What really drives healthcare costs?

[bobbysgirl]

Maybe I can contribute to your question.

Smoking and drinking is a myth. I worked someplace for 10 years and only one patient had lung cancer out of 255000 patients. One in 1000 mamograms were positive for cancer as well. This is an exact number as it was my job to do the federal numbers.

Elderly, myth. Many many young people dragging in because of colds, flu, hang nails etc. Any thing that made them not feel perfect. Then the little bit of knowledge they had, pushed doctors to order tests and x rays. Demanding patients. Oh, they brought their kids in too. The elderly are too busy getting in as much life as they can before the end.

Doctors do not - on the whole- raise prices. Contracts are signed with insurance companies. The companies know what Medicare pays and they will only go a bit above it. Why do you think doctors have to schedule 4 patients in 15 minutes? No one could pay the mortgage with the re reimbursements insurance companies pay.

It comes down to hype, propaganda, and lies. Insurance companies pocket a load of profits. Granted this all began due to the greed of doctors and their superior attitudes. I see it as the circle coming 'round for them and us footing the bill.

Drugs, now that's even more interesting.

[Mardi Gras Audrey]

I read this link and the comments. I think that the author made some good points but a lot of them were not correct. I am currently going into the healthcare industry and part of our studies include health economics. The author here misses several key facts.

1. "Providers charge more because they can". The author then states that because the govt isn't heavily involved in pricing, the providers screw the consumer by charging a bunch. This is not even a logical argument. Let's start with the fact that the govt IS INVOLVED with provider payts. Those two programs, Medicaid and Medicare, are HUGE payers. They routinely pay LESS than the cost of treatment and there is no negotiating with them (They just say what they are going to pay). As a result, providers have three choices 1. Charge private insurers or the uninsured more to make up the loss, 2. refuse to take any medi patients or 3. go out of business because you are operating at a loss. I think we can agree that they choose #1 (If they chose 2 then the elderly and poor would get no care because there wouldn't be enough providers. If they chose #3, no one gets care because they are out of business). On the drug side, the lack of price regulation means that the US subsidizes a lot of the drug development costs for the rest of the world. Woudl it be great to act like the European countries and regulate what will be paid? Sure...but I doubt people would like the result... less new drug devt.

2. Myth- "Malpractice isn't an issue (It's only 2% of expenditures)" That 2% doesn't account for how practice has CHANGED due to malpractice. If doctors are ordering all kinds of tests and requesting extra stays in order to Cover their bums, those costs ARE due to malpractice/fear of being sued (known as defensive medicine). But the 2% charge usually doesn't include those costs because how do you separate the "necessary tests" from the "somewhat necessary tests"? No one wants to be the patient that that somewhat necessary test should have been done on and wasn't so doctors do them for everyone.

3. "Doctors are overpaid". In comparison to what? Stating how much they make in relation to their patients is irrelevant. What effort and resources are put into becoming a doctor? Should they make what the average fastfood worker makes? What are the amount of student loans and time put into developing a doctor? If you don't compensate them accordingly, you will have no providers.

4. "Outpatient costs are higher".... And.....?/? Everything I have heard says that this is a good thing. People shouldn't be in the hospital unless they really need to be. It is more expensive, more resources are used and it is worse for the patient (More likelihood of infections, more stress). We continually say that people should be treated by a primary care doc instead of the ER. Why? Because it is cheaper on the system as a whole. Why would you want to put procedures that can be done on an outpatient basis back into the hospital to increase systemic costs and risk to the patient?

[gsbrq]

The biggest drivers:

Administrative overhead costs due to insurance providers being the middlemen
Profit motive of insurance & drug companies
Our misguided belief that more=better when it comes to medical treatment. Not always true.

[Deleted]

5% of medicare recipients die in a year.... 30% of all medicare expenditures go to those 5% .... it IS a problem.

[Deleted]

Drugs are a real issue... especially psych drugs, and lifestyle drugs...

[sil]

They certainly cherry-picked their statistics, didnt they?

They showed that US smoking and drinking rates are relatively low compared with Europeans and Japanese, but they do not show how our obesity rates stack up with our counterparts. Instead they show an unindexed graph that's supposed to show that "disease prevalance" (including obesity) is only a small slice of our spending pie.

Agree with AudryAlyce on all of her comments. But have to especially emphasize the stupidty of the Outpatient graph....Okay, profit margins for Outpatient procedures are high. But it seems to me that avoiding long hospital stays is the less expensive option. Perhaps show how much the inpatient hernia treatment in the UK costs compared with the outpatient treatment in the US?

Finally, lets talk about the "Astounding Administrative Overhead" I work in HC insurance, and I agree the overhead is huge and should be drasticaly cut down. But what they fail to mention is that government regulation is the biggest driver of overhead costs. The more government gets involved, the more paperwork is required. Incidentally, if you are currently searching for a job, check out health insurers....were all staffing up in response to HC reform

[april47]

Unrealistic expectations. The public wants every little thing taken care of with perfect results. Not everything can be treated without side effects and perfect results aren't always possible. Expectant mothers want all the bells and whistles when having a baby. Private rooms and being waited on hand and foot. Even the medicare moms expect luxury. Most colds and minor problems don't warrent a visit to the doctor and can be managed at home. Employers don't help when they insist that an employee get a doctor's release after every time they are sick for 2 days in a row. I was gone 2 days with a bad cold and they wouldn't let me return without going to the doctor. So I go in and he says I have a cold and gives me numerous prescriptions for stuff I don't really need.

[The Walk of the Penguin Mich]

Even the medicare moms expect luxury.

Assuming you mean Medicaid. Medicare is for the elderly.

[april47]

May 9, 2011 17:23:03 GMT -5 The Walk of the Penguin Mich said:

Even the medicare moms expect luxury.

Assuming you mean Medicaid. Medicare is for the elderly.

oops! I have medicare on my mind today. Of course there was some idiot lady in 60's that gave birth in the news a few years past.

[achelois]

Jcaho.

I cannot even begin to list all it's mandates that increase costs.

[Deleted]

"Most colds and minor problems don't warrent a visit to the doctor and can be managed at home."

I'm not sure i'm going to explain this right. But there is a 'legitimization' of the role of physician which has occured... something like the role of educators too, but that is a different story, in which parents have been lead to believe that they don't know what is right or wrong. You have to put your baby to sleep like this, you can't feed them that, they must have this immunization... etc. etc. which i think feeds the... oh man, somethings wrong, i have to call the doctor... how could i be expected to know what to do...

On one hand doctors feed this, because it legitimizes their place. Women are 'eccentric' at least if they consider home birth, etc. ... but on the other, it also perpetuates an over reliance on the profession for 'ordinary' things...

[Sum Dum Gai]

Women are 'eccentric' at least if they consider home birth, etc. ... but on the other, it also perpetuates an over reliance on the profession for 'ordinary' things...

There a big difference between giving birth at home and using OTC meds or simple rest to deal with your own cold.

[Deleted]

But somehow i think its mixed up together. You HAVE to have a gluclose intolerance test and take prenatal vitamins and have a flu shot and get this test and follow this diet.... and give your kids these shots and get that boy circumcised... on and on.... Its like they try to say... hey... you do NOT know any better... I know better... and then wonder why parents feel they have to call at the drop of a hat...

Maybe i'm crazy... who knows...

[Deleted]

And home birth is actually not that crazy of an idea. If i was doing it again today ( ... sorry, had to pause for a minute there...) ... I would not go to a hospital unless there were complications...

[wvugurl26]

Administrative costs are a rather large portion of costs. Could the companies be more effective I don't know the answer. The government has given waivers to insurance plans from the requirement in the ACA that a certain percentage of premiums be spent on care not administration.

Drugs are expensive bc we subsidize the world. I was reading on article today about clinical trials for the Plavix alternative currently awaiting FDA approval this summer. A lot of the work has been done overseas and in fact helped those patients more than it did those here. However, they still wanted more US trials bc they wanted data in the country that will make or break a drug. Newer drugs are expensive and some doctors push them. I'm sure many patients could do with less drugs period and older, less expensive drugs.

Medicaid rates are set by states but have to be approved by the feds. The states are required to track access to care and not reduce payment levels to a rate that would result in a decrease in access to care. Medicare payments are set by a rate setting body. The feds would have a whole lot more money if they did away with pay and chase. We waste billions on fraud every year and most of that money will never be recovered.

As for doctors salaries I'd venture a guess that we put a whole lot more demands on doctors than other countries do. In many other countries doctors are employed by the government so that's not an apples to apples comparison.

[Sum Dum Gai]

And home birth is actually not that crazy of an idea. If i was doing it again today ( [image] ... sorry, had to pause for a minute there...) ... I would not go to a hospital unless there were complications...

That's kind of my point though. If there are complications, which in pregnancy terms means usually either the baby, the mother, or both are in serious danger, do you want to be stuck waiting for an ambulance, or just down the hall from the guy who does emergency C sections? I know, I know, women have been giving birth for thousands of years, but they've also been dying during child birth and/or losing one baby in ten in the process for most of those thousands of years.

It's not the same thing as whether or not you should avoid fish during pregnancy, or get a boy circumsized. Neither of those things are life threatening. Giving birth can be.

[NastyWoman]

May 9, 2011 19:31:53 GMT -5 oped said:

And home birth is actually not that crazy of an idea. If i was doing it again today ( ... sorry, had to pause for a minute there...) ... I would not go to a hospital unless there were complications...

I had one at home (Netherlands) and one in the hospital (US). Believe me at home was by far the better experience. And since I am at it: according to a report I read the US ranks far worse than the Netherlands. While there are undoubtedly many factors contributing to this difference it does show that home births are not per definition inferior.

www.savethechildren.org/site/c.8rKLIXMGIpI4E/b.6748295/k.BE47/State_of_the_Worlds_Mothers_2011_Statistics_and_Facts.htm

[happyscooter]

'As for doctors salaries I'd venture a guess that we put a whole lot more demands on doctors than other countries do. In many other countries doctors are employed by the government so that's not an apples to apples comparison.'

Remember, a doctor has to pay a receptionist/secretary, book keeper, X-Ray tech, nurse, medical supplies and lab workers. Not to mention power, , phone, internet and rent. Which by the way are the same things a mall pays, rent, book keeper, phone, internet and power. But people like going to the mall.

[973beachbum]

One thing that I think contributes to the high cost is the over utilization of medical services, because of the fact that for a large percent of our population it periodically goes "on sale".

By on sale I am referring to the people who don't regularly have health insurance. Twenty to thirty years ago companies regularly gave cheap health insurance to their employees. Most employees were regular ones not contract or temp workers who they get no benefits. Now a huge part of our population is a worker with no benefits. So they go through years sometimes without health insurance.

So just like the person who knows they can't afford steaks when they are $9.99 a pound so they buy extra and stock up when they are $5.00 a pound. The people are insecure from not having health insurance before and they are scared about how long they will have it when they do get it. So they act like health care is "on sale" because to them it really is. While they have ins someone else is paying part or all of the bill. So they load up on all the medical tests and services or drugs that they think they might need so that they don't have to do it when it will cost more by not being insured.

If people felt more secure that they could get medical care when they needed it they wouldn't feel the need to "stock up" like some people do with bottles of shampoo when they go on sale.

[Jake 48]

I work in public safety, this happened just yesterday. 911 call for the women with a UTI, needing transport to hospital. Expecting an elderly lady, perhaps bed ridden, dehydrated, legit call and I have no problem with the elderly using services. ambulance arrives on scene to find, 22 year old female walking around the parking lot of the gas station/donut shop/convince store waiting for the ambulance to give her a ride to the hospital because she could not get a ride from anyone she knew. Hospital is 10 miles away.

[NomoreDramaQ1015]

Expectant mothers want all the bells and whistles when having a baby. Private rooms and being waited on hand and foot.

Man I wish. I was shoved in a shoebox room and had to go looking for nurses any time I needed anything.

And just me but I am glad I have access to pre-natal care and giving birth in a hospital. Like Dark said yes women have been giving birth for thousands of years without all that stuff, but personally I don't want to take the chance of being the one in whatever mom/child that suffers the consequences.

I'd rather be right down the hall in an emergency where the doctor can get my baby out in less than 3 minutes than be waiting for the ambulance to come, drive me 15 minutes (during non-traffic hours) to the nearest hospital, get checked in, prepped and then wheeled into the operating room.

Birth is costly, I nearly had a stroke when I looked at my bill. But I can't imagine what the bill would have been if I had had to be taken via ambulance and the emergency room to the hospital.

I also had the opposite experience that I was often viewed as a freak because I am all for having the baby in a hospital, give me an epidural if I want one and I don't want to try vaginal birth no matter what, you think that baby is stuck, you get it out. No way I want to try one way and then have to end up doing the other and have to recover from BOTH at the same time.

I felt so out of place in my childbirth class because I got the one where everyone was turbo natural childbirth this is how my birht is going to go hell or high water type moms.

Not exactly the environment to voice that you're up for an epidural in the parking lot if they offer them.

Barring a life threatening emergency I was for the most part in control of my birth clear till the end. There were some hospital policies I thought were assinine, like no eating once you were 5 cm, but those are small beans, not worth trading for the risk of home birth, IMO.

[Formerly SK]

I had an eye-opening experience last fall. I started getting stabbing pains in my left breast (I'm 38). Lived with it for a week or two and then figured it was best to call my dr. Saw her and she immediately sent me in for an ultrasound AND mammogram. Everything was negative and the pain went away a couple weeks later. BUT - I received no bill for the services. Not even the usual 20% (I have an 80/20 for lab work). When I called I found out apparently breast cancer testing is covered 100%.

It all felt very wasteful but I *know* my dr would never had said, "Why don't we wait a few weeks and see if the pain goes away before we order these tests?" With all the hype for breast cancer (catching it early etc) it would NEVER happen. Lesson learned that the burden is on me to avoid medical care as the dr will always pursue testing as a CYA.

[Formerly SK]

May 10, 2011 8:32:30 GMT -5 Jake 48 said:

I work in public safety, this happened just yesterday. 911 call for the women with a UTI, needing transport to hospital. Expecting an elderly lady, perhaps bed ridden, dehydrated, legit call and I have no problem with the elderly using services. ambulance arrives on scene to find, 22 year old female walking around the parking lot of the gas station/donut shop/convince store waiting for the ambulance to give her a ride to the hospital because she could not get a ride from anyone she knew. Hospital is 10 miles away.

[swamp]

May 10, 2011 8:32:30 GMT -5 Jake 48 said:

I work in public safety, this happened just yesterday. 911 call for the women with a UTI, needing transport to hospital. Expecting an elderly lady, perhaps bed ridden, dehydrated, legit call and I have no problem with the elderly using services. ambulance arrives on scene to find, 22 year old female walking around the parking lot of the gas station/donut shop/convince store waiting for the ambulance to give her a ride to the hospital because she could not get a ride from anyone she knew. Hospital is 10 miles away.

People like that drive me insane.

I would have liked to have given her a bottle of cranberry juice and $10 for a taxi. Oh, and a smack upside the head.

[swamp]

May 9, 2011 19:31:53 GMT -5 oped said:

And home birth is actually not that crazy of an idea. If i was doing it again today ( ... sorry, had to pause for a minute there...) ... I would not go to a hospital unless there were complications...

I had 2 perfectly seemingly normal births that both ended up with emergency c-sections. I'm glad I was in the hospital when they made that call, instead of attempting to struggle through it at home. Adn then wait 10 minutes for the ambulance to show up and drive 10 miles to the hospital.

[happyscooter]

skinnykids, you're lucky. my insurance company said 'you're screwed' for the tests my doctor was telling me to have done. I bit the bullet paid the $800.00 and said 'never again'. So if I don't post for a few weeks, you know what happened to me. I cheaped out and I am gone.

[NomoreDramaQ1015]

started getting stabbing pains in my left breast (I'm 38). Lived with it for a week or two and then figured it was best to call my dr. Saw her and she immediately sent me in for an ultrasound AND mammogram. Everything was negative and the pain went away a couple weeks later. BUT - I received no bill for the services. Not even the usual 20% (I have an 80/20 for lab work). When I called I found out apparently breast cancer testing is covered 100%

Wow scary! Glad everything came back okay.

I had a doctor not charge me for a visit because the receptionists screwed up and told me I had to have two appointments instead of one. He went ahead and saw me since I was already there but he didn't charge me. He also had words with the receptionists.

DD's pedatrician didn't charge us for a visit once when she had a cough and being a new parent, DH freaked out, especially since whooping cough is going around our county. It turned out to be nothing and our pediatrician wrote it off.

[Gardening Grandma]

The countries. being compared with the US do not have the profit-driven middlemen.

United Healthcare just gave their CEO $10M......

When my mother was a resident in Japan, she got better healthcare than she duoes now in a nh. She took a bad fall and they did not bother x-raying her until she begain to complain of pain and refusing to try to walk because it hurt her so much.

[achelois]

The reason they don't give you stuff to eat and drink is that--if you would have to rush to surgery--you don't aspirated gastric contents into your lungs on induction or emergence from anesthesia.

If that happened, you would at least develop aspiration pneumonia and,at worst, could die. It takes very little amount to cause that.

It us somewhat inconvenient but better than the risk of the other.

[april47]

As an retired NICU nurse I can tell you that we had to admit at least once a month a baby from a home delivery gone wrong. Not too long before I retired, one of those died. We tried to save her but she had inhaled too much junk into her lungs before we even got her. If she had been at the hospital when delivered she would have been sucked out and a little oxygen given immediately at birth and no big deal. So sad.