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A simple ED visit can cost <5k, 50 thousand dollars, 1 million dollars, or 5 million dollars.
An estimate for your kitchen getting redone is not like this.
The error bars around those are secondary to the fact that when people want an estimate in their mind that estimate is a commitment and being told a range from 500 dollars to 5 million is worthless information.
Yes plenty of healthcare interactions are simpler than that but if you are going to demand estimates for everything you have to capture this problem, if you are going to demand estimates when feasible we already do that.
Do the hospitals have the data on how much similar simple ED visits have costed in the past? If they do, literally how hard it is to literally print it out as a distribution graph and hand it to the patient?
For a few reasons, one is that the hospital is not in charge of the patient's bill, they are in charge of the bill that the patient's insurance gets. They don't have access to or control over that information, what the hospital can provide is something else.
Another is that anything more sophisticated than "the average patient in the ED generates X dollars in charges, here are the error bars" requires significant clinical time to develop. Do you deliver the patient only ICD codes? CPT codes? One primary code vs all encounters with comorbidity? Who is "like me" for expected billing purposes is NOT an easy question.
Another is that this information is materially valuable to the hospital's "enemies" yes that means competing hospitals but also the insurance company who if they have more complete information can leverage that. Famously - hospitals go bankrupt if they only get paid in Medicare and Medicaid (which is less than cost often), extracting the most money from commercial insurance is the only way to stay afloat without significant financial subsidy from the government, with Hahnemann being the most infamous example of how that isn't usually enough. Also see the recent issues with rural hospital failure.
The last reason is that the information is beyond the average person's ability to use and can significant problems. Someone with good insurance might go to the hospital with chest pain, generate 300,000 dollars in charges for their insurance and then be on the hook for a 150 copay. If you get a piece of paper that says "1 percent of ED visits generate charges more than 250,000 dollars" then the average person will sprint away before they can be told that their insurance is never going to charge them that.
You might maintain that you will use this information sensibly and that may be true but the average person is not you and you are unlikely to be you if you are in a moment of medical extremity. The graph isn't that useful and will literally cost lives even if they aren't lives you particularly care about.
Nobody who has complained about this in this discussion or last time has really given me an example of a clinical situation where they would put this information to use. I imagine it's not running away from the hospital when they have a ruptured appendix. It's probably for trying to figure out which colonoscopy is cheaper and shit like that. That's a much more fair use case but hospitals are disincentivized from providing these numbers for multiple financial and liability reasons and it's extremely hard to legislate this given things like the difficulty in defining care settings (What's ASC? You are telling me the ED and Obs are not the hospital even though they are in the hospital and your are on a hospital floor? Oh they are for some things but not others.....blah blah).
Hospital spending is the largest single category of healthcare spending.
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If you actually think that the error bars are secondary, than not only is getting your kitchen done exactly like that, every good and service is as well.
Providers have to decide if they want to give a unified price to all their customers, or if they can predict which type of customer is associated with which kind of cost, and offer different prices based on that. If there's anything that would set healthcare apart from other industries, it is the error bars, but since you're saying it's not them (and I agree, that only impacts the price level, not the possibility of giving a price) this is absolutely nothing new for any entrepreneur or manager.
You might be right that the customers won't want to get profiled based on their diet or whatever - that is a completely irrelevant argument to what we're discussing, and can be addressed by regulators if it bothers people too much.
No?
Nobody is really calling for this and if given a list of priorities (like overall expensive, waiting room times) people will put price transparency at the bottom.
Additionally health system do not decide how much patients pay. Insurance companies do. If you would like more price transparency in how much people pay ask the people in charge of how much patients pay.
Yes? I don't know about you, but I never had to pay more for coffee because the espresso machine broke down earlier that week, or because the waiter they hiree recently is slower than average and can't cover as many tables as fast.
Is there a reason why you keep moving to arguments that aren't relevant to the conversation?
My apologies but I don't really feel like we are going to have a productive conversation and we should call it here.
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