IMO the biggest problem is that you're not really qualified to judge medical practitioners. How am I supposed to know if what they're recommending is actually necessary? The market price of an MRI? How do I know they're not skipping care I should have to offer a lower price? Or if they're offering unnecessary procedures?

The reality is you need an M.D. to make a reasonable evaluation. This is why at an HMO we have primary care physicians. Or in any other country, GPs. They decide if you need specialized care. However, how am I supposed to pick one of them? It's Russian nesting doctors.

It's probably the most complicated thing we have to deal with in our non-professional lives.

Same way you evaluate developers. Say you are a manager at a company who needs to hire somebody to develop an application for you. You aren't technical. You have no idea if you need the thing the consultant is saying you need. So you check completed works, existing client testimonials, educational history, recommendations from coworkers or friends, etc.

Just wait until you get a reference request on your last colonoscopy :P

Seriously though in general managers have worked in and around technical people before, and their role in the process is to evaluate qualitatively. Are they a good communicator? Do they seem like awful people? They use feedback from the engineers to estimate if they're good engineers. I don't have a deep bench of M.D.s to lean on to figure this stuff out.

Actually that raises an additional interesting point... if the market price is varying from doctor to doctor it could be for many factors - how am I supposed to judge the relative quality of an MRI that would be read by two different specialists. If the quality is different then how can I be informed as to the efficacy and truth of that difference?

With a bank, Bank of America has terrible service - so I just don't use them, with a doctor though... what if I'm paying a premium price but receiving substandard care, given how complex human bodies are most illnesses compound over time and only in very select circumstances could you get a doctor to come in post defacto look at an X-Ray and say "This doctor was terrible, that's totally a tumor" maybe the real issue is that a tingling in your finger tips when you sit down that you asked your doctor about went unnoticed and twelve years later your heart gave out over totally preventable causes.

> Or in any other country, GPs. They decide if you need specialized care. However, how am I supposed to pick one of them? It's Russian nesting doctors.

Same way you would pick anything else? I shopped around for my GP and changed several.

Some factors were: years of experience, user feedback, spoken languages, any red flags for the whole practice, how they respond to my concerns and questions in conversation, etc.

The majority in terms of cost or volume? Also is this figure including oncology treatments - those drugs can run 1k/pill and while some are potentially cures many more are just pushing eventual death a bit further off. These drugs would quite possibly skew any statistic that isn't designed precisely to account for them.

Also I think it's not really fair to take full lifetime costs into consideration at once. As you get older you'll be looking at those much more expensive treatments and covered by expensive insurance but the insurance tends to be of a higher quality when it comes to reducing sudden costs - I am more concerned about younger people who generally have terrible insurance and may get hit with 4 months of 20k physio due to a sudden injury but generally have low "normal" costs.