THE COST OF HEALTH CARE IN THE USA

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This is an extract of my article, with small photos. You will find the complete article with full-sized photos in my e-book Fibromyalgia, only the tip of the Iceberg ?

Fibromyalgia is a most unusual illness, that is as yet not well understood. Decades of research, an amazing collection of physicians, thousands of consultations and an astonishing variety of diagnoses have failed to deliver even a glimmer of an effective treatment.

This study thoroughly investigates the disease, the medical procedures, the diagnosing methods, associated conditions, the sometimes obscure workings of the health industry, and comes up with some remarkable findings. Well documented and extensively referenced.

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Medical Testing and Billing

The medical industry has a long history of "chain-linking" consultations from a family physician to a specialist to still another specialist, and each time redoing all the tests, simply because allegedly meanwhile new methods or new technology have been developed, that are arguably far more performing than those used in a previous consultation. Furthermore, a sore point concerns the economical incentive of especially larger medical institutions, and what this entails as to medical testing and medical billing.

A universal side effect of this behavior is the literally exploding cost of Health Care. It is not uncommon to hear (unofficially) that it is "hospital policy" to redo every test that has already been performed by foregoing physicians, or even earlier by the same physician, to "check any change in the results". This "policy" glaringly bypasses the obvious fact that any medical test is nothing more than a snapshot of a momentary situation.

The U.S. performs more clinical tests than any other country. In 2010 it did 100 MRI tests and 265 CT tests per 1000 people, twice more than in other countries. It does more tonsillectomies and knee replacements than any other country, and has more Caesarean sections and coronary bypass procedures than in most other countries. These procedures and the use of expensive diagnostic tests are all subject to physician opinion on whether they are desirable or not. Being sick is big business!

The "mechanics" of American Health Care

cartoon of a doctorSpending on almost every area of health care is higher in the U.S. than in other countries. For example, nearly $900 per person per year goes on administrative costs. This is far higher than for instance in France, which spends $300 per person. One reason for higher costs is that the U.S. has been slow to apply modern communications technology to improve the administration and to cut down on waste.

Just a few examples. An every-day aspirin costs on average about $ 5 in a hospital. In some New Jersey hospitals, the daily price has increased to well over $ 5,000. An appendectomy, which is a perfectly common and uncomplicated procedure, costs in California on average $ 18,000, the two-day hospital stay included. The treatment of a heart attack costs on average $ 21,665, pneumonia is good for $ 9,642 and giving birth costs $ 1,344.

A coronary bypasses costs 50% more than in Canada, Australia and France, and 100% more than Germany. Hip and knee replacements are more expensive than in any other country, as is PTCA (coronary angioplasty). Why precisely prices are higher in the U.S. is difficult to say, but two things are apparent. U.S. physicians get higher incomes than in other countries, and the U.S. uses more expensive diagnostic procedures. Being sick is obviously Big Business...

Creative hospital billing

The amount of hospital bills in the first six months of 2003 increased with no less than 7.6%. Outpatient Care, whereby the patient remains less than 24 hours in a hospital, even increased by 13% in the same period. Hospitals proceed with a completely opaque billing, so that the interventions themselves apparently remain reasonably priced, but the toast is buttered with a range of additional costs. This strategy is not new, and can best be compared with the list price of a new car and its additional options...

pills and bills...Only few patients pay the full price, because insurers get rebates, and Medicare imposes a target price for their reimbursement on surgery. Which is why hospitals charge "additional expenses", just to increase the final amount of the bill.

These "additional expenses" have lost every connection to their real cost. Some hospitals annually raise their expenses by 20 to 30%, since there is no control whatsoever and they can be "adapted" at their sole discretion. In 1993, the billed amounts for "additional expenses" were on average 159% higher than the actual cost.

Ten years later this percentage increased ridiculously to an average 211% and in California, Florida and Nevada that increase reached even 300%... Most insurers receive discounts on these "additional expenses", and Medicare only pays a fraction of them. Which means that the individual patient usually bears the brunt of this financial onslaught. It would seem that the powerful military motto "Leave no man behind" was conveniently renamed to "Leave no single buck behind"...

Immense Waste...

The annual turnover of the hospital industry is well over one trillion dollars, and so the game is played with no holds barred. A recent report of the Institute of Medicine (6 Sept 2012) finds that the immense waste in Health Care diverts much needed resources from elsewhere. Its committee estimates and incredible $765 billion in unnecessary health spending, in 2009 alone. The figures are simply stupendous!

How all of this will turn out nobody knows, but as usual the insured patient will hold the short end. By law, hospitals can collect unpaid insurer bills from the insured individual himself, even though he IS insured!

Video : Cutting Health Care costs

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