[easyfrag]

One thing to keep in mind is that there's more to good medical care than a fair price:

Post-op infection rate - do all clinical employees regularly wash their hands before and after each patient encounter?

Re-admission rate - does the institution or surgeon do enough cases of a particular procedure to be proficient?

Error Rate - Are pre-op checklists ALWAYS used?

Post-op care - Are supportive therapies like Physiotherapy available?

It bugs me to see medical interventions treated like a commodity, these "products" don't always follow generally accepted market principles - a price cut in colonoscopies will not significantly increase demand.

[jerf]

There's more to everything than a "fair price". People who want to explain why Microecon 101 doesn't hold in the medical arena really should take care to not accidentally explain too much and end up proving that Microecon 101 never holds, which is demonstrably false.

(And yes, there's more to the world than Microecon 101, just as there's more to physics than Newtonian mechanics or thermodynamics, but I still get to assume that glorious theories that somehow fail to conform to such basics are probably in error.)

[draz]

I generally agree with your sentiment. However, here's something to consider - medical practices mostly over-charge to avoid insurance fraud. Wait, what?? Yes, here's how it works: if they were to ask you, "what insurance do you have" and then charge you differently (i.e. one insurance pays them better than the other, so they'd charge more), they'd be committing a crime.

So, instead, they charge EVERYONE a crazy amount, and then they get X% of the amount billed from one insurance, Y% from another insurance, etc. Fair? Not really -- if you don't have insurance, you get hit with the FULL amount (since you don't have the negotiating power the insurance company has). So while company X paid $200 for an MRI, you'd pay out of pocket $2500 without insurance.

In reality, what happens? Normally, people without insurance are an underserved population. They send them letters, and they don't pay. At the end of the day, the hospital/private practice just ends up writing this amount off, and they call it a day. It ends up being a silly game where they bill knowing they won't get paid, and then spend more money on trying to collect rather than give more realistic prices.

I, therefore, welcome this transparency.

source: I work for one of the largest and prestigious medical/research institutions in the US, and I used to do Analytics for their financial data warehouse.

[maxerickson]

Do they actually negotiate deals with insurance companies where they lose money on some procedures?

If they don't, then the problem is that they want the revenue from the higher paying insurance, not worries over fraud.

[draz]

Yes, they want more money from higher paying insurance. But if they were to officially have a menu of prices for different entities (self pay, insurance A, insurance B, etc), that'd be against the law. So they come up a "catch all" number, and they grab as much as they can get from each entity.

[maxerickson]

My point was that there is some matter of perspective in there. They could just as well offer a single price that reasonably covered their costs, but instead they are engaging in revenue maximization. So the menu is a rational tradeoff of revenue maximization and fraud avoidance, but it isn't the only one.

"Insurance companies won't play the game that way" is sort of an answer, but it isn't very satisfying.

I guess fraud statutes might benefit from some rules about the ratio between average negotiated prices and stated prices (I'm a little uncomfortable telling entities how they are allowed to price things, but large medical institutions clearly have some dysfunction in this area).

[johndevor]

From their website:

Wherever you decide to have your surgery, you should inquire about the rate of infection in their facility. Our rate of infection for 2006 was 0.3%, for 2007 was 0.2%, for 2008 was 0.04% and for 2009 and 2010 was .001%. These percentages are astoundingly low compared with an estimated national average of 2.6 % per year.

[11Blade]

It is misleading. It is a surgery center. They do not do complicated abdominal surgeries that require post-op hospitalization.

If you concentrate of endoscopy, elective orthopedic surgeries, and outpatient surgery, the infection rates will be much lower.

compare that to colon and pancreatic surgery or complicated thoracic/lung/heart surgery.

I give them credit though for cutting their infection rate from 0.3% to 0.001%

11Blade (yes. a scalpel)

[zdean]

Actually, a 'fair price' would be reflective of all of these factors. If a hospital/health provider feels that it excels in these areas, then they could just as well publish these quantifiable measures along with their prices. Then it's up to the consumer to decide how valuable these factors are to them. However, there's no reason to assume that the hospital that's charging 1/4 what others are charging is demonstrably inferior in any of these ways just because of the price.

[homosaur]

Of course they are commodities, and of course it would increase demand, I don't know why you would suggest otherwise. It might not be like pricing blenders and there are other considerations but there's no reason to think that this wouldn't affect the market positively for buyers. You're ignoring the largest single market which would benefit from public pricing and lowered rates, the uninsured. It doesn't matter to you because you throw your insurance card up there and someone else pays the bill but if someone knew a colonoscopy was $X then they could budget for that and pursue competitive options.

Plus, the things you mentioned have little to nothing to do with pricing. There's plenty of shit hospitals that charge outrageous fees. Just look at Texas. It doesn't take more money to engage in proper sanitation, it takes good management. These are two separate issues entirely.

[conexions]

Those are all important things...and they should be publish on the internet as well. The only way to bring prices in healthcare down is to allow the customers to be able to compare price and quality. When my wife was pregnant our number one priorty was to find a doctor with a low C-section rate and I was incredibly frustrated to find no public means of finding this out. If patients are given the tools to research price an quality, I believe it will have a huge impact on the healthcare system.

[antitrust]

Adding to your comment:

There's a lot that cannot be quantified as well.

For example, some doctors I trust more than others because I think their diagnostic skills, empathy, listening skills and ability to absorb case knowledge are superior to the generalized level of their peers' abilities in the same area.

However, I wouldn't want someone to make an Excel spreadsheet with every patient's assessment of his/her doctor in the same way, since I think most patient's judgment skills will be on a similar standardized level that is below what I would need.

It's sort of like martial arts fighters. We can measure number of wins/losses at tournaments, but we can't assess how well they'd do when approaching an unknown situation with assailants who do not play by the rules.

[zdean]

Of course this is quantifiable. In the simplest sense, there's no reason you couldn't allow patients to rate doctors/hospitals based on these factors. But in a broader sense, you have to assume that these factors in turn affect the issues highlighted in the comment (infection rates, re-admission rates, etc.). If the listening skills do not in turn lead to better, measurable care, then it's a non-factor. If it does, then it can be measured.

Now, the measurements may not (especially initially) be perfect. But at least you're creating data points that give you SOMETHING to work with.

[dclowd9901]

Neither does a price cut in huge black dildos; what's your point?

[petermonsson]

Does your current hospital show you these statistics?