Healthcare Prices

There are tremendous variations in the delivery of healthcare in the USA. See the interactive graphic in Slowing the Growth of Health Care Costs in America. The screen capture of this Robert Wood Johnson Foundation study shows medical reimbursements per Medicare enrollee in 2006. There is also a growth rate graphic that shows many of the lowest reimbursement areas having the highest growth rates.

Moving towards integrated health clinics, like the Mayo Clinic, requires aligning Medicare incentives to this model - not the payment for service currently used. Legislation towards value-index payments is held up in Congress. (link)

Health insurers profits rose in the third quarter (2010) reflecting "reduction in utilization" (aka patients can't afford to go to doctor) and "appropriate pricing" (aka premium increases) (link). The quoted terms are from the Aetna CEO Ronald Williams. If you are a stockholder - good news.

Accountable care organizations monopolizing local health care? Will this be an unintended consequence of health reform? Here is a white paper from America's Health Insurance Plans (link).

Will patients pay?

The next wave of change for US health care payments from McKinsey Quarterly (May 2010) suggests that patients will pay "balance-after-insurance" up to about $1000. But one has to ask - what value-added does "balance-after-insurance" offer the patient or the provider? I doubt there are medical professionals processing the claims anyway - so why not use information technology and inform upon demand (before services rendered) what insurance will pay? I've worked with health systems that use "balance-in-advance" in which insurers determine in advance what they will pay so that the patient portion is collected before services rendered. These aren't first world countries so if they can do it then why can't the US?

The Self-Pay Conundrum: How to Balance Margin and Mission

Obtaining reimbursement for outpatient services from managed and un-managed insurance

Navigating Health Insurance Claims

Guide to Health Insurance Claims

Navigating Hospital Pricing

Chargemaster? List Price? See Why Medical Bills Are Killing Us I couldn't even get a guesstimate from a hospital - ended up with a $50,000 operating room bill. I had to write to the CEO to get someone to respond. That was before Twiiter :-)