Hospital Pricing:
Why do Certain Hospitals Charge Significantly
More for the Same Medical Procedures?
Most IMPORTANTLY: Sick-Care Hospital Stay Prevention!
© 2018 Health Realizations, Inc.
If you are planning an operation you likely want the best Hospital with the best team your Doctor recommends and cost likely doesn't matter after you exceed your health insurance deductible.
Even if you have a high deductible, when you’re in need of immediate medical care and end up in a hospital, price again is likely the furthest thing from your mind -- that is until the medical bills start rolling in.
For Americans with comprehensive insurance coverage, the true costs of medical care may never really surface for you personally, but for those with high-deductible plans, skimpy coverage or no insurance at all, knowing that you could have had the same procedure performed down the street for half the cost, or less, probably makes your blood boil.
The truth is, because certain hospitals have a higher market share, they’re able to command higher prices. This market prices can mean you’ll end up paying over $1,200 for an MRI that you could have gotten for under $700 in the next town over, and if have no insurance you’ll likely fare even worse.
According to statistics published in Health Affairs, self-pay patients were charged 307 percent more than the Medicare allowable costs and about 2.5 times more than insurers pay.
But even for those with insurance, hospitals with the greatest market share often charge as much as they can get away with, according to an article by reporter Peter Waldman.
Why are Certain Hospitals More Expensive?
One California hospital, Sutter Davis Hospital, reportedly charges prices that are up to 70 percent higher than those at its neighboring hospitals. And if you were to call your insurance company to find out what those prices may be, they wouldn’t tell you because the prices are kept secret. As Waldman wrote:
“The pricing power of local hospital systems has received scant attention in the search for answers to the nation’s rising medical costs, according to Alain Enthoven, an economist at Stanford University. In 2009, as consumer prices fell for the first time in 54 years, the U.S. health care bill rose by 5.7 percent to $2.47 trillion, a record 17.3 percent of the economy.
“Provider consolidation is driving up health care costs,” said Enthoven. “We need effective antitrust enforcement, and we haven’t had that for some time.””
As it stands, powerful mergers between hospitals and doctor groups, called “accountable care organizations,” are causing prices to rise even higher. Waldman reported:
“Higher prices stemming from hospital mergers that took place between 1997 and 2006 alone add $12 billion to annual health care costs, according to a study last year by Cory Capps, a former U.S Department of Justice economist. Capps, now a consultant, estimated that the ability of powerful hospitals to stimulate usage and the merging of doctors’ groups might be adding another $6 billion to $10 billion.”
Can You Shop Around for Lower Cost Health Care?
To some extent, in some cases more or less, the answer is surprisingly “YES”! If you’re going to be having an elective surgery or other medical procedure, you can go to your insurer’s Web site and look for cost comparisons that allow you to shop around for the best prices at local hospitals.
That said, some hospitals, such as Sutter, do not disclose pricing, making it virtually impossible for you to find out costs ahead of time. And until there is true free market competition between hospitals, it’s unlikely that fair market prices will surface. This is especially true since so many are shielded from health care costs via health insurance, which only allows hospitals to price gouge even more.
As an IMPORTANT aside, cost certainly isn’t everything when it comes to your health. While you’re doing your research on costs, it’s also worth looking into the safety ratings for varying hospitals as well. At HealthGrades.com you can find ratings for patient safety incidence, hospitals and nursing homes and use the information to help make an informed decision about where you’ll receive the best care, for the best price.
How to Stay Out of “Sick Care” Hospitals in the First Place
Your best bet to saving money on medical care is to stay out of the hospital as much as possible, a strategy that may be easier than you think.
The key to reducing your risk of chronic illness is prevention, focusing on a healthy lifestyle and developing healthy habits by eating nutritious foods and getting regular daily exercise.
Are you willing to make the positive choices you need to stay healthy?
Start adding more fruits and veggies to your diet.
This is easier said than done, of course, so for those of you who need a little help, prayer, meditations and music can calm your mind, soothe your emotions and create a state of deep relaxation in your body.
Every day we’re exposed to chemicals in our food and water, pollution in our air, and emotional stress in our lives. Over time, these toxins accumulate in your body and can manifest as insomnia, fatigue, digestive problems, aches and pains or even chronic disease.
Detoxification gives your body a chance to rest, clear out toxins and become nourished. Generally this is done by first removing and eliminating toxins, then providing your body with healthy nutrients.
Ask about a detoxing program at your next appointment.
It’s during the time you are sleeping that your body is rebuilt and repaired.
Support your sleep health during the day with healthy food and nutritional supplements.
High-quality food should be the backbone of your nutritional program, but supplements, which are only available from health care practitioners, can also be beneficial.
According to the National Institute on Aging:
“Regular physical activity may be the most important thing an older person can do to stay healthy and self-reliant. In fact, the more exercise you can do in later life, the better off you’ll be.
Studies suggest regular, sustained exercise can help prevent or delay some diseases and disabilities as people grow older. And, in some cases, it can actually improve some of these conditions in older people who already have them.
In a study conducted at Tufts University in Boston, for instance, some people age 80 and older were able to progress from using walkers to using canes after doing simple muscle-building exercises for just 10 weeks.
In addition, physical activity can improve your mood, lessen your risk of developing adult-onset diabetes, slow bone loss, and reduce your risk of heart attack and stroke.”
By reading, doing crossword puzzles, learning new things, working part-time and socializing you can help keep your brain cells strong.
Instead of waiting until you’re sick, then relying on the sick care system to patch you back up, give your body a fighting chance by leading a healthy, low-stress lifestyle that will keep your body strong and OUT of the hospital.
“It may seem a strange principle to enunciate as the very first requirement in a Hospital that it should do the sick no harm.”
--Florence Nightingale
Sources
Bloomberg.com
Health Capital Volume 3, Issue 1
