Thursday, April 07, 2005
Wall Street Journal: "Pregnant women are by necessity and ingenuity paving the way in what is called 'consumer driven' health care"
[Vanessa Fuhrmans, "Childbirth for Bargain-Hunters," The Wall Street Journal, 5 April 2005.]
There are those that argue individuals cannot shift the marketplace in health care due to a lack of knowledge of all of the huge amounts of data necessary to make educated decisions, or that health care is a "special case" and cannot be left to consumers alone. These arguments have existed for decades in all areas of the market, and ring no more true now than they ever have. In fact, they typify a defensive posture in the face of mounting evidence against them:
Expecting her third child this winter, Sandra Hughes became an unexpected pioneer in the new world of health care -- a world in which consumers have a direct stake in limiting their spending on treatment and tests.
Mrs. Hughes and her self-employed husband had health insurance, but couldn't get maternity coverage because of two previous Caesareans. So in nine months, Mrs. Hughes went from novice health-care consumer to hard-knuckled haggler. She negotiated discounts with doctors, convinced her obstetrician to match another's offer and wrote to the chief executive of a local hospital demanding a reason for refusing to meet her price.
Pregnant women are by necessity and ingenuity paving the way in what is called "consumer driven" health care. As companies boost premiums for family coverage -- and in some cases drop dependents altogether -- a growing group of women lack health coverage for pregnancy, one of the biggest medical costs they face. Others are in some type of consumer-driven high-deductible plan, with a Health Savings Account, that gives patients incentives to shop around.
As a result, these women are forced to navigate a murky system of health-care pricing and to make medical decisions based as much on checkbooks as maternal instinct. In the process, they are pushing doctors and hospitals to negotiate with them and challenging conventional billing and treatment practices.
Patients are learning how to make the complex medical billing system work in their favor. When Sandra Hughes in Florida reviewed a breakdown of what her previous insurer paid for her last pregnancy it showed her the rates were much lower than what the doctors and hospital charged so-called cash patients who pay out of pocket. When she asked for the same deal on her current pregnancy, one obstetrician complied. When she asked another doctor's practice to match it they did, cutting the usual $3,000 fee to $1,900.
When she tried the same with the hospital, she met resistance. Although her old insurer had paid $3,200 for her last Caesarean section there, Mease Dunedin Hospital in Dunedin, Fla., said its best price for a cash patient was $5,000. She says she wrote Jim Pfeiffer, president and chief executive of Mease Hospitals, demanding he justify the discrepancy. "By then, I was almost nine months pregnant, and I was angry!" she says.
Mr. Pfeiffer says he didn't receive the letter, but says the hospital's average cost for a Caesarean is actually $5,100, with a list price of about $10,200.
Since she already had negotiated deals with an anesthesiologist at Mease Dunedin and liked the care there before, she choose to remain at the hospital. But she says, "If more people asked about prices, it would all be far more transparent."
[Greg Scandlen, "Choice is revolutionizing health care," The Flint Hills Center, 28 September 2004.]
[Vanessa Fuhrmans, "Childbirth for Bargain-Hunters," The Wall Street Journal, 5 April 2005.]
There are those that argue individuals cannot shift the marketplace in health care due to a lack of knowledge of all of the huge amounts of data necessary to make educated decisions, or that health care is a "special case" and cannot be left to consumers alone. These arguments have existed for decades in all areas of the market, and ring no more true now than they ever have. In fact, they typify a defensive posture in the face of mounting evidence against them:
Expecting her third child this winter, Sandra Hughes became an unexpected pioneer in the new world of health care -- a world in which consumers have a direct stake in limiting their spending on treatment and tests.
Mrs. Hughes and her self-employed husband had health insurance, but couldn't get maternity coverage because of two previous Caesareans. So in nine months, Mrs. Hughes went from novice health-care consumer to hard-knuckled haggler. She negotiated discounts with doctors, convinced her obstetrician to match another's offer and wrote to the chief executive of a local hospital demanding a reason for refusing to meet her price.
Pregnant women are by necessity and ingenuity paving the way in what is called "consumer driven" health care. As companies boost premiums for family coverage -- and in some cases drop dependents altogether -- a growing group of women lack health coverage for pregnancy, one of the biggest medical costs they face. Others are in some type of consumer-driven high-deductible plan, with a Health Savings Account, that gives patients incentives to shop around.
As a result, these women are forced to navigate a murky system of health-care pricing and to make medical decisions based as much on checkbooks as maternal instinct. In the process, they are pushing doctors and hospitals to negotiate with them and challenging conventional billing and treatment practices.
Patients are learning how to make the complex medical billing system work in their favor. When Sandra Hughes in Florida reviewed a breakdown of what her previous insurer paid for her last pregnancy it showed her the rates were much lower than what the doctors and hospital charged so-called cash patients who pay out of pocket. When she asked for the same deal on her current pregnancy, one obstetrician complied. When she asked another doctor's practice to match it they did, cutting the usual $3,000 fee to $1,900.
When she tried the same with the hospital, she met resistance. Although her old insurer had paid $3,200 for her last Caesarean section there, Mease Dunedin Hospital in Dunedin, Fla., said its best price for a cash patient was $5,000. She says she wrote Jim Pfeiffer, president and chief executive of Mease Hospitals, demanding he justify the discrepancy. "By then, I was almost nine months pregnant, and I was angry!" she says.
Mr. Pfeiffer says he didn't receive the letter, but says the hospital's average cost for a Caesarean is actually $5,100, with a list price of about $10,200.
Since she already had negotiated deals with an anesthesiologist at Mease Dunedin and liked the care there before, she choose to remain at the hospital. But she says, "If more people asked about prices, it would all be far more transparent."
[Greg Scandlen, "Choice is revolutionizing health care," The Flint Hills Center, 28 September 2004.]
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