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https://www.eurekalert.org/pub_releases/2017-03/s-wtr030617.php
More than three in every five Americans see a doctor who receives some form of payment from industry. This is according to a new survey led by Genevieve Pham-Kanter of Drexel University's Dornsife School of Public Health in the US. It is the first nationally representative study to examine the prevalence of industry payments among the general population of patients.
[...] The survey was done in light of the Patient Protection and Affordable Care Act, which addresses concerns that industry payments could lead physicians to make decisions that are not in the best interest of their patients. Since 2013 the Act requires pharmaceutical and medical device manufacturers to report gifts and payments they make to healthcare providers. This information is publicly available on the Centers for Medicare and Medicaid Services' Open Payments website.
[...] The survey highlighted that 65 percent of respondents had visited a physician who accepted an industry payment. This was particularly the case for those visiting family medicine physicians (63 percent) and obstetricians and gynecologists (77 percent).
The Open Payments website can be found at: https://www.cms.gov/OpenPayments/index.html
References:
Pham-Kanter, G. , Mello, M., Lehmann, L., Campbell, E., Carpenter, D. (2017). Public Awareness of and Contact with Physicians Who Receive Industry Payments: A National Survey, Journal of General Internal Medicine, DOI: 10.1007/s11606-017-4012-3
(Score: 4, Interesting) by AthanasiusKircher on Wednesday March 08 2017, @03:28PM (6 children)
I'm not a "free-market" libertarian absolutist, nor am I a socialist. But I do believe that often some of the worst abuses in market systems happen with a markets that are only "partly free." The oversight or management tends to constrain some things, but actually often promotes other abuses. Classic example is stuff like Fannie Mae and Freddie Mac, which had enough freedom to really screw up the mortgage market, but just enough government oversight to make them subject to a guaranteed bailout when they screw up. Kind of like the parent who lets the teenager run crazy around town and get into all sorts of mischief, but always shows up to give a mild scolding and pay people off if the kid gets in serious trouble. Eventually, the kid learns he can do crazier and crazier things, with effectively no limits. Either a more active supervised parenting style OR a completely "hands-off" style that lets the kid go to jail for serious offenses would likely be better in preventing escalation of mischief. The "partly free" solution is the worst of both worlds.
Anyhow, we have a similar oversight problem in healthcare. It's sort of a "free market" in the sense that physicians and hospitals can kind of charge what they want. But standing in the middle between them and the consumer is a bunch of other people who distort those fees and frequently even hide them. That's been a big part of the "sticker shock" I think a lot of Americans have recently seen with the arrival of more high-deductible plans, where they actually have to pay out of pocket up to several thousand dollars per year until they hit a deductible (rather than the traditional $5 or $10 copay for a visit or whatever).
Same thing with stuff like drugs. If your doctor is used to a system where your drug payments are effectively rolled into your premiums, most people just say, "Oh, I need to pay X dollars/month for my premium," and that's it, even if several hundred dollars of that may be going to subsidize payments to drug companies. You just pay your $5 copay or whatever for your monthly supply and don't think more about it -- because the costs are all somewhat hidden, leading to greater abuses through coalitions between physicians, drug companies, pharmacies, etc. who dictate a bunch of money changing hands "behind the scenes."
But now with more people having to pay out of pocket for medications, more people are realizing, "Huh -- do I really need this drug costing me $100/month?" They may have effectively been paying for it before through premiums, but because all of that was subject to a bunch of manipulation and regulation among three or more parties (with some government oversight, at least in terms of FDA limiting possible drug options available), consumers aren't actually really participating in a "free market" to make rational choices in response to pricing.
Bottom line is it's all messed up, and the more layers of bureaucracy between the consumer and how prices are set, the more screwed up the market will be. So, either we move toward a system where health insurance is really just "insurance" in the sense of catastrophic coverage (sort of what high-deductible plans are doing), or we introduce a LOT more government oversight to control costs (e.g., single payer). But the former option can only work in stabilizing the market if costs are actually transparent to consumers, which medical costs often aren't. Before you get treatment from a doctor or hospital (outside of emergency situations), you should be able to get an estimate, just as a car mechanic or really any other reputable business could give you. Without that, we're just opening the system up for pervasive abuses, and drug companies and medical equipment suppliers are only one side of that.
(Score: 2) by fishybell on Wednesday March 08 2017, @05:48PM (1 child)
This to me is the biggest problem. They can't tell you how much a service will cost until they try to bill your insurance? Really? Of course costs are high when every time they try to squeeze as much money as possible and see what the insurance will accept.
If you can't shop around for a cheaper alternative, how is anyone's rate supposed to go down, ever?
(Score: 3, Interesting) by AthanasiusKircher on Wednesday March 08 2017, @09:27PM
They can't tell you how much a service will cost until they try to bill your insurance? Really? Of course costs are high when every time they try to squeeze as much money as possible and see what the insurance will accept.
Yes, I completely agree -- this is preposterous. Frankly, I think every doctor's office should be required to post a list of fees for standard services. "Sick visit - $X, Physical - $Y" and amounts for add-ons with in-office care. If they do blood tests or urine tests or whatever in-house, I should know what they will charge me before I take the test. If they add on a fee for ECG or some other machine, I should be able to tell what that's going to be. If I go to a hospital for an out-patient procedure, same thing. Yes, they could list a fee range for unpredictable things that can occur during a procedure, but unless you're undergoing majority surgery that could have a multitude of complications, it should be reasonable to give you an estimate.
As for insurance "discounts," this could also be easily standardized. Basically, what they're doing is offering a group discount anyway -- they could just make it easy and just have a standard percentage discount, like just about every other business on the planet. "Oh, you're in-network, well, you get a 15% discount on all services in our office." Done. Period. End of story. Easy to calculate. A doctor's office wants to exempt services from the discount? Fine -- again, put it on the public posting of fees: "Group insurance discounts don't apply to posted fees for ECG and blood tests other than standard lipid panels done for a physical" or whatever. Done.
For people who pay out of pocket or who haven't satisfied a deductible, this should all be clear. It's a little harder to solve the problem of whether a procedure is "covered" by insurance, but that again should be something very easy to find out. You get the estimate from your doctor's office, and it has some billing code numbers, you go to your insurance website, type in those code numbers, and it should pop up whether the procedure is covered or not.
The biggest thing with all of this is that it would likely make healthcare immediately cheaper, even BEFORE any benefits from a better market where consumers can shop around. Why? Because insurance negotiation of fees and billing crap is a HUGE overheard cost. Somebody at the insurance company has to negotiate all those details of fees with a doctor's office or medical group or hospital, and those frequently get renegotiated. Then your doctor's office needs to file claims, then the insurance company has to process them, then errors get made by someone, and things get refiled... perhaps the doctor's office has to negotiate whether something is covered, etc., etc.
It's just way too complicated. With a required estimate and verifiable coverage up-front, probably 80% of all those negotiations can be avoided, saving staff time at the office/hospital and for the insurer, and thus saving you a lot of money. You also avoid the nonsense of having to resolve billing errors after the fact, which is always a bad idea because nobody's interested in helping the customer at that point. For larger or more questionable procedures from a coverage standpoint, if you have the estimate in hand, you check it over yourself, and sign it to accept that you're willing to pay up to that amount. If you have a problem with the estimate, you resolve it up-front or simply go find another doctor. Everything is streamlined.
(Score: 3, Interesting) by bzipitidoo on Wednesday March 08 2017, @05:57PM (3 children)
Being able to charge what you want is not the kind of freedom meant by the "free" in free market.
I don't like that term "oversight", with its connotations of control, as in, price controls. The market is a game, with rules and ways to cheat. Some games rely on players, either others to catch cheating, or an honor system in which the players themselves check their own moves to assure they aren't cheating, even inadvertently. That works best when there are very low or no stakes. Soon as big money pours in, watch out, the cheating will explode if unchecked. Many games have neutral officials to watch for and deal with cheating. Markets need honest referees. I prefer the term "officiating" to "oversight".
The medical market, such as it is, is extremely corrupt. All kinds of crap goes on that would be busted in an instant if tried in another market. I really do not understand why we continue to let them get away with it. There is a woeful lack of transparency. Most markets have "list" prices. Medical's list prices are uniquely inflated, and changeable, and hidden. It's not just 2x the street price, it's 20x or 100x or even more, what with crap like charging $300 for a $2 bag of saline solution and $10 for one $0.10 aspirin pill. Not only are prices not posted prominently, often they are not revealed until after the fact. You think you're all settled up with the doctors, and then months later, more bills come.
Patients who inquire about the reasons for such pricing are treated to bullcrap that boils down to assertions that the line items do not really represent the care that was provided, as if it's so damn hard to label and quantify health care. The excuses can be truly weak, like the one about how the hospital has to charge more to make up for all the deadbeat patients who can't afford (or won't pay for) their care. So I should pay double at the gas pump too, to make up for all the people who drive off without paying? And besides which, most business have losses, losses from shoplifting and embezzlement and spoilage and so forth, what makes losses in the medical biz so uniquely deserving of gigantic levies to make up for it, particularly when the billing practices are such low hanging fruit ripe for huge improvements? We had the ruckus over Daraprim and EpiPens. We need more action. And that's just the start, before health insurance weighs in, needlessly adding to the complexity.
And all that is just a part of the "fee for service" system that encourages waste on unnecessary testing and care. Medical cost and care so obviously needs reform. Better officiating isn't enough, need a bunch of rule changes, make it into a whole new game. Obamacare stopped a lot of the bull in the health insurance biz, but it didn't do much about the doctors themselves, its biggest shortcoming.
(Score: 3, Interesting) by NotSanguine on Wednesday March 08 2017, @06:17PM (2 children)
The medical market, such as it is, is extremely corrupt. All kinds of crap goes on that would be busted in an instant if tried in another market. I really do not understand why we continue to let them get away with it. There is a woeful lack of transparency. Most markets have "list" prices. Medical's list prices are uniquely inflated, and changeable, and hidden. It's not just 2x the street price, it's 20x or 100x or even more, what with crap like charging $300 for a $2 bag of saline solution and $10 for one $0.10 aspirin pill. Not only are prices not posted prominently, often they are not revealed until after the fact. You think you're all settled up with the doctors, and then months later, more bills come.
This is quite true. a number of years ago, against my better judgement, I allowed myself to be admitted to the hospital for IV antibiotics while tests for MRSA [wikipedia.org] were performed. After three days, the tests came back negative for MRSA and I was discharged.
When I received the ubiquitous EOB [wikipedia.org] from my insurance company, it was for over US$7,000.
I reviewed the EOB and saw that the insurance company had been charged for two hospital rooms at the same time (quantum entanglement, perhaps?), as well as a Pap smear [wikipedia.org] (I am male and, as such, have no cervix).
I complained to the hospital billing folks who basically said "don't worry about it, you're not paying." I continued to piss and moan, as I thought it was outrageous that the insurance company should be charged like this. It smacked of fraud to me.
The hospital billing people finally set up a conference call with the insurance company's payments group and me. They talked in what amounted to code for a while and I insisted upon being told why the hospital was charging for stuff that was obviously fraudulent without any complaint from the insurance company.
They hemmed and hawed for a bit, then finally came out and admitted that the contract between the insurance company and the hospital specified a flat rate per diem for inpatient services (I don't remember specifically, but it was something like $1000/day) and that the EOB was complete bullshit.
I suspect they create these bullshit EOBs so they can cover their asses when they overcharge someone with no insurance.
So there you have it. Corruption, collusion and price gouging. Why is it that we shouldn't we have a single-payer system, again?
No, no, you're not thinking; you're just being logical. --Niels Bohr
(Score: 2) by Justin Case on Thursday March 09 2017, @03:21PM (1 child)
Corruption, collusion and price gouging. Why is it that we shouldn't we have a single-payer system, again?
Because it would be a single-target for corruption, collusion and price gouging.
Never mind that it is immoral to force other people to pay for what you consume.
Hey, why don't we have single-payer grocery stores? Just pick out all the steak and booze you want and someone else will pay.
Why don't we have single-payer auto dealerships? Then everyone could have a premium car.
We do have single-payer national defense, which in the USA costs half a trillion dollars a year, soon set to rise? And of course "single" payer is a lie. There is no magic money machine making the payments, it is millions of taxpayers, who never run out of money we can steal.
(Score: 2) by NotSanguine on Thursday March 09 2017, @06:33PM
Your analogies are moronic.
The most efficient health care provider in the US is Medicare. Which is, you guessed it, the closest thing to single-payer that we have.
What's more, it's paid for by everyone for everyone, with add-on programs which can expand benefits if one is willing to pay.
Removing the profit motive for health care would go a long way toward eliminating the abusive corruption and collusion and describe above, and in improving care for everyone. Which would boost overall health and improve productivity and heighten economic activity.
As for "defense" we spend more than the next dozen or so (in dollar value) nations combined. And most of them are our allies. This is moronic, yes. However it has nothing to do with healthcare.
Those other countries (and most others too), have single-payer health care, cover *everyone* and spend less than half what we do, often with better aggregate outcome statistics.
tl;dr: you're talking out of your ass and it smells that way too.
Why do you hate America?
Why don't you want to improve our economy? Don't you want to Make America Great Again?
No, no, you're not thinking; you're just being logical. --Niels Bohr