{"id":5684,"date":"2013-05-13T21:48:47","date_gmt":"2013-05-14T02:48:47","guid":{"rendered":"http:\/\/wholehealthchicago.com\/?p=5684"},"modified":"2022-03-21T14:59:11","modified_gmt":"2022-03-21T19:59:11","slug":"the-insanity-of-healthcare-pricing","status":"publish","type":"post","link":"https:\/\/wholehealthchicago.com\/blog\/2013\/05\/13\/the-insanity-of-healthcare-pricing","title":{"rendered":"The Insanity of Healthcare Pricing"},"content":{"rendered":"\n

It\u2019s hard to believe now, but about 50 years ago when you went shopping for a new car you simply had no idea how badly you were being stiffed by the dealer. Oh, sure, he might show you the invoice price from Detroit, but he\u2019d also routinely add hundreds of dollars for shipping, dealer prep (whatever that was), accessories, undercoating, and rustproofing.<\/p>\n\n\n\n

I clearly recall driving to a suburban dealership with my father and his being told that if he wanted the great price he\u2019d seen advertised, then the back seat in the four-door sedan would \u201cbe extra.\u201d And indeed, when we opened the rear door\u2026there was empty space. The seat had been removed and could be restored for an additional several hundred dollars.<\/p>\n\n\n\n

As a result of this industry-wide chicanery, buyers would drag themselves from dealer to dealer, trying to find what seemed like the best deal. Car dealers ranked at the very bottom of public opinion polls.<\/p>\n\n\n\n

Then, in 1958, Congress passed the Automobile Information Disclosure Act, which required car dealers to affix essential pricing information to the windows of every car sold in the US. Today, the sticker must include fuel economy, greenhouse gas emissions, and crash-test safety results. If that\u2019s not enough information for you, there\u2019s always Consumer Reports and numerous websites for price and quality comparisons. Although you\u2019ll still have to negotiate the value of your trade-in, at least you\u2019ll be buying a vehicle as an informed consumer.<\/p>\n\n\n\n

Haggling over healthcare costs <\/b><\/h2>\n\n\n\n

When it comes to big-ticket items in health care, you\u2019re back in the 1950s trying to get the best price for a Buick Roadmaster.\u00a0 Most prospective patients don\u2019t bother to check, but were you to do so you\u2019d find it\u2019s very difficult to get anyone to commit to a price. That, and you never know for sure what add-ons are going to appear on your bill. If you comparison shop, the price ranges will make you shake your head in disbelief.<\/p>\n\n\n\n

In fact, the old clich\u00e9 \u201cYou get what you pay for\u201d simply doesn\u2019t exist in healthcare. Data on quality, so readily available for big-ticket items like cars and washing machines, is virtually unavailable in health care. You\u2019ll be wheeled into an operating room, as World War II pilots used to say, on a wing and a prayer, not knowing for certain if your surgeon is the malpractice king of Illinois or has just been released from a rehab program and taking Valium to steady his hand.<\/p>\n\n\n\n

These were the conclusions (though less dramatically stated) reached in a recent article published in JAMA Internal Medicine<\/i> entitled simply Availability of Consumer Prices From US Hospitals for a Common Surgical Procedure<\/a>.<\/p>\n\n\n\n

In this study, researchers tried to find out how much a total hip replacement would cost an imaginary 62-year-old woman who had no insurance but did have the financial means to pay cash. They telephoned two groups of hospitals: 20 of America\u2019s top-ranked orthopedic hospitals (as rated by U.S. News and World Report<\/i>) and a selection of randomly chosen hospitals, two in each of the 50 states plus Washington, DC.<\/p>\n\n\n\n

How much will it cost? <\/b><\/h2>\n\n\n\n

Using a standardized interview script, a researcher (probably one Jaime Rosenthal, the medical student listed among the authors) would call the main number of the selected hospital and go through the same steps you yourself might encounter to get a price for a hip replacement. The authors were seeking what\u2019s called a \u201cbundled price,\u201d an all-inclusive dollar amount that covered both surgery and hospital costs. If a hospital couldn\u2019t supply a bundled price, separate calls were made to orthopedic surgery practices to obtain individual prices for surgery.<\/p>\n\n\n\n

This process must have been exhausting for the poor Jaime. At virtually every hospital or doctor\u2019s office phoned, there was confusion, suspicion, and unreturned voicemail messages. Each hospital would be contacted up to five times in an attempt to get pricing. If after five calls a price was not obtained, the hospital was tagged as being unable to provide one.<\/p>\n\n\n\n

The results?<\/p>\n\n\n\n