Yep, we Americans are all paying too much for health care. According to Eric Topol in The Patient Will See You Now, the future of medicine is in your hands, Some hospitals charge up to $1,200 for every $100 of their total costs. And the 100 most expensive hospitals charge 7.7 times their cost. For example, a single tablet of acetaminophen will at $1.50 to your bill, while you can buy a whole bottle of 100 pills will cost you $1.49.
The U.S. is the only country that doesn't control the cost of health care. In Spain a hip replacement is $7,731, while in the U.S. the average price is $40,364! Are you aware that the average uncomplicated pregnancy in the U.S cost $37,341! This is why medical tourism is so popular. People go out of the country to receive reasonable health care.
What other market would consumers have no idea what they are being charged or how much the insurance will pay until after the service? Why are we unable to shop for medical care the same way we shop for an automobile?
Hospitals, doctors, and labs bill uninsured individuals and insureres vastly different amounts for the same service. The charges are not based on costs but on whatever the market will bear. Almost all other developed countries' governments negotiate and regulate pricing. The powerful lobbying groups of all sectors of health care make sure that doesn't happen here. And we, like sheep, allow it to continue.
Research has identified six areas of waste that could bring down the cost of health care. They was five years ago. Little has been changed since. These areas of care are, Inefficiently delivered services, prices that are inflated, excess administrative costs, fraud, missed prevention opportunities, and Unnecessary services - the biggest wedge of the waste pie.
There are many widely used medications that have no research showing their efficacy. Many are widely advertised as better than older medications, even though there is no evidence to support that. Patients expect the newest drug, whether it is better or not. And because it is thought to be better, companies can get away with overcharging for it."More than 1 in 10 Americans takes an antidepressant and for women age forty to sixty, the rates is 1 in4. But studies have shown that more than 2 out of 3 of the patients taking those drugs do not fit the accepted criteria."*
And then there is the failure to use pharmacogenomics to determine what medication best fits the individual needing it. Pharmacogenomics is the use of your genetic markers to trace which meds work for which person. This is an exciting new field of research that is being practically ignored. Only a very few medications have been researched for the genomic or biomarker for predicting responsiveness to common conditions. Using this information could lead to a major turnaround in effective medical care. A recent look at cancer patients has shown this to be a very hopeful field of science. And it could make enormous changes if more common conditions were studies.
And then, of course, is the unchecked use of medical imaging - CT scans, MRI, ultrasounds, mammography. The use of scans in the U.S. dwarfs their use in an;y other country in the world. MRI and CT scans in the U.S. exceed $250 billion. On top of the financial costs, 3 to 5 percent of folks getting scans will get cancer because of the cumulative exposure to ionized radiation. How many of these scans are necessary?
Women have routinely been getting mammograms annually in the U.S. Yet most of these women are not high risk for cancer and are exposing themselves unnecessarily to increasingly high amounts of accumulated ionized radiation. And recent research has shown that frequent mammograms have not been shown to result in a lower rate of breast cancer. Other countries have even eliminated mammograms without evidence of an unexplained lump or other symptom. Yet, as long as our insurance pays for the scan, Americans do it "just in case." We are never told about the amount of radiation we are exposed to and how much we have accumulated over the years, even though there is research to support the fact that radiation causes cancers.
Many of these imaging centers cost millions to build and operate, so the cost to the consumer is high, especially when those costs are inflated when passed on.
How many of us get annual physicals, even when we have no symptoms or history that would support the need for a physical? Other countries have recommended giving up annual physicals. The annual physical has become an American ritual, with more tests, more scans, more procedures and more operations. Is it any wonder that there is such a battle around health care? Someone is making a lot of money on our perceived need for all this. And most of us are unwilling to let go of that belief, especially our medical professionals who reinforce it. Doctors are still paternalistic gods who know what is best for our bodies, even when we know more about or own bodies than they.
This has been the history of health care in America for centuries. We own our bodies but not information about our bodies. We are convinced that we couldn't possibly understand the complexities of our own health. The future will change all that. In my next blog we'll look at the impact of the information age on our ownership of our healthcare.
*This blog is based on the book The Patient Will See You Now, the future of medicine is in your hands, by Eric Topol.