We Need to Design Health Care Reform That Puts Patients Before Profits

Re:We Need to Design Health Care Reform That Puts Patients B... by jcranberry on Friday October 18, 2019 @02:56PM (#21294102)

Are you sure that we should be going after hospitals rather than the insurance companies? I've been told by a doctor friend of mine that the price of treatment in hospitals are often affected by how much insurers are willing to pay. They bill an insurance company X, the insurance company only a fraction of that and the hospitals just have to deal with it. So suppose they get more leverage and they increase how much they charge--is that an increase in how much insurance companies pay or how much patients pay? Or both? And how does this compare to the actual costs of treatments before and after such an acquisition?

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Re:We Need to Design Health Care Reform That Puts Patients B... by Zelphyr on Friday October 18, 2019 @03:07PM (#21294194)

Except, as I understand it, it's more like this:

Hospital bills Insurance Company $XXX,XXX.XX and Insurance Company says, "No, we'll only pay $XX,XXX.XX" so Hospital pays it. What's not mentioned is that it only cost Hospital $XXX.XX for the procedure so while they're complaining that the insurance companies only pay them a fraction of what they billed for the procedure, they're still making a massive margin.

That's not to suggest they don't have real, valid expenses. That's not even to suggest their expenses aren't high but, how would we know? They won't even tell us, the patients, how much any given procedure costs. It all seems like a wink-wink-nudge-nudge between them and the insurance companies to me while the rest of us get screwed.

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Re:We Need to Design Health Care Reform That Puts Patients B... by jcranberry on Friday October 18, 2019 @04:12PM (#21294708)

That would imply hospitals are a very profitable business. However, only 18% of hospitals are for profit in the first place, and nearly a hundred hospitals (mostly rural) have closed in the last year. The operating margin of NFP hospitals in 2017 was 1.7%. The average operating margin of the S&P 500 was 10.7%. And id bet insurance companies are looking better than hospitals as well.

Plus hospitals cant just charge for procedures at cost. There are revenue sinks hospitals have no choice to deal with. If someone without insurance and no source of income gets hurt and has to go the ICU, it can cost upwards of 10k a day. Who pays the bill? The hospital. And they cant discharge such a patient until they're healthy.

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Re:We Need to Design Health Care Reform That Puts Patients B... by aaavl2821 on Friday October 18, 2019 @04:31PM (#21294834)

The dynamics between hospitals and payers depend on market and negotiating leverage. A small hospital in a competitive market will struggle, while a large hospital system in an unsaturated market will do very well.

Are hospital failures due to payers, or due to competition from other hospitals? If a payer is getting squeezed by a big hospital system, it may in turn squeeze a smaller hospital or provider.

One of the biggest for profit hospital chains, HCA, generates 20-25% EBITDA margins. Many non profits are very powerful and make lots of money, they just spend more on salaries so their net income is lower. But yes many hospitals do struggle.

Insurance companies must spend 80% of their premium revenue on healthcare services. So their profits are in effect capped.

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