Getting An Estimate of Surgery Costs
In cosmetic surgery, pricing may not be as important as the reputation of the provider
If you’re a patient about to enter hospital for a procedure or treatment, one of the hardest things to obtain is an estimate of how much all of that is going to cost. Talk about healthcare being an industry, it is well within a consumer’s rights to know what he is paying for and how much it will set him back.
In today’s world of egalitarianism and transparency, one would expect that hospitals would give a reasonable estimate of the expected expenditure, in much the same way that a consumer expects a price quote for services to be rendered in practically every other industry. But yet, as a government study in the US published last month confirmed, consumers are usually unable to get accurate information about how much medical treatment will cost them before they receive it.
There were several reasons disclosed for this: difficulty of itemizing health care services in advance, billing coming from multiple providers, and the variety of insurance benefit structures. Add to this legal and competitive concerns about sharing price information, causing price comparisons to be extremely difficult.
I have always maintained that unlike other industries and businesses, healthcare services do not provide any ‘money-back’ guarantees should good outcomes are not achieved. Even if the surgery was a failure and death results, the costs of services provided still have to be paid by the consumer. Worse, if the surgery undergoes complications despite competent surgeons and fail-proof equipment, the unexpected expenditure incurred will prove to be an extra burden for the consumer. Herein lies another problem – the nature of medical treatment and surgery is such that, despite the best of intentions, unexpected complications can occur and upset the most carefully-thought budgets.
In an emergency, pricing and choice goes out of the window
What do I recommend? Several hospitals now put up a price-list on their websites and it may be prudent to search around if you are price-conscious and paying out-of-pocket. But the final decision still depends on other factors like the quality of healthcare delivery and the reputation of the attending doctor as these do determine a good outcome. Legislation is pending in many countries where it is mandatory to exhibit a price-list so that price variations are transparent.
Even then, these price-lists will come to naught in the case of a medical emergency, where its really a case of Hobson’s choice and the consumer is pressured to pay for the services, like it or not. Yet again another example of why healthcare is not like any other industry..
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No Facebook Please..I’m A Doctor
..that’s the message, as far as patients go, that is. The British Medical Association (BMA) has issued a clear warning to doctors: they should not accept Facebook requests from patients.
The BMA says social networking and patients do not gel
In today’s world of social networking, many doctors, nurses and medical students use social media – including Facebook, Twitter and blogs – with no problems. But the BMA recommends they adopt conservative privacy settings and declare any conflicts of interest when they post online. This is especially so when they invite patients as friends. The dangers of breaching confidentiality, damaging their professionalism and risking the doctor-patient relationship are too great, BMA says.
I do feel there is substance in this warning. All too often, its too easy discussing personal medical details with an online friend, not realising that, even with privacy settings on, such details may be accessible to others.
Even with Facebook accounts set up between only doctors, many have been disclosing sensitive medical information – and even mocking patients – on Facebook. The NSW Medical Board in Australia has cautioned one doctor for making “flippant and derogatory” comments, and warned others to “think twice” before disclosing patient details on social networking sites.The NSW president of the Australian Medical Association was astonished that doctors posted patient information on Facebook.
Maybe its time that medical students be lectured on the inappropriate use of social media..
Related articles
- Doctors warned of social media risk (mirror.co.uk)
- Facebook friends a no-no for doctors (guardian.co.uk)
- How doctors can use Facebook responsibly (kevinmd.com)
Excuse Me..But Are You A Real Doctor?
Looking at the number of people with the honorific prefix “Dr” before their name, its not surprising that the public is getting quite confused on what the title represents..
Apart from the Doctors of Philosophy (Ph.D) and doctorates from some branches of engineering who do not dabble in healthcare , the title “Dr” can lead to lots of confusion among the public. This was borne out from a recent survey by the American Heart Association which among other things concluded that patients are not sure who is – and who is not – a medical doctor.
The survey asked if the following were medical doctors:
Orthopedist/orthopedic surgeon: Yes, of course! Except it wasn’t so obvious for the 16% of respondents who said “no” or were unsure.
Chiropractor: Not a medical doctor, a fact known by 64% of those surveyed.
Dentist: a dentist is not an M.D., but 69% thought otherwise.
Physical therapist: Not an M.D., but 22% said “yes” or were unsure.
Nutritionist: Not an M.D. Also a meaningless title. Same with “food coach,” “nutritional consultant” whose qualifications can range a lot. Look for “registered dietician” to be sure that they have attained the required training.
Ophthalmologist: Yes, an M.D, though 29% said “no” or were unsure.
Optometrist: Not an M.D., though 46% thought otherwise or were unsure.
Optometrists: almost half of survey respondents thought they were medical doctors
Primary-care physician: 9% actually said a PCP wasn’t an M.D. or weren’t sure.
Nurse practitioner: Despite the fact that this job title unambiguously includes the word “nurse,” 31% thought it required an M.D. or weren’t sure. The AMA is taking steps to make sure such confusion is minimised among the public.
Australian Nurse Practioner - often mistaken as medical doctors by patients
Regarding the latter, The American Nurses Association says this is part of the AMA’s “ongoing effort to limit the scope of practice of health care providers who are not physicians” and would make it illegal for non-physicians to say anything that would lead people to believe that their education, skills or training are the same as an M.D.
Turf protection, or, public service? You decide..
The Greek Tragedy & Healthcare
If there’s any lesson to show that healthcare today is an industry, take a look at Greece. With the economy heading south, even healthcare is affected just like any of the other industries in Greece – production problems, delivery issues and lack of supplies are for real. What with the current economic turmoil, a leading global pharma company has even decided to pull the rug and stop supplying a state-of-the-art medication to the beleaguered country.
Novo Nordisk is planning to withdraw the sales of its Novopen insulin syringe in Greece
Novo Nordisk, a Danish company and the world’s leading supplier of insulin (a drug used for treating diabetes) is withdrawing the Novopen from Greece as it objects to a government decree ordering a 25% price cut in all medicines (see here).A spokesman for the Danish pharmaceutical company said it was withdrawing the product from the Greek market because the price cut would force its business in Greece to run at a loss.
This has resulted in local action groups condemning the move as brutal, bad timing and a neglect of corporate social responsibility. Novo Nordisc on the other hand claims that it is owed $36m (£24.9m) dollars already by the Greek state, whose coffers are now empty.
Most likely, many other big pharmas will follow suit soon and is likely going to cause a crisis within a crisis soon. (Doctor2008: its now reported that another firm, Leo Pharma is also withdrawing sales). Which is a shame, because Greece in recent times ensured everyone of its citizens received free healthcare services and at the same time had one of the most admired private healthcare services in Europe, the so-called “Greek Paradox”.
Back to my opening sentence – its all very well for some activist groups to proclaim universal healthcare rights for all, but this has to be tempered with the realities of the economics of modern healthcare delivery. No country in the world can afford a liver transplant for every patient with advanced cirrhosis of the liver; so I beg to differ with those who say healthcare is a basic human right…I would amend it to say that basic healthcare is a basic human right.
Developing countries like Malaysia could do well looking at what’s happening to Greece, because when push comes to shove, healthcare, like any other industry, will be subject to ups and downs of economic forces and suffer the same consequences as any other industry.
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Obama’s Health Bill – Guess Who’s Unhappy Now?
Making history, President Obama signed into law the healthcare bill yesterday, making it the first time that there is healthcare coverage for every American. Well, this certainly made the Republicans unhappy, they citing that the phenomenal costs involved will drive the nation deeper in debt.
Putting Pen to Paper - President Obama transforms the bill to law
Also not looking forward to the new law will be all the private health insurance companies, who for years have been making handsome profits, mainly by including various escape clauses to exclude payments for health expenditure where it mattered most, such as in claims for pre-existing illnesses.
Even so, one of the more unpublicised facts from the new law, hidden within the massive pages of the bill, is a requirement that will make calorie counts mandatory for thousands of restaurants. More than 200,000 fast-food and chain restaurants will now have to state the number of calories each item on their menu has, the idea being to inform the consumer the number of calories they are consuming.
Chain restaurants,like Starbucks, will have to state Calorie Counts on all items on the menu
Grumblings are also being heard from doctors. The new law introduces curbs on doctor-owned hospitals and promotes an independent payment advisory board that does not include doctors, However, it does not include a performance-based payment system and does not address reforms meant to reduce medico-legal litigation costs (this being arguably one of the main reasons why heathcare costs are so high).
While the healthcare bill has become law with the President’s signature, storm clouds are looming – attorneys general from 13 states – 12 Republicans and one Democrat – have begun legal proceedings against the federal government seeking to stop the reforms on the grounds that they are unconstitutional. So it does look like the ‘victory’ is not yet sealed in stone..
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At $282 Million an Hour, It Ain’t Cheap!
The US spent $2.472 trillion on healthcare in 2009..that works out to $282 million an hour, give or take some loose change.
According to this article in the Journal of Health Affairs, this means that the healthcare portion of the GDP rose to an all-time high 17.3%, more than double of that of most other countries.
No wonder President Obama is placing healthcare reforms as a top priority – at the rate its going, healthcare expenditure will soon burst at its seams. Even more alarming is the fact that, for the first time in the next few years, public spending for healthcare services (Medicare, Mediaid, Veteran hospitals, children insurance program) will outstrip the largely private-sector driven healthcare expenditure. Put in another way, by 2012, public (government) spending will account for more than half of the total healthcare spending in the US.
In the US by 2012, the dark blue and yellow portions of the pie will shrink to less than half
Why is this so?
The main reason appears to be that healthcare spending continued to rise despite the recession that resulted in reduced spending in other areas of the economy.. After all, people do continue to get sick, in good times or bad.
This healthcare spending continued to rise partly due to the aging population; but the real reason is due to increasing prices (3.2% a year) and increasing use –utilisation in tech-jargon – at 1.5% annually.
Quite naturally, President Obama is looking at cutting expenditure like reducing Medicare costs, but this has not gone down well with the Democrats, creating delays in approval at Congress. Already, the President has backed down quite a bit from his original proposals and the way ahead appears to be for the Democrats and the Republicans to work together for a common solution – which is easier said than done.
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Healthcare Costs: Barking Up The Wrong Tree
If you have been following the progress of President Obama’s proposed healthcare reforms, you would have noticed the numerous obstacles and protracted course it has taken. When he first mooted it during the presidential campaign, Obama the Democrat stood for government to provide healthcare for everybody by expanding the role of the existing Medicare into a compulsory public insurance scheme. This has now metaphosised currently into two Bills to be considered in Congress: the House Bill and the Senate Bill, both with differences. But whatever the Bill, Obama had to backtrack by accommodating private insurance companies; with the proviso that they would operate in a single insurance exchange incorporating public insurance schemes.
Too Much Emphasis On Who's Paying For What!
Why is this important to all of us outside the US? Quite simply, healthcare is a massive trillion dollar industry in the US and whatever happens here is bound to affect the rest of the world. Meanwhile, as the bureaucrats and politicians mull over what’s next, healthcare delivery seems to be spluttering along. Take for instance, the plan to close the only acute care hospital in Greenwich,NY (St Vincents) because of insurmountable debts (see here). This has understandably created a strong protest from the local community.
St Vincents Hospital,Greenwich Village,New York - in near-bankrupcy and facing imminent closure as an acute-care facility (pic from New York Times)
Elsewhere, I wrote in a recent posting about the plan to close the Royal National Orthopaedic Hospital in London for very much the same reason – soaring expenditure well over budget.
If we look at the healthcare reforms in the US or Great Britain, the question regulators need to ask is not who’s going to pay for the costs. The bigger question should be : how to reduce costs?
There’s a growing feeling that not enough attention is being given to look at ways and means to bring expenditure down. Rather, more attention seems to be devoted in identifying the payors. Should not more focus be given to minimising duplication of services for a particular geographical region to enhance efficiency? Or capping the litigation costs and awards for medicolegal suits? Or enhancing the usage of generic drugs that have proven efficacy?
Many of these measures will generate strong opposition from vested parties, but since the health reforms are about fundamental rights to healthcare, it would seem logical that the wellbeing of the public should override the interests of those with vested interests, like big pharmas and private insurance companies, for instance.
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If You Can’t Beat Them, Join Them..Then Beat Them!
Even if you have never heard of the Royal National Orthopaedic Hospital (RNOH) located in north London, it doesn’t take too much to gather that it is a national healthcare institution revered by the British. The RNOH is one of the world’s leading orthopaedic hospitals and treats 60,000 patients a year. The big problem is this ageing hospital is in a chronic state of disrepair and costs millions of pounds to maintain every year.
The RNOH in Stanmore,Middlesex - leaking through the roof as well as the budget
The hospital is the single biggest employer in the constituency, but nearly two-thirds of the buildings are pre-fabricated pre-war structures. Water leaks through the ceilings while surgeons operate on patients (I know a few recently-constructed hospitals which are doing the same!), and the maintenance backlog is running at an estimated £54m. The NHS trust, which owns and operates the RNOH figures it would be in the best interest (whose?) to decentralise the hospital services and shut down the current one, so that it would be more economically viable.
Prof Tim Briggs..taking on the Labour MP on a single-issue campaign in the next General Elections
Well, not if Professor Tim Briggs, medical director of the RNOH, can help it. He intends to challenge the former health minister Tony McNulty as an independent candidate for Harrow East with the aim of securing the future of the renowned institution. Despite intense lobbying the last 15 years , he has not got the required £60m from the NHS despite the support of the Prime Minister and successive health ministers.
Now, Professor Briggs is applying to the electoral commission to register his new political party, the Central Party for Reform, before he takes on the incumbent Labour MP.
And his chances of winning? Going by precedence (In 2001, Dr Richard Taylor unseated the incumbent Labour MP when he fought to save Kidderminster hospital), he does appear to have the upper hand..
Read more about it here.
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