The hospital charge as much as they can, because some patients are unable to pay. This way they make up the difference (or make more).
The idea is that you go to the billing staff and threaten that you will go bankrupt and will not pay anything. Then negotiations begin. Rich pay cuz they don't care, suckers get conned, and poor gets their credit destroyed. Classic USA.
It is another 'american' system akin to tipping only taken to extreme.
to profit, and profit they do. They deliver record returns on investment year over year.
But otherwise you use bankruptcy as a bargain card. Because nither side wants to go there.
She left the hospital with a smile, impressed how easy and friendly people were. Nothing serious so nothing to pay. She was very worried and they even managed to make her smile.
This was in Verona, Italy some years ago, in the ER of Borgo Roma. It was late night and just a short queue to wait. It has been a great human experience and we will be always grateful to the doctors there.
This was my first time i learnt of US health system.
Imagine waking up in the middle of night, realize you might have heart-attack and the next thing you think of is if you can afford an ambulance.
Referring back to the (G)GP - when trying to put geo-political context around such comments, it's useful to mention the geo-political context of your comment.
Really? How so?
This paper [1] covers "the NHS, child and family costs of falls, poisonings and scalds".
> In total, 344 parents completed resource use questionnaires, with > 95% of children recovering within 2 weeks of injury and almost 99% recovering within 1 month. Mean NHS costs ranged from £2588 to £2989 across injury mechanisms for children admitted for ≥ 2 days, from £719 to £1011 for those admitted for 0–1 days and from £97 to £178 for those attending an ED but not admitted.
All this boy's treatments were on the same day, and he only fell off his bike -- these British figures include accidents like scalding -- so in the UK, he would have been at the lower end, i.e. under £1000.
It does make sense if you have a law that limits the profit rate for a particular enterprise so it has no other way of increasing the profit than pushing up the price to a level where 20% of that price is the desired outcome.
Netherlands has a really nice system that would probably work for the US as well if there were any political interest to fix the healthcare system. Right now both parties are heavily in the pockets of insurance companies so the only things you can see is failed half-assed, broken solutions like Obamacare that cost billions even to operate a website.
https://www.aeaweb.org/research/regulating-health-insurers-a...
https://www.bloomberg.com/news/articles/2014-09-24/obamacare...
So, what I am saying is that I fail to see what attempts at limiting the price has to do with the price being too high in the first place.
Means their profits are capped at 20%. Only way to grow profits is to inflate costs by colluding with private health providers.
Right now the focus is on the people and freight rail transport system but it's happening.
I know it's more complicated than that but everything has its cost. $19k is the cost for the US stitches and anesthesia.
Edit: I'm not a fan of this system but it works. Isn't the US the #1 medical care quality country?
You cannot. We're talking about anesthesia and stitches for a child. Even if it were legal to do these procedures without a medical licence, which it absolutely isn't, it would still be a terrible idea, even if you could get your hands on the right supplies.
> try to find a cheaper hospital
We're talking about emergency medical treatment for a child. You think there's time to search around for the best price?
> Isn't the US the #1 medical care quality country?
Absolutely not. The WHO ranks the USA as 37th out of 191 countries: (PDF) https://www.who.int/healthinfo/paper30.pdf
Even in the hospital, this work was probably done by a nurse with a 2 year degree. You can go to any clinic and have it done. If the kid were at summer camp, they would have probably had the staff nurse do it.
Emergency rooms are both overkill for this, and happily overcharge as well.
We are all talking as if the hospitals performed a dangerous complex procedure and saved the kids life. If so, then isn’t 19,000 a small price to pay? If not (and it’s a simple task as I believe) then why did they charge so much?
Neither are found in a normal first aid kit.
> I would bet that you can legally use it at home
No, suturing is a surgical procedure.
> this work was probably done by a nurse with a 2 year degree
I'm not a medic, but from what I can gather online, suturing is considered an advanced specialised skill for nurses.
> If the kid were at summer camp, they would have probably had the staff nurse do it.
I doubt it, even with a qualified nurse on site. No summer camp wants a reputation for being reluctant to take injured children to the emergency room, neither do they want liability.
> Emergency rooms are both overkill for this
Does any first-world country agree with you on this? As far as I'm aware suturing is always treated this way, it's not just for-profit medicine and artificial gatekeeping.
> We are all talking as if the hospitals performed a dangerous complex procedure and saved the kids life
It's routine emergency medicine. Nothing more, nothing less.
> If so, then isn’t 19,000 a small price to pay?
No, it's absurdly inflated.
> If not (and it’s a simple task as I believe) then why did they charge so much?
Because they could. There's a deep power imbalance at play. You can't go price-shopping when your child needs emergency treatment. You might know going in that medical expenses are the top cause of personal bankruptcies in the USA, but you can't haggle. You won't even know what you owe until after the fact.
Brits like myself are generally horrified at the way American medicine is run. This kind of thing simply doesn't happen in the UK. (That's not to say our healthcare system is perfect, of course.)
I could look up research articles on best practices but I often find that those things just pay lip service to what we are “supposed” to do and not what actually happens.
Also I take exception to this notion that unless your country has economic power in the top 20 of the world, then whatever practices you have has no value.
Extreme specialization is a byproduct of rich economies but that shouldn’t be confused with it being a good practice in all cases.
Exactly, this child got the emergency treatment. His dad wasn't asked to pay 19k upfront.
I write all this because I was born in a country where all medical treatment is free for everyone.
Guess what? It's super low quality. Doctors got paid less than in McDonald's. If you have a serious problems you literally have to search for a right doctor. It might be someone not even in your large town. And, you pay upfront! So, I'd rather live broke than die because no one even treats me.
Public healthcare isn't entirely free where I live, but the fraction of the cost paid directly by the patient is small enough that it qualifies as mostly free to most people. Complaining about public healthcare almost seems like it's a national sport, and it's true that you can get shorter queues and faster response in non-emergency cases if you go private, but the quality of public healthcare as a whole still doesn't suck, and especially emergency care and treatment for serious conditions is still pretty good.
Doctors get paid less than e.g. in the U.S., but they're still among the most well-paid professions.
What I think leads to disaster is if funding to public healthcare is poor and the quality is low, which leads to people not appreciating the service and thus towards further devaluation of the public system, which becomes a vicious cycle.
It may also make sense to not have healthcare entirely free so that people don't start going to see a doctor too easily for reasons not requiring a doctor, but I think a system where it's potentially way too expensive does at least as much damage.
I don't claim to know what happened in your country of birth, but there could be factors other than just free healthcare.
No it's not. $19k is what that hospital arbitrarily chose to charge for stitches and anaesthesia. What it actually cost the hospital was significantly less. Several orders of magnitude less I'd wager.
The fact that the insurer was able to negotiate a payment of ~36% (less than half the original price) and the hospital still had enough margin to be profitable should be telling.
> I'm not a fan of this system but it works. Isn't the US the #1 medical care quality country?
No. Not even remotely. It's 36th in the world as ranked by WHO. It is, however, ranked #1 in the world for the most expensive healthcare system. And by some margin too. I don't consider that a placement to be proud about either.
$19k represents a ridiculously inflated markup that's not even in the ballpark of what the costs are, even in USA. Things like liability insurance etc add some extra costs, but not nearly enough so that tenfold increase would make any sense.
"First, greater attention should be placed on reducing health care costs. The U.S. could look to approaches taken by other industrialized nations to contain costs, including budgeting practices and using value-based pricing of new medical technologies. Approaches that aim to lower health care prices are likely to have the greatest impact, since previous research has indicated that higher prices are the primary reason why the U.S. spends more on health care than any other country..."
https://www.commonwealthfund.org/publications/issue-briefs/2...
My wife on NHS (UK) gave birth on a sofa with pretty much no equipment - and they conveniently missed the time when epidural could be administered. Waiting times are bonkers. And NHS was touted as a best system in the world in 2018.
It's just political propaganda if you ask me.
The NHS is a great institution but the UK government seem hell bent on destroying it while passifying their voters with misleading soundbites about their investment in it.
https://www.commonwealthfund.org/
https://www.theguardian.com/society/2017/jul/14/nhs-holds-on...
Seems slightly surprising to me - I would have assumed it would be France or one of the other EU countries.
Edit: I'm a supporter of the NHS but it has been chronically underfunded and had too many management consultants trying to "improve" it over the years.
I just wanted to add that when my wife gave birth in the UK on the NHS last year she had an amazing experience and the level of support before during and after was incredible.
In general all my experiences with the nhs have been positive. In comparison the only other country I have experience with is Hong Kong where I had a dr laugh in my face when I enquired about a genetic condition I may have inherited.
The nhs is far from perfect and could use improvement. I think it’s just that most other countries are even worse.
It depends which indicator you choose ... if you choose life expectancy, the #1 rank turns to #36 :
https://en.wikipedia.org/wiki/List_of_countries_by_life_expe...
Of course, it depends from the indicators you use... Who tried, came up with this:
https://www.who.int/healthinfo/paper30.pdf (World Health Organization - Measuring Overall Health System Performance for 191 Countries)
At page 18 you will find the results. Spoiler: The US are not n.1... not even top 10.
The fact that life expectancy in the US is lower (and decreasing too) than any other developed nation is pretty much all you should need to know.
Also. Is it better to have the best medical care (if it's true) for some or a great system for everyone?
The medical care quality isn't relevant to the point, but it is dependent on how you want to measure it. If getting basic care to your citizens at an affordable cost is any important metric , then the US fails miserably.
I never goto the ER even if I need to anymore. I'm too busy paying off my $30k bill for a single EKG.
Totally agree. And even if the billing department could tell you the price, which they can’t, is the dad supposed to call around for quotes while the kid bleeds?
It is designed this way like a cartel, inflate prices, nothing free market about it.
To paraphrase Marc Andreessen, with free markets and competition, you now can buy an amazing giant 65" 4K LCD TV with all of the latest greatest features for barely $500. Stuff gets better, cheaper, and more convenient for the consumer, while the companies duke it out to get ahead.
But when things get overly regulated, subsidized, or effective cartels are formed, you end up with situations like monotonically rising US healthcare costs, monotonically rising US housing costs and monotonically rising US college costs.
This isn't an issue of too much free market competition.
Honestly, we're not talking about having a wart removed here. It's basic medical treatment for a child. That should be beyond reproach in any civilised country.
https://en.wikipedia.org/wiki/Aneurin_Bevan
NB Of course, it is perfectly possible to disagree with this view, it just happens to be something I personally strongly agree with.
its certainly not free market capitalism. part of the problem is that the government makes it illegal to turn away ER patients. maybe you think thats moral or maybe you dont, but the point is that an ostensibly free market becomes corrupted with outside influences like this. you cant create a system designed for the free market to be the mistake fixer and then make the market not free and not expect bad mistakes.
i think this is the greatest failure mode for america: pretending non-free markets are free. in some cases, its the worst of both worlds by a very large margin.
It's kind of like wanting to talk about electric field around a charge while pretending the magnetic field isn't a thing. Much like physicists noticed that electric and magnetic fields form a common entity together, perhaps it's time more people recognized that market and governance are just as much intrinsically intertwined. Either one needs the other to exist in any but most degenerate form. And both actively try to influence each other.
This is not capitalism but government meddling and third party payer inflating prices.
Sure, the USA is one of the best medical care systems in the world (and it's definitely better quality than any public service you will find in Europe) but it doesn't cover cheaper services.
Under an unregulated market, with pure capitalism, you would see cheaper, smaller hospitals pay-as-you-go or via cheap insurances.
This really reads as "Is this some peasant joke I'm too rich to understand".
Everything about the American healthcare system feels like a nightmare to me. From the cost, to the fact that it’s usually tied to your employer (!!) and that even if you have good insurance, you have to make sure to get care from “in network” healthcare professionals.
It seems to require a tremendous amount of energy for very little benefit for average citizens.
"As a Canadian doctor" is authority. You often find this with appeals from "As a mother" -- it's just a fallacy.
Including the cultural context you're viewing things from can be useful so that people can understand where you're coming from.
I think in almost any western country (and many non-western) 'free' (or close to) healthcare is a basic right of citizenship, so it's extremely difficult to try to comprehend how 20-40% of the average person's salary could be consumed by treating a child's minor accident.