healthcare price transparency

When you’re shopping for something, sometimes price is the only consideration. Yet think about the times when price matters, but you’ve already determined the only brand or brands you’re interested in buying. Let’s say you’re buying a car. You’ve done plenty of research, using the criteria that are important to you. Fuel economy, vehicle safety statistics, passenger/cargo capacity, style, color – your vehicle-value-determining checklist. Only after you’ve built that list will you start to hone in on price, shopping around to find the dealers that have what you want in your price range. Value is only fully visible when you know what  you’re getting for the price. Even in something as simple as grocery shopping, price isn’t always the #1 driver of purchase decisions. Sure, for some things generic Brand X at rock-bottom price is the way to go … on things like shop towels. However, ask any Coupon Queen what her quest is all about, and she’ll tell you that it’s about brands, then it’s about price. She’s not clipping coupons for generics, unless it’s a store brand that meets her quality metrics. Price is important. Value is critical. In the “how much is that?” campaign in healthcare, we’re as concerned about quality as we are about price. In healthcare there are quality metrics that far outstrip those for consumer products, but many of those healthcare quality metrics have been hard for consumers – patients – to find and use in assessing healthcare value. That’s changing with the rising availability of quality metrics like the Hospital Safety Scores from The Leapfrog Group released at the end of November. The US Department of Health & Human Services’s Agency for Healthcare Research and Quality – that’s a mouthful (and a massive amount of information on one site), let’s stick with HHS’s…

I’ve asked this question frequently over the years, starting in the ’80s, continuing to today … and I’ll keep it up until someone realizes that it’s a failed paradigm. What we have here, kidz, is what happens when a society decides that socialism is anathema, but doesn’t empower and educate its citizens about how to take responsibility for themselves in ways that will keep them healthy, productive community members. Business started picking up the tab for healthcare during World War II, when stiff wage controls made it impossible for defense plants to give their employees raises. In place of more money, they started to pay for health insurance – which state and federal government were more than happy to turn into mandated employee benefits over the next 20 years. What happened then was predictable: three generations have been out of touch with the true cost of healthcare, and the true cost of their choices about their health. If you’re a good little American consumer, you do whatever your television tells you to do: eat this. Buy that. Otherwise the terrorists win! Three generations of disconnection from the real costs of our medical care have delivered us an epidemic of obesity – thanks to plentiful empty calories, courtesy of agri-business, and our willingness to beach ourselves on our sofas, in our SUVs, or at our computers, the better to receive more messages about what we should buy and eat. Health insurance costs have skyrocketed as we’ve become a nation of couch potatoes. Companies are scaling back their employee health benefits as those costs continue to rise, putting more and more people in the un-insured or under-insured bucket. Is that rise in healthcare costs, which in turn drives higher premiums, combining with the federal mandate that all companies offer employees health insurance…

A hip or knee replacement can offer people with chronic joint pain the chance to return to an active life. The potential promise of being pain-free, in some cases after decades of restricted movement, is a powerful incentive to arthritis sufferers around the world. I know from direct observation that not all joint replacements result in the patient returning to the dance floor, or the jogging track, or even the walking path. My dad had a hip replacement in 1996 that inserted the wrong appliance, leading to 18 dislocations in the ensuing three years. The issue was finally resolved with yet another surgery, paid for by Medicare and my father’s supplemental insurance. This was a doctor error, not an appliance failure. Imagine my surprise this past Saturday (April 3, 2010) at this piece in the New York Times, revealing that almost all manufacturers of artificial joints offer no warranty whatsoever to US consumers who wind up with defective products surgically strapped on to their skeletal structure. The dodge is facilitated by the way device manufacturers sell the implants: to the hospital, not to the patient. The skids on that dodge are further greased by the consulting fees paid to many surgeons by implant makers, giving those surgeons little impetus to bite the hand that feeds them. Here’s a chart for the visual learners: US device manufacturers who sell artificial joints overseas offer warranties in the countries outside the US where their implants are used. Why not here? One reason could be our tort-crazy system. Got a consumer complaint? Don’t try to work it out directly – hire a lawyer and sue the bastards. That does not, however, excuse the failure of medical device makers to offer any kind of warranty on their products. And it’s not excuse for their expectation…

I attended the 2nd edition of the bill conference in Richmond VA today (for the record, that’s Saturday, April 6, 2013), and wound up kicking off the talks with what’s become my core topic: #howmuchisthat, healthcare edition. That link goes to the hashtag’s home on Symplur, the healthcare hashtag registry that’s also a veritable time-sink of terrific healthcare thought leadership. Including healthcare data visualization. You’re welcome. Why is this a topic I care so much, and know so much, about? I believe that in all the hot air that’s been expended in the discussion about healthcare and healthcare reform in the US – and boy, howdy, is that some hot air! – very little shrift is given to how consumers (commonly called “patients”) can effect grassroots change themselves. The firehose below takes a wander through the history of US healthcare, particularly from the cost angle, and resources that the average human can use to start figuring out, ahead of time, how to assess the value (medical and fiscal) of their healthcare options. Here’s the firehose. Steve Brill’s epic TIME piece, Bitter Pill  pack a lunch, it’s the longest article TIME has ever published My take on where Brill missed the mark on his “fix this mess” recommendations A Feb. 12 post that raises Brill’s issue in what I think of as a great-minds-thinking-alike synergy My health econ guru Uwe Reinhardt’s Chaos Behind a Veil of Secrecy article in January 2006 edition of Health Affairs A post that includes intel on the RUC and the LA Times piece – both of which I mentioned in my verbal firehose A NY Times story on the unintentionally hilarious 2013 report in JAMA (Journal of the American Medical Assn.) on the wide disparity in pricing for hip replacements in the US – the RUC is an AMA committee! Society…