When you book a flight do you fly first class or carefully
consider price as the main factor in making a choice of airline and seat? When you schedule a surgery, do you look at
price or consider only the quality and convenience/location of the facility and
physician?
There, I believe, you have one of the two fundamental causes
health care costs are out of control in this country. There are tools out there to compare costs of
medical and dental procedures at different facilities/providers, but as
consumers we have been removed from the pricing picture because we’re paying
someone else—the insurance company—to pay for the actual services. If we shop at all, we’re typically shopping
for the best insurance plan, the one that is likely to cost us the least out-of-pocket. Once we make that choice, we select our
providers based on other factors than price.
The result is that we have bigger and fancier hospitals that
resemble hotels more than the now-old-fashioned image of what a hospital looks
like. I suspect you’d complain, as I
likely would, if I had anything other than a private room there during a
stay. And I wrote about this a few weeks
ago, but we have more specialists rendering care and not enough first-level or
primary care providers. That drives up costs.
I point the finger at myself in this matter, too. I came face-to-face with the choice this week
when I went on my health insurer’s website to check which doctors are
in-network for a specific procedure. I
was pleasantly surprised that the site offered quality ratings and price
estimates based on their claims history with those providers. I found a $900 difference between the
low-cost provider and the doctor I was leaning toward choosing. In this case, it actually would come mostly
out of my pocket since I have a high-deductible plan. Nonetheless, I am almost certain to go with
my higher-priced preferred doctor. He
had high quality ratings (but so did the low-cost provider), came with
recommendations from a couple of friends who are health care professionals, and
practices at a facility that’s one-third the distance from my home compared to
the other choice.
(I appease my conscience by telling myself this is a
preventive/screening service and thus likely a cost-saver in the end for
everybody.)
As long as we shop based on convenience and “the
experience”, we will likely see health care costs continue to rise because
providers will cater to those preferences.
And even if we don’t pay the price directly, we will pay it through
higher insurance premiums (including Medicare) and deductibles.
Nations with much lower health care costs but comparable or
better outcomes (think India) tend to centralize services (i.e. you have to
travel farther to get some specialized services/procedures) and make some
aspects of the experience more like an assembly line than the American concept
of quality care. Could we accept that
here? As one author quoted by Bloomberg
recently said, we tolerate cramped seats and peanuts for a snack in order to
snag a cheap flight and extra luggage at no charge; why not apply that
principle to choice of health care provider?
But we may say to ourselves, “It’s my health, I need to
spend to get the best. It’s more
important than the seat choice on a two-hour flight.” Agreed.
But if quality and outcome ratings are the same for two providers why
would we choose a higher-priced one for any reason other than convenience and
the perceived experience? It’s something
to think about.
I said at the outset that this was one of two causes health
care costs are spiraling ever higher.
I’ll address the other reason next week.
Until then,
Roger
“Stop judging by mere
appearances, but instead judge correctly.” John 7:24 NIV®*
*Scripture quotations taken from the Holy Bible, New
International Version® NIV®
Copyright © 1973, 1978, 1984, 2011 by Biblica, Inc.™
Used by permission.
All rights reserved worldwide.
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