The Pressures on Health Care Providers

In the article, “Health providers pressured by insurance, drug costs” by Tom DiChristopher, DiChristopher discusses how the financial pressures from high drugs costs, and negotiations with insurance companies effect the health care provider. This is a point of view that is not often discussed. The typical discussion that people have is about how the cost directly effects the patients. The article states that health care providers are trying to deliver high quality care at a much lower price. Health care providers are struggling with how to do this.

The biggest issue I have with health care providers trying to limit their care by how much things cost is I worry that patients will not be receiving as high quality care as they may have in the past. I believe it is not a health care providers responsibility to worry about how much things cost while they are trying to save someones life. Health care providers are trained to save lives not save money. I believe the real problem is why health care cost so much in the first place. In the article it discusses how one of the biggest problems is how much medication costs. I believe this is the core of the issue. If the pharmaceutical companies are not forced to lower their prices, health care professionals may be forced to treat patients in ways that are not as efficient. In the article it is argued that the price is justified because of the amount of research that goes into the product and they believe if they produce a life saving product they should receive a profit. I agree that there is a substantial amount of research that goes into these products, and that the scientist and pharmaceutical companies should be rewarded, however, if the product is too expensive for the patients who need it, the purpose has been defeated. Health care should put their patients first not their business.

At the end of the article Noseworthy said, “We’ve basically defunded the NIH over the last 11 years, and that’s a problem if you’re going to be the leading developer of new treatments in medicine. Our position could fall if that doesn’t turn around.” Because the United States is a leading developer in new treatments in medicine there is a lot of expectations and pressure put on us. Trying to solve the problem of high health care costs by defunded research is not the answer. They are taking the money from the wrong place. The real issue is with the pharmaceutical companies, and how the charge master prices are developed. If something doesn’t change, and health care providers are expected to deal with the business side of health care while treating patients, or high quality health care system will diminish.

Article: http://www.cnbc.com/2015/10/30/health-providers-pressured-by-insurance-drug-costs.html

Alternatives to the Chargemaster?

In Steven Brill’s article, “Bitter Pill: Why Medical Bills are Killing Us,” he describes the chargemaster as “every hospital’s internal price list,” which is then used in patient bills to calculate the final cost of care. Because each hospital is free to determine their own chargemaster and there is no regulated process for doing so, these chargemasters often have grossly inflated prices for services, especially when compared to the prices for services paid for through Medicare or Medicaid. This leaves every American not on either of those programs to flounder with astronomically high medical bills. Even with insurance negotiating prices down from that chargemaster starting point, charges for services are still many times higher than they cost the hospital to provide. To combat this, Brill says that we must “outlaw the chargemaster” and also “amend patent laws” to limit the power of pharmaceutical companies charging high prices for ‘their drugs,’ “set price limits or profit-­margin caps” on drugs, and cap profits for CT and MRI scans and for in-house lab tests. He also suggests medical-malpractice reform, capping administrative salaries in the medical field, and posting profit margins publicly.

I think that Brill’s suggestions are wonderful, but he does not say enough about how we can manage to make all of these changes happen. So, that is my question: how do we get from where we are now to a world of no chargemasters, legal reform, and caps on costs and salaries?

Process Reflection 1

The Sociology of Healthcare class and the materials covered have opened my eyes to the corrupt and unjust nature of the United States Healthcare system. Before taking this class, I was not very familiar with the healthcare system or all of the different types of coverage or even the history of healthcare or insurance policy. Today, I have a better understanding of the healthcare system and the way it is organized. After reading about different healthcare plans and different experiences in the system,  I often look back at my own healthcare experience for context. However, I feel that I am unique in the sense that my coverage is provided by the government; specifically the military. This system is not perfect by any means but I have not had a problem gaining access to healthcare and have never had to pay any off the wall charges. For instance, I had a thumb surgery for a tumor removal. The bill came out to $6,000 but my family only had to pay a small copay of about $40.

I do not pay for individual visits to see a healthcare provider and medications are also covered under my insurance. I simply cannot imagine being an individual who does not have insurance or who is denied coverage. Why is it so difficult to convert to an overarching system that provides access and care to all people regardless of income or age? If it is costing us billions of dollars each year then why can’t we find any cheaper alternatives or stop over-utilizing and wasting money on unnecessary procedures and tests? This fact alone makes me think that the healthcare system is not in the business of making people better but instead is in the business of profiting from illness. For example, the article that struck me most was the article that discussed the “chargemasters” payment system. This was a database that determined cost of services from surgeries performed and down to the instruments being used.  It surprised me that this database basically came from no where. It was based on theory and had no real context. This makes me question who really determines cost? Why is there so much inflation?

Our healthcare system needs a serious overhaul.  Who or what will change it? Only time will tell.

Process Reflection 1

Each class and article has revealed to me a new level of intricacy and topic of inquiry that govern the healthcare system that we live in today. In my naiveté, I did not realize that as a buyer of health insurance that I am a “patient-consumer” with very little choice or power as a pawn in what has developed to be a corrupt market. I want to believe that when I visit a hospital or doctor that there are no hidden motives that govern how they treat me; however, this hopeful illusion is quickly dissolved by arguments like Quadagno’s Stakeholder Theory and Timmerman’s discussion of the shift in medical professionals’ actions in favor of self-interests.

I am bewildered by the fact that in our system one man has the power to upcharge a life-saving drug from $13.50 to $750 per pill, that people can be “too poor” for private insurance and simultaneously “too rich” for Medicaid, and that some people are forced to file for bankruptcy due to medical bills that would have been otherwise alleviated if the individual were not two years shy of 65 years-old. How has our country’s policies evolved to let hospital “chargemasters”, Big Pharma executives, and other providers in our multi-payer system gain this level of power and influence over our quality of healthcare?

Why are medical bills so outrageously high? Who comes up with these high “charges”?

                In the article ““Bitter Pill: Why Medical Bills are Killing Us,” Steven Brill discusses the outrageous cost of hospital bills and the large disparity between healthcare costs in the US versus other countries. The prices that hospitals set in place for various services appear to be arbitrary in nature and lacking context. The name of this so called database of charges is called the “chargemasters”. I have honestly never heard of such a system. Who is in charge of establishing these costs and why are they so abnormally high? According to Brill’s research,  it appears that the hospital system is charging patients way above market price and, in turn, receiving a significant revenue while putting most of its patients into debt. Brill even comments on the fact that nonprofit hospitals make millions in revenue while their presidents make a hefty salary. To account for the revenue, Brill states, “the hospitals improve and expand facilities (despite the fact that the U.S. has more hospital beds than it can fill), buy more equipment, hire more people, offer more services, buy rival hospitals.” But what about quality of care for the patient? Despite, a large revenue we don’t seem to care about making the efficiency of the healthcare system better. We continue to struggle with problems of over utilization. Brill discusses the issue of overuse of CT scans for people who don’t always need it. Is this done for the purpose of avoiding lawsuits of malpractice and making sure that all the bases are covered or is this to help pay for the cost of the machinery since these CT scan machines can be very expensive?

Whatever the case may be, the healthcare system is a current mess and chivalry does seem dead.

Why do Non-Profit Hospital Organizations make Extremely Lucrative Profits?

In the article “Bitter Pill: Why Medical Bills are Killing Us”, the author Steven Brill compiles research and data on bills from hospitals all over the country. There is a trend where non-profit hospitals are turning around huge profits.

To quote Brill, “Its nearly half­billion dollars in revenue also makes Stamford Hospital (non-profit) by far the city’s largest business serving only local residents. In fact, the hospital’s revenue exceeded all money paid to the city of Stamford in taxes and fees. The hospital is a bigger business than its host city.” …. “There is nothing special about the hospital’s fortunes. Its operating profit margin is about the same as the average for all nonprofit hospitals, 11.7%, even when those that lose money are included. And Stamford’s 12.7% was tallied after the hospital paid a slew of high salaries to its management, including $744,000 to its chief financial officer and $1,860,000 to CEO Grissler.”

Meanwhile, taking a definition from google for a non-profit organization, “A nonprofit organization (NPO, also known as a non-business entity) is an organization that uses its surplus revenues to further achieve its purpose or mission, rather than distributing its surplus income to the organization’s directors (or equivalents) as profit or dividends.”

-https://en.wikipedia.org/wiki/Nonprofit_organization

Is there some loophole in this system where these non-profit hospitals get around this stringent definition?

Pay No Attention to that Chargemaster Behind the Hospital Bill

As infuriating as the very existence of the chargemaster is, I believe we ought to focus on the bigger picture. That is, we ought to be questioning why medical bills are so high now rather than who should be paying them. What does it say about our health care system and our nation’s economic and social philosophy when we allow lobbyists and private groups with financial resources to single out those who are least able to pay and burden them with the highest rates? Our anger ought to be directed at addressing the issue of why there is a blatant and glaring lack of transparency in the world of medicine in America. At this very moment, hospitals are pulling the wool over our eyes and charging patients far more than what their care actually costs. Brill establishes that the gap between what hospitals charge for certain things (procedures, tests, etc.) and what Medicare would pay for the same things is mindbogglingly immense. How can we, as American citizens, feel comfortable about whatever care we are being given when we fear the associated costs and we are unaware of where these ridiculous bills are coming from? I posit that if the medical profession had more transparency, the public outrage alone would force radical reform to occur. This begs the following key questions: is total transparency in the medical field in America possible? Is this an attainable goal in the future or is our nation condemned to a future of rising arbitrary costs and exploitation of the less fortunate subset of our population? What, if anything, must FIRST happen/change in order for us to potentially achieve such radical reform? 

Chargemaster Conundrum

After reading Steven Brill’s article entitled “Bitter Pill: Why Medical Bills Are Killing Us,” I was stunned, confused, and rather afraid of this so-called chargemaster. I have heard that each hospital can set their own prices internally, but I never knew there was a document and file that listed out all these prices. What I wanted to know is where are these prices coming from and who decided to set these prices in the past? (In the article it said that it used to be one list but now it is in a data base because the prices are always increasing). Also, why is it that every hospital’s prices are different and that the uninsured or those ineligible for Medicare technically have to pay the most of these ridiculously high costs? And if the chargemaster is the one that has all the set prices, why is it that the doctors just shrug off the problem as if it is no big deal and shouldn’t we be targeting and focusing on the chargemaster in hospitals as a way to make medical costs go down in this country then?

The confusion of Chargemaster

In Steven Brills “Bitter Pill: Why Medical Bills are Killing Us”, he brings up the concept of ‘chargemaster’ in hospitals. In his example, a woman named Janice (who is uninsured), was billed $21,000 dollars for her stay in the hospital when she experienced heartburn. After reading this anecdote, I am confused about the concept of chargemaster. Who creates this list of prices for every given hospital (as they all differ)? Also, who decides when to apply these prices to a given patient? Was Janice charged these high rates because she was uninsured?