In our last post, we asked if healthcare can be transparent. We wondered if you would take your car in to get major repairs without first asking for an estimate? It’s likely this wouldn’t be something you would do with your car, but in terms of your health, it’s something that happens every day. We don’t often ask for price estimates for our labs, x-rays, medications or elective surgeries.
Not only should you know the price and the overall benefits and risks of a procedure, so should your doctor. I was a practicing physician for nearly 20 years and have learned about the lack of healthcare transparency in health systems throughout my career.
If you ask your doctor the price of services we order, we generally have no way of knowing. Or when your doctor prescribes a medication, we will often not know the price of the drug.
Another instance where price is unclear to physicians, is that we don’t know the cost we spend to accomplish a specific surgery or procedure and how this compares to our colleagues. When we study this carefully using the Wisconsin Health Information Organization (WHIO) database, there appears to be 30-35% variation in the resources and supplies a doctor uses for both high and low cost procedures, like an angioplasty, joint replacement or delivery of a baby.
Do we care about these differences, and if we do, why?
Let’s say we are delivering a baby and our main goal is to have a healthy mom and baby. One doctor delivers a healthy baby using medicines and monitoring equipment at a low cost, while another doctor uses 30% more medicines and equipment.
Now if this is your grandchild or your baby, if both doctors achieve their goal of a healthy mom and healthy baby, what benefit did you get when one doctor gives you 30% more medication or monitoring? What’s more, every medication we give has a risk of an unanticipated reaction, some more serious than others. Either of these situations can clearly be dangerous. Some people mistakenly think that more care was better care. If more care means 30% more drugs, radiology, more hospital days with potential healthcare associated infections, then more care can be more harm.
We all need to insist on excellent outcomes and to not compromise on high quality. But we also want our doctors to perform a service or procedure with the best results by exposing our bodies to only what is necessary, which is also generally lowest cost.
As we are spending more on healthcare in America than any other country, the burden of this cost is being put more and more on the patient. As we’ve previously discussed in our other posts, if cost keeps you or people you love from being able to access care, cost is a feature of healthcare quality. Furthermore, to be able to understand and plan for these costs, healthcare costs to both the member and doctor must be transparent.
People are accustomed to being frustrated with their insurance company. I want to remind everyone, insurance companies do not make the bills, we pay the bills after trying to assure that your care is safe and consistent. And often times, the upfront price of care isn’t transparent to us either.
Overall, we want you to know the cost of care. As a first step, it is important to ask the price of your procedure or services to at least be informed and set your expectations. You are ultimately paying the bill and that’s how buying something is supposed to work. However, we also want health systems to inform your doctor of their cost of care and to be sure that they are using only what is necessary when providing this care.