Thursday, December 29, 2005

Shopping for Health Care

A recurring motif here at InsureBlog is Consumer Driven Health Care. In general, this means avoiding plans with expensive “first dollar” benefits (such as $20 office co-pays and $10 prescription cards). By choosing plans with high deductibles, and using one’s insurance as a safety net for large claims, more dollars stay in one’s pocket. And, in many cases, result in favorable tax benefits, as well.
Inherent in this philosophy is the idea that consumers will become more pro-active in deciding how and where to spend their health care dollars. For example, Provider X charges $100 for a mammogram, while Provider Y’s is only $85. Assuming equal quality, why would one choose Provider X?
The challenge is that, for the most part, health care costs are like airline fares: one never really knows ahead of time how much a given service will cost, and different patients (with different plans) will pay different amounts.
Confusing? You bet.
Some carriers, like Aetna, are coming around, and making this information more accessible to insureds. But not all:
These mystery shoppers soon learned what most of us already knew: the folks at the doctor’s office rarely (if ever) knew how much the service or procedure would cost. In fact, less than a third of these shoppers could get firm prices in a single call. I have no reason to suspect that it’s much different for actual shoppers, either.
Of course, this is a national phenomenon, not limited to the Golden State:
A survey by the Kaiser Family Foundation and USA Today found that 52 percent of people polled nationwide said their doctors never or rarely discuss the costs associated with the procedures they recommend.
Of further course, one wonders whether or not most patients ever ask about those costs. But those patients who’ve bought into the CDHC model, generally through Health Savings Accounts (HSA’s), probably do. I went poking around the net, but have thus far been unable to find a study of how many HSA’ers [ed: you just made up that word!] do, in fact, ask about these costs. In an admittedly informal and non-scientific survey, I asked some of my HSA clients whether they asked about these costs. To my surprise, only about half of them said they do.
Yet there is evidence that older “tried and true” treatments can be just as effective as the newest, at far lower cost. Now, your provider may have a very good and valid reason for suggesting the latest technology or purple pill, but that’s really another reason to discuss the issue.
Last winter, for example, my daughter experienced the thrill of a kidney stone. I am assured that this pain is second only to that of childbirth, and seeing her retching, I can believe it. At the hospital, a very brusque resident put her on the fast track for a certain procedure, somewhat akin to an ultrasound, but more invasive. He was quite taken aback when I called an immediate halt to the proceeding. “But she must have this procedure,” he exclaimed. “Fine,” I replied, “please explain to me why it is preferable to the old sonic blast method.”
Which rendered him quite speechless.
My point was that, before we go for the latest tech, let’s examine the options for both cost and efficacy. Eventually, the chief urologist came in to explain, to my satisfaction, why this procedure was, in my daughter’s case, superior and ultimately, more cost effective. At which point she underwent it, and has been quite the happy camper since.
The lesson here is not that I don’t care about my daughter’s welfare, but that I wanted to be an informed consumer. The resident was apparently unaccustomed to having his word (or authority) challenged. But that’s really the point: if we are to be informed consumers, we have to act as informed consumers.
Judy Rupp, information and assistance case manager with the Northern Oklahoma Development Authority Area Agency on Aging, recently wrote:
Couldn’t have said it better myself.
UPDATE: Hospital Impact blog has another take on this subject. Recommended.
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