Reminds me of this really good article. TLDR: Man tried to call a number of hospitals to find out how much childbirth is going to cost him and received no answers.
Well, in fairness to the hospitals, most of us here are software developers: how many times, early on, did somebody push you to give an "estimate" for a task that was underspecified and then try to hold you to that estimate? How many times did it happen before you learned to sidestep estimates unless you already knew everything that you needed to know beforehand?
Quite often, actually. This is why we pad our estimates.
It's inescapable, in that providing a description of the problem that is precise enough to generate a perfectly accurate estimate is very close to actually just being the solution. As you do the work, the estimated time to do the work approaches the time already spent doing it.
But a lot of customers want essentially the same thing--probably a glorified CRUD app with pretty management dashboards, and a workflow that exactly parallels the all-paper workflow first designed in 1965. If you do that sort of thing often enough, eventually you get a feel for how much it costs, even with the variation across customers.
Medicine has a great advantage over software in that decades of hyper-detailed hospital billing--set up in an effort to maximize the yield of patient cash-ectomies in the face of insurer pushback--can now be subjected to statistical analysis. All those diagnosis and billing codes can be plugged back in to the billing databases to discover the median cost for the care to treat a particular ailment. It isn't so hard to then say that I am willing to pay the median actual cost, plus an X% margin for the hospital, even if the actual cost is less, provided that the hospital also eats the difference if the cost is actually more. On average, if everyone did this, the hospital still makes enough money to stay in business.
Some diagnoses in particular, such as the one every woman on the planet is likely to get an average of 2 times during her lifetime, probably while between the ages of 16 and 50, are particularly amenable to cost averaging. If you can't quote the cost of a hospital childbirth to a patient with months of lead time, including the possibility of emergency surgery, you deserve what happens to you when every actuary can crank out an answer using a pocket calculator within 15 minutes of being asked to do so. You know how much it costs. You just don't want to say, because that takes away your leverage to charge more.
But ethically, the care provider should probably not have that leverage, because if they haggle, people can die. If you cure a disease that affects 3 people in 100000, we can talk about the size of your bonus. But if you (the hospital) are on your 3rd laparoscopic gallbladder removal in the same week, and still don't know how much it costs, I want the power to set the price taken away from you.
Realistically, how am I supposed to act in a financially responsible manner when I don't even know the order of magnitude a service will cost?
Unforeseen complications are not exclusive to the healthcare industry. Imagine if you were trying to build a house, but had no idea how much it would cost. "Realistically, no construction company will give out a price; they don't know what unexpected complications may arise."
Something needs to happen here. Either healthcare is socialized (my strong preference), or the industry needs to implement some type of price transparency.
With respect to financial responsibility, if the cost of the delivery is a concern I don't think the couple in question is financially stable enough to start a family anyway. Even if this proposed change does occur there's a good chance it actually makes the procedure in question more expensive. If we start making hospitals list prices beforehand, then they're going to have to raise the base price for an ucomplicated birth in order to subsidize those that do experience complications.
Not to mention, your analogy to construction works is a good one - but perhaps not in the way you intended. Plenty of construction projects run into complications and experience cost overruns. The only situation in which I can see hospitals giving out prices is in the same context as construction projects. Non-binding estimates that are projections based on prior assumptions, which will change if unexpected situations occur.
In fact the best analogy I've come across is with car mechanics. Fixing a person is like fixing a car. The shop can charge a set rate for labor, and will provide an invoice for parts. In that sense, price is perfect transparent. But even the best mechanics can't predict with certainty what it'll take to fix a car without seeing it first. Who knows when they'll pop open the hood expecting to do a standard operation only to find that the car is messed up way harder than was originally predicted.
> With respect to financial responsibility, if the cost of the delivery is a concern...
As the GP noted, if you don't even know the order of magnitude to expect, the cost will always be a concern. The upper bound on the price is in the trillions, after all.
> If we start making hospitals list prices beforehand, then they're going to have to raise the base price for an uncomplicated birth in order to subsidize those that do experience complications.
This function is currently performed by insurance companies; a frequent criticism is that insurance should limit itself to true emergency situations, but when any routine operation can balloon in price unexpectedly, it's not irrational to want its purchase mediated through the insurance provider.
While the exact prices may not be exposed, estimates from past customers can be found online without much difficulty. If you seriously think that a hospital charging trillions of dollars is a possibility, I don't think you're writing comments in good faith.
Prices negotiated with insurance companies are negotiated under conditions very different from an uninsured patient. For example, risk of non-payment is drastically higher among the uninsured. This had to be offset by charging a higher rate so those losses are made up on patients that do pay. If you offer to pay for medical procedures in cash and immediately then you can usually negotiate the price down to a fraction of the list cost.
> While the exact prices may not be exposed, estimates from past customers can be found online without much difficulty.
They can?
Vox's reporting over the past couple years has suggested quite the opposite—that past prices are not easy to find, and that even when they are, your price can drastically vary from someone else's even for the same service. That's why they started this "submit your emergency room bills" project.
Realistically, no airline is going to give you a price for transit to a destination. They don't know if there will be a terrorist attack or if the baggage handlers on the other end will jack up their rates.
I like the spirit of this. However, what the airline is really willing to price is "best effort to provide transit to location either beginning the time stated or as soon as convenient for them after". Fortunately, their operations are predictable enough that most customers are fine with this.
That's not quite enough scope control for all services.
A terrorist attack is an extremely low frequency event to the point is being nearly non-existent. The same cannot be said of birth complications. Baggage handler rates don't change on a dime. Labor rates do affect ticket prices, but they're drastically more predictable.
Yes, but the same logic applies: you either negotiate prices out with a network in advance, or insure against the major complications. None of that is different for a health care operation.
No. The same logic does not apply, as the two situations are drastically different. The regularity of airline costs is drastically greater than the regularity of healthcare costs. Airlines can set ticket prices upfront because they predict their expenses on a given flight with a reasonable degree of accuracy. Hospitals, subject to extreme and frequent irregularities between what patients may need, cannot. At least not with individual patients. Insurance companies are very different types of customers as compared to individuals. Because the negotiated price applies to a large group of people, the question isn't "how much do we have to charge to break even on X procedure?" The question becomes, "How much do I have to charge for X procedure, *averaged over hundreds or thousands of patients?". Each patient is effectively a slot machine for the hospital. Insurance companies negotiate on behalf of a large number of patients so that the aggregate cost becomes something that is predictable enough to negotiate.
My veterinarian manages to give quotes - before they do emergency treatment, they come up with a low, typical, and high quote, and I have to agree to pay up to the "high" price before they'll start the treatment (if I refuse, then they'll come up with an alternate, possibly less effective, treatment plan.
It's a little harder to do that with humans since they aren't going to pause an operation, keep the incision open, and tell the spouse "We found an unexpected tumor, so let's wait an hour while we generate a new quote and you can decide if you want to pay it".
But that should be part of the quote "Unexpected events can cause us to exceed the quote", and then they should have to document why it was unexpected.
They have nice pricing tables for insurances,. Just not for patients. Even unexpected complications will have a billing code but the prices are kept secret.
Insurance companies are very different types of customers than uninsured patients. They're effectively averaging their price over a large number of patients. Most are probably slightly more expensive than necessary, but that difference helps subsidize those that experience complications. Furthermore, individual patients fail to pay at a much higher rate so that is reflected in the cost as well. A hospital can't just give the "insurance price" to uninsured patients as this may put them underwater.
Try a private hospital in London[1] — it's £7,585. This is presumably high-end; it's a place princesses and sheiks' wives go to give birth.
It says "Additional charges are made if you require critical care. If your baby requires transitional or specialist care, this is free if they are entitled to NHS care and is chargeable if they are not."
But the hospital doesn't know if the birth is going to be uncomplicated until it actually happens. If the hospital gives out only a projected price, then it could lure people into false sense of security. A non binding price is effectively ad worthless a no price.
> But the hospital doesn't know if the birth is going to be uncomplicated until it actually happens. If the hospital gives out only a projected price...
The hospital can totally give a realistic, projected price: It can know what the probability of a complicated birth will be, and it is also able to amortize that over all the uncomplicated births.
There's no sane public-policy reason it should be structured like a reverse slot machine: you pull the lever, get a fixed prize, then find out how much you'll pay for it.
If it's a projected price, then the original commenter is still screwed if the birth becomes complicated. It's still a slot machine. Furthermore, it would incentivize sketchy practices like setting a lower base price than competitors but aggressively discovering (or manufacturing) complications so that the average price is considerably higher than the base price.
Not necessarily, it could be the hospital that gets screwed, they can eat the extra cost of the complications -- that could be factored into the base price, add X% to the bill account for the slight possibility of an unexpected complication.