is approximately $ 29,000. But at least 5% of hospitals charge more than $ 57,000. Cancer centers designated for excellence by the National Cancer Institute vary 70 times in what they charge thyroid cancer patients for radioactive iodine treatment.

As a patient facing medical treatment and the costs that go with it, it is important that you know whether your hospitals or doctors are charging the average rate, low rate, or outrageous rate. As crazy as it sounds, most health care providers can’t tell you how much it will cost to have a procedure like knee replacement. Also, when prescribing medication, your doctor is unlikely to know how much you will be asked to pay.

The reasons are complicated. First, hospitals charge different amounts to different consumers. They’ve negotiated deals with insurers that charge commercially insured patients two to five times more than Medicare patients. For example, commercially insured patients who receive a pacemaker or implantable defibrillator in a typical California hospital might be billed around $ 114,000. Medicare and VA patients will pay around $ 20,000 or around 18% of the cost for the exact same procedure. In California’s 284 major hospitals, commercially insured patients pay about 3.3 times more than Medicare patients for the exact same services. Additionally, studies suggest that higher prices are not linked to better quality care. To be fair, hospitals can actually lose money on Medicare and MediCal patients, but make up for it by charging more privately insured patients.

Until this year, these price differences were kept secret. But, as of January 1, hospitals are now required to tell patients what they charge. This policy, known as the Transparency Rule, was proposed by President Trump and is enacted by the Biden administration – a true example of bipartisanship. But the navigation was not smooth. The American Hospital Association, Association of American Medical Colleges (AAMC), Association of Children’s Hospitals (CHA) and Federation of American Hospitals (FAH) have filed lawsuits to block price disclosure. A study of America’s 100 largest hospitals in early 2021 found that 65% ignored the rule and 82% did not meet the requirement to disclose how much they agreed to agree to specific health plans.

Legal teams at hospitals have argued that they protect patients from confusing information. And, they have a point. The few compliant California hospitals have posted the required information in obscure places using essentially uninterpretable formats. Most large medical centers simply ignore the requirement to display the prices they charge to individual patients. And what happens to hospitals that refuse to disclose how much they charge? These hospitals, which generate hundreds of millions of annual revenues, are fined only $ 300 per day for non-compliance. Over a year, it’s about the same as a nurse’s salary.

Why should you care? After all, your insurance plan pays the bills. Law? Well not exactly. Health care costs are reflected in taxes and payroll deductions. In 2021, the average employee is expected to pay $ 15,500 for health insurance premiums plus out-of-pocket expenses, an increase of about 5.3% from last year. With rising health care costs, real wages for everyone except the wealthiest have remained relatively stable. Wages have remained stagnant, but the total amount (wages + benefits) that employers pay to retain workers is increasing. When more of the earnings are spent on Medicare, less is available for the paycheck.

So what can we do about it? First, hospitals should obey the transparency rule and disclose their prices like most other businesses. Second, there should be real consequences when hospitals don’t comply. The US health care industry absorbs nearly $ 4 trillion a year; a fine of $ 300 / day for non-compliance is ridiculously insignificant. Finally, patients should be given the awards in a form they can understand. The uncontrollable costs of health care spill over into all sectors of the economy. The hospital transparency laws are a step in the right direction. As consumers, we need to be assured that they are taken seriously.

Robert M. Kaplan is a faculty member at the Center for Clinical Excellence at Stanford University, former Associate Director of the National Institutes of Health, and former Scientific Director of the United States Agency for Research and Quality of Care health.


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