“The Price Is Right?” – Taking the Guesswork out of Medical Tourism Pricing

Back in May, I wrote a post entitled, “If You Have to Ask…Fuggedaboutit! “, in which I described the difficulty I had in trying to get pricing information from facilities in Latin America and the Caribbean, and why transparency was needed if medical tourism was ever going to be implemented into workers’ compensation.

David DePaolo this week posted another wonderful piece on that very topic, medical transparency. His article, “Medical Transparency: Resistance is Futile”, was a commentary on a video posed by a video blogger named John Green, on YouTube that asked the question, “Why Are American Health Care Costs So High?”

 

The reason, David suggests that costs are higher here, is because they can charge whatever they want to, and people will pay it.

According to John Green, there is no central pricing controls as there is in other countries, consumers will pay whatever is charged because they don’t know any better, and because, as I’ve said before, there is no transparency in pricing, both domestically as John and David state in the video and article, and in medical tourism.

David goes onto state that it makes sense that health care pricing should be a factor in medical care decisions, and he points to a news article from WorkCompCentral that discusses this with regard to a surgical facility in Oklahoma.  These decisions are usually made, David says, when there is time to make an informed judgment about a procedure, which is usually most of the time, especially in medical tourism.  [Emphasis added]

Some medical businesses are beginning to advertise their prices, according to David, and it is causing a debate in certain medical circles. The Surgery Center of Oklahoma is one of those businesses that have posted its prices and a bidding war has begun with other facilities in that state.

As far as general health care is concerned, David says that pricing transparency is gaining momentum, but as we have seen in medical tourism facilities, such transparency is anything but transparent.

The state of North Carolina passed a law requiring hospitals to provide prices for 140 common procedures and services, and the federal government published the billed charges for the 100 most common procedures for inpatient services, including spinal fusion.

While much of what David and I have been discussing so far is related to general health care costs; as for workers’ compensation, the issue of price is meaningless, David points out, without knowing the quality of the care provided, meaning outcomes. Again, this is where medical tourism fails to be transparent, because it claims on the one hand to be less expensive, but won’t tell you how much, nor will they tell you what their quality outcomes really are, only that they are better than what is found in the US. Man may not live on bread alone, but medical tourism shouldn’t live on faith alone either, it has to have facts and data to back up its claims, the data must be reliable, and they have to be transparent.

In workers’ compensation, much of the decision making is not incumbent on the patient/injured worker, so that price is not their concern, as it is not their money.  These decisions are often left to physicians, insurance companies or claims administrators, attorneys, the state, or the employer; therefore, the patient/injured worker only decides if they are going to undergo a particular procedure.

There is no reason, David says for the patient/injured worker to not know how much is being charged for a service or a product before the actual purchase of the service or product.

The only thing that a patient/injured worker would be concerned about is the quality, because it is their body that is going to be operated on, so naturally they want to know that the outcome will be successful. You’d want to know that the spine surgery you are about to get is going to leave you either paralyzed or will allow you to walk again, right?

Education about quality, the doctor/patient relationship, easy and available data that can be interpreted, as well as choice in providers (even medical tourism providers) will make a difference, according to David.

Transparency will be good for the ultimate health of the medical industry and workers’ compensation, which has been my argument all along, and as consumers get used to seeing prices before making decisions about procedures, the more that pricing will become a factor in choice.

Once that happens, David believes, those competing on prices will start publishing outcomes and quality measures, and there will be competition based on outcomes. It is a matter of culture, and both the culture of the medical tourism industry and the workers’ compensation industry must change. Not to do so will be very costly and very dangerous for those who pay for health care and those who receive health care.

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Thank you so much,

Richard

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This entry was posted in Health Care Costs, Medical Tourism, Quality, Quality Measures, Transparency, Workers' Compensation and tagged , , , , on by .

About Transforming Workers' Comp

Have worked in the Insurance and Risk Management industry for more than thirty years in New York, Florida and Texas in the Claims and Risk Management spheres, primarily in Workers’ Compensation Claims, Auto No-Fault and Property & Casualty Claims Administration and Claims Management. Have experience in Risk and Insurance Business Analysis, Risk Management Information Systems, and Insurance Data Processing and Data Management. Received my Master’s in Health Administration (MHA) degree from Florida Atlantic University in Boca Raton, Florida in December 2011. Received my Master of Arts (MA) degree in American History from New York University, and received my Bachelor of Arts (BA) degree in Liberal Arts (Political Science/History/Social Sciences) from SUNY Brockport. I have studied World History, Global Politics, and have a strong interest in the future of human civilization in all aspects; economic, political and social. I am looking for new opportunities that will utilize my previous experience and MHA degree. I am available for speaking engagements and am willing to travel. LinkedIn Profile: http://www.linkedin.com/in/richardkrasner Resume: https://www.box.com/s/z8rxcks6ix41m3ocvvep

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