Castlight Health, financed by the Cleveland Clinic and other investors, is one of a number of companies that have started publishing health care prices charged by doctors and hospitals. Others include Aetna life insurance company and the state of New Hampshire.
Employers who have shifted workers toward high-deductible insurance policies that require them to pay larger out-of-pocket costs are one spur for better health care cost information. Patients with more information about prices often spend less. The state of Indiana found that in 2009, patients with high-deducible plans spent 25 percent less than patients with a more traditional plan, the Times reported.
In another example of the variability of health care prices, Castlight found that colonoscopy prices in the San Francisco area ranged from $500 to $3,000.
While there are many medical emergencies for which patients have no time for comparison shopping, health care consumers should be encouraged to shop around for many routine medical procedures, examinations and tests, and to be aware of the costs of overusing emergency medical services.
“Castlight found that colonoscopy prices in the San Francisco area ranged from $500 to $3,000.”
Now me, I have done a little comparison shopping. We have similar variability in my neck of the woods. If you do the colonoscopy in a surgicenter with no conscious sedation it is about 350 (no insurance billed, no medicare or medicaid, cash on the barrel). In general, public hospitals in England will not give you conscious sedation, and 20 years ago we didn’t do conscious sedation either. Colonoscopies were definately uncomfortable, but people expected this and didn’t do “screening colonoscopies” to try to prevent colon cancer. They only had colonoscopies if they had a problem like blood in the bowel movements or something.
If you do it cash on the barrel with conscious sedation (infinitely more pleasant) then it is about 1,500.
If you do it in a facility that accepts Medicare or medicaid and (therefore by definition will also bill insurance) it is indeed close to 3,000. This, of course, is to subside medicare and medicaid (which ends up paying about 350 for the procedure despite the fact that conscious sedation is now routinely used) by making folks with Blue Cross pay more than the cost (1500) that colonoscopy with conscious sedation would cost.
If everybody had a high deductable plan (and this would have to include folks who currently have medicaid or medicare) and if everybody was willing to put up with significant discomfort, then prices would drop to 350 which is the true market price without the cost shifting of the government, or the “luxury frills” (the conscious sedation) of a consumer based marketplace.
That means that if everybody had a high deductable plan (say up to 6,000) then costs could drop by half if folks wished to keep frills like conscious sedation, or might drop by as much as 90% if folks wished to do basics only. This would mean, however that every indigent patient, and every elderly patient would have to pay all costs up to the deductable (and many would probably forego these, making medicine even “cheaper”).
Whether that is a “good thing” is worth debating.
#2, that’s where preferably charities and in the /last resort/ government come in, with strict rules like means testing, etc. to ensure that participants are actually indigent, disabled and so on. (I myself would not include so broad a category as ‘the elderly’ in determining who should qualify.)
Inquiring minds intently wonder whether Clueless, who apparently thinks sedation for a colonoscopy is a “frill,” has ever been through that procedure without sedation? ?? ???
An important piece of info is missing.
#4. Nope. Went through mine with sedation. I watched several without sedation as a medical student and I agree, it does look quite uncomfortable. When it is time to do my repeat, if sedation is considered a “frill”, then i will pay extra to have conscious sedation if that option is available. After all, I paid extra to have my kids wisdom teeth removed with sedation, despite the fact that my own wisdoms were removed without sedation some 35 years ago. (Ouch!). Improved pain control during medical procedures has been one of the successes of the past 20 years, however it does increase costs. This emphasis on pain control is not found in the British public health service (except for the terminally ill) and neither colonoscopies nor wisdom teeth extraction merit sedation there.
If the aim is to control costs, then it should be noted that neither sedation during wisdom teeth extraction nor during colonoscopies are strictly necessary. Sedation is not considered routine in England, let alone in non-Western countries.
The question was, why does the cost of a colonoscopy vary so much. The answer is that it varies because that cost may include different entities besides the basic physician/equipment fee. Part of the additional costs in some centers relate to techniques (such as sedation) that make the procedure both more comfortable, and more likely to produce a complete study. (It is quite hard to look at the ascending colon, let alone to remove polyps without sedation, and most non-sedated colonoscopies stop at the transverse colon). Another part of the additional costs reflect cost shifting to pay for patients with Medicaid, Medicare or the uninsured who are subsidized by those who have insurance.
In Dentistry, there is relatively little cost shifting, and patients are at liberty to refuse sedation, in order to save money. For this reason, there is only modest variation in prices between dentists, mostly having to do with better techniques (more natural crowns, inserts, amalgams and the like). Folks who want cheap, can have their partly rotted teeth extracted with local anesthetic, and folks who wish comfortable, and good looking can have their the rotten areas carefully chiseled away, and a crown placed under conscious sedation that will if anything look better than what was there before.
It would be nice to be able to extend perfect teeth and orthodontia to everybody. However if we did (by forcing people to carry dental insurance and subsidizing those who can’t afford it), then costs would soar, the government would first try to subsidize costs, and then institute price controls and insist on justification, and we would have the same problem with unaffordable dentistry that we have with medicine.
Before everybody starts shrieking that good teeth are a basic human right, and that even poor countries like Rwanda offers “health insurance” to all (a point that was made in this recent – if stupid- NYtimes article)
http://www.nytimes.com/2010/06/15/health/policy/15rwanda.html
let us consider what that “insurance” buys.
In Rwanda your universal insurance buys the opportunity to have teeth extracted if they are abscessed. (This option is already available to all in the United states through various free/low priced dental clinics, medicaid, etc.). Even bought on the open market a simple extraction can be had for little more than the price of a hair cut.).
In Rwanda, medical insurance is universal. But access to health insurance is not the same as access to health care. As noted in this article
http://www.cato-at-liberty.org/2010/06/22/health-care-rights-and-wrongs/
“There’s a difference between health care and health insurance. Nobody in the United States is denied health care. Between Medicaid and federal law requiring emergency rooms to treat all comers, we simply do not have children dying in the street (like in, say, Rwanda, where, according to the Times, the most common causes of death are “diarrhea, pneumonia, malaria, malnutrition, infected cutsâ€). As Michael says, “Yes, the poorer nation has a higher levels of health insurance coverage. But the wealthier nation does a better job of providing medical care to everyone, insured and uninsured alike.â€
http://www.cato-at-liberty.org/2010/06/22/health-care-rights-and-wrongs/
However even though uninsured americans have vastly better health (and teeth) than those in more “enlightened” nations who have universal health insurance, it is true that folks who are middle class in the USA have access to a level of comfort that surpasses that enjoyed by America’s uninsured. That is why Rwanda’s elites (as well as the elites of the rest of the world) flock to America for their health care. We are already broke, so we can’t lift our own poor to the ranks of free orthodontia for all. However we can make ourselves feel better by dropping our desires to the level of basic health care (and only basic health care) for all.
The big question is “is that what we want?” (And I’m not being facetious. Justice, and equality are worthy goals. How much comfort, life expectancy, cosmetic appearance are we willing to give up in order to have it?).
Funding problems? A solution …
http://www.nypost.com/p/news/opinion/opedcolumnists/radical_pick_for_medicare_mv32rWv9ka3kByU8H9sxBK
Ya see, stop at the transverse isn’t exactly accomplishing the complete goal of the procedure. It would seem a shame to endure the prep and then (just to save the cost of doing some Versed or Propofol safely) pass up the opportunity to inspect the whole thing. Would a big honking (slooow push) dose of fentanyl (or such) make one comfortable? I don’t think appropriate sedation is a frill, but I’ve always wondered whether the point of the Versed or whatever is just amnesia.
I had my wisdom teeth extracted with locals and it was a bit of a long “drill ’em apart” procedure and obviously completely tired out the oral surgeon’s arm trying to pull hard enough, but I was not extraordinarily uncomfortable. Having my tongue lost in space and iffy swallow control for a few hours, on the other hand, was quite inconvenient.
“Ya see, stop at the transverse isn’t exactly accomplishing the complete goal of the procedure. It would seem a shame to endure the prep and then (just to save the cost of doing some Versed or Propofol safely) pass up the opportunity to inspect the whole thing. Would a big honking (slooow push) dose of fentanyl (or such) make one comfortable?”
Like the big honking dose that Mike Jackson got? There is a reason why conscious sedation requires the ability to monitor the patient (with resultant increase in costs. As to getting past the transverse, we certainly got up to the cecum without anesthesia previously, it was simply…um…pretty uncomfortable. If folks wish to wimp out at the transverse, well, that would appear to be their look out, wouldn’t it? SURELY you don’t think it is appropriate for an American to spend 3x what the British pay for a simple colonoscopy just because some folks can’t keep up that “stiff upper lip”? My goodness! Wasting money on conscious sedation! It’s just greedy doctors piling on more costs!
We interupt our current program for a Health care message from Dr. Obama:
“Bend over Libs! It’s time for your checkup!”
As best I recall, Michael Jackson got a big dose of Propofol not fentanyl and then his drug-giver didn’t stay with him. Recipe for trouble if you ask me.
I’m asking a serious question: (assuming continuous monitoring), does something like Versed or Propofol appear to make the patient more comfortable (during the procedure) than would be the case with just a generous dose of fentanyl? Or is the Versed or Propofol really just providing amnesia?
Thanks