Wednesday, February 17, 2010

Undecipherable Healthcare System in USA

A doctor in India recommends someone to undergo bypass surgery. What does that patient do? Collect the details of the hospitals around that area that does bypass surgery and compare the experience of the doctors who perform the bypass surgery and the amount each hospital charges for this procedure. There may be some hospital that may charge a huge amount that may not be affordable for the patient but there may be another hospital in the same city that my charge less for the same. Based on the financial status of the patient he/she will select one hospital to perform the surgery. Once the patient is done with the surgery, he pays the amount that was agreed upon at the start and leaves the hospital. That is the end of the story. Something very similar to selecting a hotel for food. If you have less money and time, you go and eat in a fast food restaurant while if you have lots of both you dine in a five star hotel. In both cases you eat and pay for it then and there itself. No one is going to send a bill to you few days later for the food you ate.

Things won’t work that way in US. Based on your insurance you have to select the doctor. Otherwise you may end up paying more. During the visit you pay just the co-pay. Once your visit to the doctor is over and within few days you start getting so many letters like this one below. The benefits summary below is the one I got after I took my daughter for her normal three month’s shot.

Have a look at this benefits summary. The doctor’s office after your visit charges a huge amount to the insurance company so that they can get maximum amount from the insurance company. The insurance company pays an amount to the doctor/clinic based on the experience and market rate. In order to get the maximum possible amount the doctor/clinic overcharges the insurance company. Now some doctors/clinic charges the remaining amount to the patient by sending him/her the bill. The patient has no idea that a bill of such an amount will come to his house a few weeks after the procedure. There is no way in US to know how much a patient may end up paying for a particular procedure beforehand like in India.

Now the doctors/clinic make money by billing mammoth amount and insurance companies makes loads of profit by raising the insurance premium every year. But who is the loser in all this transaction – the common man who pays the insurance premium and goes to the hospital as a patient. Hopefully the health care reform bill will pass one day and things change. Hoping for the best…

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9 Comments:

Anonymous Anonymous said...

ur blogging just for the sake of blogging....do it with full heart....dont just cook up something...

Ajith

February 17, 2010 11:06 AM  
Blogger Jennifer said...

Brijesh, We also recently got a bill that we fail to understand. These bills make the highly educated perplexed!!

One thing that makes health care more costly for me, you, and health insurance is Medicaid/state health programs. I used to work with people who had these programs for health care payments. The problem is that these programs pay the LEAST amount possible, so that increases payments for you and me so that the clinic can balance out payments. It is also for this reason that health care is not as easy accessible for those on public health programs. Especially, in NY state, many dentists prefer not to take public health because of this. There is a small movement going on where some clinics refuse to take any health insurance. Health insurance increases costs even for clinics - they have to hire extra people just to fill out a multitude of forms! (Again these costs passed on to patients.)

February 17, 2010 12:21 PM  
Anonymous Mumbai Paused said...

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande


THE COST CONUNDRUM
What a Texas town can teach us about health care.
by Atul Gawande

From New Yorker.

Interesting article. It will give you an in depth view.

February 17, 2010 2:21 PM  
Anonymous Anonymous said...

Did you know that if you receive the full amount of unemployment - $240 per week in Arizona - you will "earn" too much money to qualify for government assisted health care? Crazy. Even without a job you earn too much? Who is qualifying for this help?

February 17, 2010 5:02 PM  
Blogger Karthikeyan said...

I think this topic is a bit more complex than this post suggests. It sounds like all the blame belong to the greedy doctors who force insurance companies to jack up the price. I don't think so. I would put a much larger blame on the health insurance companies, the way this country's legislature has been captured by vested interests and the ignorance of over half of the American public.

As for the healthcare reform, I think it's more or less another give away to the health insurance companies. Consider this -

1) mandate that everyone has to buy private health insurance (I think the estimate is 30 million new customers) without any kinda new regulation on pricing.

2) No public option for people who just don't want to get any private insurance.

3) Drug re-importation from Canada out of the window.

4) No negotiation rights for Medicare to reduce the cost of drugs.

Without any meaningful reform the current version of the healthcare bill just hands over 30 million new customers. (Yes, I know abt the pre-existing clause. But there is no word on how much it would cost for people who have those conditions.)

February 17, 2010 5:37 PM  
Anonymous Anonymous said...

It is not that complicated if your employer has a good health insurance program. Few years back, I had by-pass surgery. My cardiologist referred me to the hospital he visits and the surgery, post op care were excellent. I did get a summary from my insurance company where the costs were laid out by line item and what my contribution would be. I was able to make $25 a month to clear off my contribution. The insurance company called me now and then to enquire about my health and also if they could provide any assistance.

I am sure there are other plans that are not that great, but it is not accurate to generalize.

February 17, 2010 8:47 PM  
Blogger Brijesh Nair said...

Jennifier/ Mumbai Paused/Karthik,
Thanks for your comments. Your comments gives my blog post a completeness,

February 18, 2010 6:05 AM  
Anonymous Anonymous said...

Kaychandovan (Karthikeyen) is right in that things are too complicated to be summarized in a 10-line post. I do not have a full understanding of how health care actually works in this country but my bill for 6 hrs at the ER was over $2500 and it doesn't need a genius to see that something is terribly wrong with the system. Too many people in the loop are making way too much of easy money. Luckily, like Anon@1:47, I'm blessed with a good insurance plan and may 'only' have to pay about $75-150 but its easy to see why the less fortunate have had to file for bankruptcies just because they fell sick..

-Anand

February 18, 2010 6:28 AM  
Blogger Jennifer said...

For the last commenter- spending $2500 in ER- I am curious how long you had to wait to be cared for! It's not just the cost in money, but time. What happened in the waiting room and in the 6 hours in the ER. A few years ago I had to go to ER for back pain. I waited more than 4-5 hours (sometimes the pain we go in with reduces out of frustration of waiting....) then in the ER itself I was there for about another 6 hrs seeing the doctor maybe 15 minutes in total!!! I am sure the price was high for that visit.. IT's CRAZY.

March 05, 2010 1:04 PM  

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