Unequal Healthcare Costs

[broughden]

Bill Of The Month: A Tale Of 2 CT Scanners - One Richer, One Poorer Bill Of The Month: Hospital's CT Scan Cost 33 Times An Imaging Center's : Shots - Health News : NPR

Interesting story from NPR about one patient getting two CT scans. One was $800, the other $8000.

And how a nearly regional monopoly jacked up their prices.

[MunoRN, RN]

There's actually far more to these cost comparisons than it would seem, in this case for instance the outpatient imaging is actually profiting far more than the hospital even though they are only charging $800 compared to the hospital's $6000 charge. The median outpatient imaging profit margin is 26%, which is relatively obscene, compared to the hospital company in the story, which has a profit margin of about 3%.

There are a number of reasons for this. One is that outpatient imaging centers can generally expect to get paid for each scan they do, whereas the hospital is only get paid for a portion of them, so you're paying for your scan as well as the patient before you and after you. The costs are also generally higher to operate inpatient imaging services. There are also intentional adjustments to costs for certain services in order to discourage excessive use, with this being a good example since it doesn't appear there was a legitimate reason for the patient to have had a CT done in the ER setting, the problem appears to be the cost wasn't high enough to deter an unnecessary scan.

[broughden]

But who cares about profit margins or subsidizing the indigent when your bill is $800 versus $8000?

I wouldn't care if the $800 bill was 90% profit margin, when I'm only asked to pay $800 in relation to the higher cost but lower margin.

[MunoRN, RN]

But who cares about profit margins or subsidizing the indigent when your bill is $800 versus $8000?

I wouldn't care if the $800 bill was 90% profit margin, when I'm only asked to pay $800 in relation to the higher cost but lower margin.

The problem is that the bill (which was actually just over $6000) is actually what the hospital has to charge to simply exist. They could bill you $800 instead, although that would mean the hospital would no longer be able to operate and the $6000 CT scan wouldn't be an issue because there would be no hospital to go to.

[broughden]

That's not what they "need" to survive. They are supplementing indigent care, which they are required to provide by law, by ripping off insured customers.

Where they should be fighting with the legislature to provide adequate funding to offset their indigent costs.

[MunoRN, RN]

That doesn't really change the costs to everyone else. They could instead get otherwise unpaid costs from government funds, which means it would come from taxes, which we pay for, it's just a round-about way of making everyone else cover the costs of those who can't pay. I would agree however that routing all funding through a single payer such as the government would make more sense as it would reduce overall costs.

[broughden]

It would be a fairer distribution at a decreased rate across the entire taxed state versus one patient and their insurance company paying $8k for a CT scan.

You know, the way the rest of the world does it and keeps costs down.

[MunoRN, RN]

And I completely agree it would make far more sense to split up the costs in a far more equitable way, and that single payer universal healthcare is the only rational way to do that, and it has the added bonus of being more efficient which then reduces that total cost we're sharing.

But in the more nonsensical system we currently use, hospitals have to have a margin that is a positive number, and that means things like $6k CT scans.

[amoLucia]

Muno - You are explaining this very well. You usually are very informative when $$$ has to be explained.

[JKL33]

The fact that primary care has all but abdicated the care of 'sick visits' (even for established patients) in many areas certainly didn't help him, either. Sounds like the very first person who spent two minutes with him - a lowly triage nurse - clued him in that he wasn't likely headed to stat emergency surgery for not feeling well.

[Susie2310]

Very high levels of executive pay and health care monopolies are huge factors in unequal healthcare costs. Far from being barely profitable, some health care systems are highly profitable.

[broughden]

Very high levels of executive pay and health care monopolies are huge factors in unequal healthcare costs. Far from being barely profitable, some health care systems are highly profitable.

Exactly.