Though U.S. legislation targeting the problem of surprise medical bills advanced out of key congressional committees in 2019 with support from leaders in both parties, Congress ultimately failed to pass a law to end such bills.
Erin Fuse Brown is an associate professor of law at Georgia State University. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal.
Center for the Digital Future at USC Annenberg (Feb 19, 2020):
Many Americans are willing to make significant personal tradeoffs to lower their health insurance rates or medical costs, such as agreeing to 24/7 personal monitoring or working with artificial intelligence instead of a human doctor, the Center for the Digital Future at the USC Annenberg School for Communication and Journalism finds.
Among the study’s findings:
- Nearly 1 in 4 Americans (24%) would work with an artificial intelligence-based technology if it lowered the cost of their health care.
- Most Americans (80%) think that access to health care is a basic right that should be available to all citizens regardless of their ability to pay. This is a view shared even by a majority of citizens who identify themselves as very conservative (56%).
- Significant percentages of Americans are willing to make profound lifestyle choices in exchange for lower insurance rates. For example, one-third of Americans would agree to 24/7 personal monitoring by insurance companies or health care professionals if their insurance rates were reduced.
- Twenty-one percent of Americans said they would stay in their current job if leaving it meant losing their current health coverage.
- Almost all Americans say health care is a key issue in the 2020 presidential election (92%).
- Even though Americans say they are satisfied with their current health insurance, they are open to alternatives. Thirty percent of Americans would consider buying health coverage from any company that offers lower costs, including a variety of non-insurance companies such as Amazon, Google, or Costco.
HCCI Releases 2018 Health Care Cost and Utilization Report
Per-Person Health Care Spending Grew 18% from 2014 to 2018, Driven Mostly by Prices
The report examines four groups of health care services and dozens of sub-categories. Of the four major categories, outpatient visits and procedures saw the highest 2018 spending increase (5.5%). Other notable trends include:
- Inpatient services.
- Per-person spending on inpatient admissions rose 11.4% between 2014 and 2018
- Within each sub-category of inpatient admissions, average prices grew steadily between 2014 and 2018 while utilization trends varied. However, the 2.0% price increase in 2018 was lower than the near 4% annual increases from 2014 to 2017.
- Outpatient services.
- Increases in prices and use led to a 16% increase in spending from 2014 to 2018.
- ver that period, ER visit spending increased 32% and spending on observation stays went up 29%.
- Professional services.
- Spending increased 16% and growth accelerated over the 5-year period, driven by office visits and administered drugs.
- Psychiatry also saw strikingly high spending growth of 43% from 2014 to 2018, which was driven mostly by increased use.
- Prescription Drugs.
- Generic drugs accounted for 88% of all prescriptions. .
- Out-of-pocket payments for prescriptions for generic drugs was less than one-fifth of out-of-pocket payments on brand drugs.
From a JAMA Network online article (February 4, 2020):
High medical prices and billing practices may reduce public trust in the medical profession and can result in the avoidance of care. In a survey of 1000 patients, 64% reported that they delayed or neglected seeking medical care in the past year because of concern about high medical bills. The field of quality science in health care has developed measures of medical complications; however, there are no standardized metrics of billing quality.
A recent study found that only 53 of 101 hospitals were able to provide a price for standard coronary artery bypass graft surgery. Notably, among the hospitals that provided a price, the price ranged from approximately $44 000 and $448 000 and was not associated with quality of care as measured by risk-adjusted outcomes and the Society of Thoracic Surgeons composite quality score.
In the same way that there is wide variation in pricing, aggressive collection tactics also can be highly variable by institution. In a recent analysis, 36% (48/135) of hospitals in Virginia garnished wages of patients with unpaid medical bills, and 5 hospitals accounted for 4690 garnishment cases in 2017, representing 51% of all cases.7 In total, 20 054 lawsuits were filed in Virginia against patients for unpaid debt. For many hospitals that sue patients, legal action follows multiple attempts to contact patients through letters and calls, and some hospitals may offer to set up payment plans or even negotiate charges.
From Health Care Cost Institute (HCCI) online release (12/17/19):
From a Health Care Cost Institute (HCCI) release (12/17/19):
- Holland had the lowest prices for hip and knee replacements with prices less than 25% of the US price. Prices for hip and knee replacements in the United Arab Emeritus (UAE) were the closest to the US at 71% of the price.
In a WTOP-FM interview, Health Affairs Editor-In-Chief Alan Weil assesses how consumers may (or may not) benefit from two long-anticipated rules, recently unveiled by the Trump Administration, that increase price transparency for both hospitals and insurers.
From a New York Times online article:
For new patients, whose visits entail more work than those of established patients, facility fees typically range from $131 to $322 per visit; for established patients, they are slightly lower. In surgical centers and free-standing emergency rooms, the facility fee can be thousands of dollars.
A facility fee is an additional charge that some medical practices can add to the cost of each doctor visit. The additional charge usually comes as a surprise because, unlike an exam or a test or treatment, the facility fee is not tied directly to hands-on care.
The purpose of the facility fee is to compensate hospitals for the expense of maintaining the physical premises. Hospital-owned, off-campus medical practices are also allowed to charge the facility fee to cover specific regulatory requirements, such as building codes, disaster preparedness, equipment redundancy and other items that are largely invisible to patients.