Thinking About Your Health: Are patients tired of spending too much for health care?

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The conversation around health care and what we pay for it is beginning to change. The realization that we pay way more than other countries for the same services is beginning to sink in. Why do Americans on average pay $8,143 for hospital and physician services for cataract surgery while the Swiss pay $2,566 and the French only $1,938? By all accounts, outcomes are similar.

Thinking About Health

This biweekly column about health issues publishes on Mondays in the Steamboat Today. Read more columns here.

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Courtesy photo

Trudy Lieberman

For too long Americans have accepted these high price tags for medical care without asking questions. Politicians have justified them saying American quality is better. But studies by many organizations have shown that justification doesn’t necessarily hold up, and in the last year or so I’ve detected a pushback from the public.

Last spring came the expose of hospital and pharmaceutical prices in Time magazine by journalist entrepreneur Steven Brill. One piece I wrote about Brill’s 36-page story got more than 13,000 hits on one website that reprinted my post. Brill told me that was indicative of interest from the public he received. People want to know why medical care cost so much.

At the end of last year a 20-year-old Californian named Nick Gonzales had his appendix removed at Sutter General Hospital in Sacramento. The bill for a 24-hour stay was $55,029.31. His family’s insurance policy covered a good chunk of it, but he still was left with $11,119 to pay out of pocket.

At the end of last year he posted his bill on the link-sharing community Reddit, saying “I never truly understood how much health care in the U.S. costs until I got appendicitis in October. I’m a 20-year-old guy. Thought other people should see this to get a real idea of how much an unpreventable illness costs in the U.S.” His $55,000 bill went viral much to the chagrin of the hospital.

Two weeks ago Dr. Rita Redberg, a prominent cardiologist at the University of California, San Francisco Medical Center, and a colleague penned an op-ed in the New York Times with the catchy title “We are Giving Ourselves Cancer.” Her piece was about the overuse of CT scans in the U.S. “CTs, once rare, are now routine,” she wrote. One in 10 Americans undergo a CT scan every year, and many of them get more than one.”

Not only are many unnecessary, and add to the country’s national health care tab, but they also deliver high doses of radiation Redberg writes. She reports that the use of medical imaging with high dose radiation, particularly CT scans, has soared in the last 20 years resulting in exposure to medical radiation that has increased “more than six-fold between the 1980s and 2006 according to the National Council on Radiation Protection & Measurements.”

CT scans are becoming common in emergency rooms where patients are getting scans at rates that are five times higher than in the mid 1990s, Kaiser Health News reported in 2011. While some use surely saves lives, Kaiser noted that doctors’ fears of malpractice suits, patients’ demands for the tests and the presence of more machines and the financial pressure on hospitals to use them boost their use.

Patient demand? Hummm! Redberg had a suggestion, which I agree with. Since patients are becoming more aware of the high costs they must pay out-of-pocket, they must ask if a recommended test, whether a CT scan or something else, is really needed. Clearly Nick Gonzales needed his appendix removed. But for many patients there’s time to weigh the benefits, safety, and costs of what physicians recommend.

Redberg suggested patients consult a website called http://www.abimfoundation.org/Initiatives/Choosing-Wisely.aspx Choosing Wisely, sponsored by the ABIM Foundation which furthers medical professionalism. Working with the medical specialty societies, Consumer Reports, the AARP, and other organizations the foundation has created the website to help patients make smarter decisions about medical tests especially those commonly overused.

When it comes to CT scans Redberg advises asking: Will the scan lead to better treatment and outcome? Can you get the recommended therapy without the scan? Is there an alternative that doesn’t involve radiation such as ultrasound or an MRI? Can radiation exposure be minimized if a scan is necessary?

Come to think of it, these questions can be adapted for other tests too. I’ll add another. Because of the Great Cost Shift from insurance companies to patients, you might want to ask how much of the bill you’ll have to pay yourself. And if you feel inclined to use social media, there’s always a way to alert others to the high cost of medical care.

Comments

Sam Relaford 9 months, 1 week ago

Reading this I had a reality check. Our president decided that all Americans must have health insurance. Most policies I have looked atare very expensive and most of the people I know cannot afford the added strain on their already stretched finances. So why didn't the government go to the hospitals and health care providers and put limits on what they can charge patients?? I recently broke my hand and finger. Not serious but it required a couple x-rays and a cast. $2000 dollars!! For about an hour at the ER! Really!? I understand that some of the modern equipment is very expensive, but to me that doesn't justify putting the screws to the people that rely on the medical proffesionals to stay healthy. In my mind I think that the hospital billing should be redused by at least 50%. Then perhaps people would be more able to pay their bills and not skip out on them. Which is why I am pretty sure why the hospital looses millions of dollars a year .People cannot afford these times of uncertainty an troubles.

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David Moore 9 months, 1 week ago

There are a lot of factors that contribute to the cost of healthcare. Most people just do not want to believe them or don't care so it's not worth wasting time on, people believe what they want to. After working in healthcare for two and a half decades, I understand why it is so expensive, and it comes from many angles. The cost of operating a hospital is astronomical, nobody is lining their pockets, at least in this area they are not. I am not defending anybody, I am just putting it out there that it is caused by more factors than most people realize. And just a comment on the post above, reduce the billing by 50% and you won't have a hospital, anywhere, they simply will not be able to cover the costs of operation.

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Sam Relaford 8 months, 4 weeks ago

Ok so a 50 % cut in all areas may be too much. But you have to admit that there are alot,ALOT, of things that are very over priced at our hospital. Like te cost of oral medications if you are an inpatient or the cost of a simple diagnosis at the ER. I undertand if a person comes in with severe injuries or illnes that it does ost alot to help them. My point way that I feel that more could be done on the billing end to help with the cost as well as the patien end. I dont understand why it is so difficult for people like me to obtain insurance coverage. I make too much money to qualify for any type of aide but not enough to afford theost o a $300 a month insurance premium. I recently aplid for insurance coverage and was told it could take up to 45 days before I even know what kind of insurance I would qualify for. :(

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