Sunday, June 2, 2013

More Provocative Articles on the Health Care System

This week was a good one for health care articles.  There were 3 in particular that caught my attention and resonated with me.
1.      “The $2.7 Trillion Medical Bill” in today's The New York Times :
2.     "Finding the Right Hospital" in The Atlantic on May 28th:
3.      "A Lone Voice Raises Alarms on Lucrative Diabetes Drugs" in The New York Times on Friday May 31st:

 “The $2.7 Trillion Medical Bill” reminded me of the Time magazine article by Steven Brill a few months ago on the same subject.  The main points were about the variability in costs across different locations for the same procedure. Most patients don’t know how much a procedure costs until after it is done and the insurance company has processed or denied their claim. Both articles compare prices of medicines and procedures across the world, showing that the US has the highest costs.

Just this past week, I reveived my reimbursement information from Aetna, my health insurer.  My Sandostatin shot for April was billed to Aetna at $13,343 and reimbursed at $8,757.  My March Sandostatin shot at the same dose was billed at $5,000 and reimbursed at $2,722.  I recently changed doctors but I can’t imagine why two centers can charge such widely different amounts for the same shot!  I called Aetna to find out what was going on and the person I spoke with said that different centers have their own reimbursement rates for procedures and that the Sandostatin shot may be more expensive but other procedures may be cheaper.  I also believe the price of Sandostatin may have gone up because I’ve seen a few postings about that on the ACOR online message board.  I guess as long as my insurance company is covering it, I shouldn’t worry but it does make me a bit crazy!

I think it would be helpful if there were more standardization of prices and if it were possible to know up front what everything would cost.  It would make it much easier to decide which procedures to have, to shop around for better prices and to make sure that medical costs would not cause financial hardship. 

The second article covers patient satisfaction ratings and how, if at all, that may influence where one should go for treatment.  It was very interesting because patients may not be the best people to evaluate their medical care. The article cites some examples where the ratings are high but the outcomes are worse.  One commenter on the article stated “The closest analogy to hospital care is auto body repair. Both are insurance-paid and cost insensitive. And in each case the customer generally presents in distress, either by ambulance or tow truck, and in no position to choose. While both may advertise quality of service the customer is unable to judge that quality unless things go drastically wrong.”

As more hospitals publish patient satisfaction scores and more healthcare professionals are being compensated based on these factors, it is becoming a controversial issue.  One of the blogs I read, “Skeptical Scalpel”, shown on my blog list, frequently deals with the issues involved in hospital/doctor ratings.

The third article deals with a Dr. Peter C. Butler who found that a class of diabetes drugs may cause pancreatic cancer. It states in part: “Public Citizen and the Institute for Safe Medication Practices, two watchdog groups, have both arrived at the same finding….Dr. Butler faces powerful opponents in the makers of the drugs and many diabetes specialists, who say his studies are contradicted by other evidence….More information could come out in June when the National Institutes of Health will hold a two-day meeting on possible links between diabetes, diabetes drugs and pancreatic cancer. Dr. Butler will be one of the speakers.”

This article is less relevant than my usual rants but it just reinforces my concerns about the influence that big pharma has on the type of information that is released to the public and regulatory agencies. Both the effectiveness and potential hazards of drugs may escape public scrutiny until the class action lawsuits begin.
These articles continue to highlight the major problems and potential solutions within the US healthcare system. I’m not sure how things will ever change from the convoluted mess that we have now.