Sunday, 12 February 2012

Patient choice and competition? Forget it: advice on haggling with your doctor in America

David Cameron wants to usher in a new era in health care for England. At the centre of all of this is the right for every 'consumer' of health care services to have the freedom to choose, from a variety of competitive service providers.

There is one problem with this vision. It's total tosh. And there are a number of very good reasons why.

Still, the best way to illustrate why is to trawl the array of helpful 'consumer' advice columns across the Atlantic dedicated to shopping around for the best deals on health services. They are basically like Readers Digest, but aimed at cancer patients.

Now, a cynic would argue that it is really very difficult indeed for any consumer to exercise real choice if the product they are buying is too complex to understand. Or, worse, still, to do so with comparatively little data with which to make informed decisions.

How many people really know their Acebutolol from their Atenolol? Or their Penbutolol from their Propranolol? And yet, the free market, to operate efficiently, requires consumers to exercise informed choice.

So, how are users in the USA advised to make informed decisions? Well, the first step is to talk to your doctor. Simple enough in theory, except:
"Your physician may be just as uncomfortable with these conversations as you are. That’s because... doctors are simply not trained for this".

Oh, and besides, "for a variety of reasons, doctors are likely to suggest the most expensive options first".

But you have that hospital appointment looming... what with that massive tumour you've been ignoring for the last four months sticking out of your leg. Well, first things first:
"check if your company lists average prices for various treatments, tests and procedures online".

Not a bad idea. Except "data isn’t great, and prices can vary significantly from one provider to another".

Well, this might all be irrelevant if you are one of those awkward customers that don't tell the hospital you are coming first, you selfish sod. You could be the kind of guy that "lands in the hospital without the benefit of any planning and gets slammed with a huge bill, say $15,000 for a coronary angiogram, and insurance ends up covering only a fraction of the bill."

But, at the end of the day, the very least you can do is check your bill and see if you are getting a fair deal. Right? Well, it's not quite that simple:
"Be especially vigilant about hospital bills since they tend to be complex and may contain errors" (this seems to be quite an issue - another advice column reiterates the point that you should "closely examine each bill to identify errors, which are common").

Oh dear. Not helpful. But assistance is at hand (at a price), because "having your doctor on your side in a dispute with a hospital can swing a lot of weight".

That's good. Well, if you can trust your doctor, that is, as "some doctors are in practices owned by hospitals, adding a potential conflict of interest".

Sigh. And factor in the health insurance company and: "Sometimes it seems consumers* are caught between two entities protecting their own financial interests and agreements"

Still - it could be worse, folks. You could be uninsured! In that case, first, tell your doctor "that money is tight or your health coverage leaves you on the hook for a big portion of the costs should compel the physician to tailor treatment to your needs" (that is a euphemism for getting rubbish treatment. Although, if you are very lucky, it might be conversely that you avoid in this instance getting over-treated by some self-interested physician. In this brave new world, both the insured and uninsured can get screwed).

And if you are uninsured, you will get the double slap in the face of having to pay out of pocket for your medical treatment and, to add insult to injury (very apt phrase in this case) you will have to pay MORE than someone with insurance. Why? Well, because:
"What’s happening is that people without insurance are paying full price, while insurance companies, with their high volume of patients, can negotiate steep discounts. For patients paying for care out of their own pockets, it’s important to let everyone you encounter know that. The next step: ask for the discounted rate... the reality is, you may not have as much leverage as the big insurers. But it almost always pays to ask".

I'm sure we cannot wait for Cameron to bring us lucky Brits this wonderful world of choice and competition.... and hopefully we'll all remember who brought it to us at the next election.

*that's 'patients' to us.

1 comment:

  1. The really stupid thing about "patient choice" is that in an efficiently managed healthcare system there basically is no choice, because you won't get more than a small proportion of the country with more than one specialist cardiac (or whatever) unit in easy reach.

    Dave seems to think that the most expensive and iniquitous health care system in the world should be a suitable model for "reforming" one of the most efficient, but just about anybody who knows what they are talking about seems to think that what the NHS actually needs is to be left alone for long enough that people can get on with the job of treating the sick, rather than reorganising around this week's set of reforms - which are of course always portrayed by the Ministry of Truth as being uniquely aligned to the core mission of the NHS, unlike the last lot, which suddenly turn out not to have been.