We have just completed the general registration period on The. Tribune, and I wasn’t particularly happy with what I saw this year.
To the Tribune’s credit, our health plan premiums did not increase. But everything else was bad news. As you can see, deductibles increased significantly, up 66% year over year. And, just as badly, the amount of each treatment that insurance pays has decreased by 10 percentage points almost across the board. Not good, Bob.
I say this out of empathy for you, not to garner sympathy. Most Americans, like me, have found their deductibles and copays significantly increased this year, according to reports, as companies tried to keep premiums level. National survey of employer-sponsored health plans by Mercer. Mercer also expects an even bigger leap forward.
That means both you and I are likely to have more medical bills than last year. So I became more interested in how much medical procedures, tests, and prescriptions cost. Unfortunately, medical billing is a dizzying mess, and even solutions seem to cause problems. I will explain what I mean.
Cost transparency resources
The good news is that Utah has important resources available for researching the cost of medical procedures.
First, Utah is one of 18 US states with an established All Payers Claims Database (ABCD). The idea here is pretty cool. Essentially, all bills sent to health insurance companies are recorded in one large database, which researchers can use to figure out which procedures are most often performed, which drugs and when. It can answer all kinds of medical questions, such as how much is administered and how much each procedure costs. Costs, which hospitals and doctors are the most expensive, which doctors are the least expensive, etc. We love data. This is great data.
The most complete representation of this data I was able to find is here: State Open Data Website Posted from 2021 to the end of 2022 in one big Excel spreadsheet. That sheet is huge at 141,000 rows and very unwieldy. Simply put, different hospitals charge differently for the same procedure or series of procedures, making it very difficult to compare the same.
Unsurprisingly, the most common procedure was COVID-19 testing. The most expensive item on the list is when a primary children’s hospital administers nusinersen, a drug for spinal muscular atrophy. In 2021, hospitals charged an average of $120,000 for the surgery.
Alternatively, consider a “total knee arthroplasty,” or total knee replacement. In total, various hospitals in Utah cost him $22,000 to $124,000.
Still, this data is cumbersome due to its large size and difficulty in comparison. So the State Comptroller’s Office tried to come up with a solution that would make it easier for people to access medical pricing information. health cost.utah.gov. You can go there, choose one of the 177 procedures and tests, and see costs from various doctors and hospitals. For example, a strep test can cost anywhere from $5 to $124. Because it all seems to go to medical billing.
The biggest problem is that the data on the website is quite old. At best he’s from early 2020, at worst he’s from 2018. As you know, healthcare costs have exploded over the last three to five years. Also, if you want to do something outside of these limited steps, you won’t find any information about it there.
If you need more up-to-date information, the hospital itself may be your best source.can go to healthcare.utah.edu/pricing For the University of Utah Health Care System, or intermountainhealthcare.org/patient-tools/hospital-cost-estimates/ For Intermountain Health Hospital, enter information about you and your insurance to get an estimate of how much your surgery will cost.
Unfortunately, only 8 out of 20 hospitals in Utah Researched by PatientRightsAdvocate.org in February 2023 It was fully compliant with federal cost transparency rules.
problem
In announcing the health cost.utah.govState Comptroller John Dougal I explained the main use cases of the site: People shopping for the lowest price for a particular medical procedure.
The problem is that this doesn’t really happen all that often.
Most people don’t have many choices about where to get medical care. In an emergency, proximity to the hospital is probably most important. Except for emergencies, people go where insurance covers some costs. In most plans, most local hospitals and doctors are outside the network and thus effectively off limits.
Interestingly, the cannibal section is where the site gets the most attention, with over 15,000 users there. I looked up medical cannabis prices. That makes sense, especially considering how many people don’t use insurance to pay for that product.
Dougal also hoped primary care providers could use the site to intelligently refer patients to doctors and treatments that fit their budget.But that doesn’t seem to happen much either – they there seems to be I’m pretty disappointed with the number of people using this website so far. Again, the issue of insurance exclusivity comes into play, as do the incentives for insurers. They are probably more motivated to receive care that clients can comfortably refer to than the least expensive care.
These problems aren’t unique to Utah.. As these states enact large all-payer claims databases and other items that promote transparency, one of their primary goals has been to reduce healthcare costs. The idea is that transparency leaves hospitals vulnerable to free-market pressure from competition, perhaps forcing them to charge lower prices for their services or risking bankruptcy. Same as normal business.
That didn’t happen. in fact, Survey November 2022 entitled “The Impact of Price Transparency and Competition on Hospital Costs: A Study of the Whole Payer Claims Database” considered exactly this problem. The results were pretty dire.
First, the study found that states with an All Payers Claims Database (APCD) tended to have higher healthcare costs than states without one. This is the opposite of what you would expect.
Perhaps that is the correlation going in the wrong direction. It’s not that the APCD is driving higher medical costs, it’s that the high-cost states are trying to solve the problem by creating his APCD. Or maybe the hospital system administrator is looking through her APCD to see what she can do with the charge. Anyway, it’s not great.
Second, the researchers found that states with weak market competition and no APCDs at all actually had the lowest hospital costs. In fact, “market consolidation has allowed care to be coordinated more effectively, saved operating costs, and benefited from economies of scale due to its size,” they say. In other words, according to this study, competition does not appear to be making hospitals cheaper.
Now listen. I love data. I have loved numbers since I was little. I majored in mathematics. I’m a data columnist for the Tribune. But the research, and frankly, the dynamics and incentives considerations here, seem to indicate that healthcare costs are high. In fact, it’s not a problem that data transparency can solve. Cost can’t normally be a factor in the health care decision-making process, so bills can skyrocket without much impact on anyone but ordinary folks like you and me..
This poses a problem for bodies such as the Utah Medical Data Board and the State Board of Audit’s aforementioned Medical Price Transparency Tool. As you know, the State Legislature has both scheduled for his July 1, 2024 sunset. While this sounds harsh, it seems to be a relatively standard procedure that committees and projects must demonstrate effectiveness in order to continue receiving funding.
Proposals for ending these programs have been largely overshadowed at Congress’s recent Health and Human Services Committee meeting, but I’ve heard that the issue will be raised further at the June Commission’s meeting. At the last meeting, experts said The Utah Health Data Commission seemed relatively confident it would get funding again, and I hope so. It’s good to collect this data to understand the current state of health care in Utah. The Utah Health Data Commission is more than just a commitment to transparency.
But we also need to understand the limitations of free market approaches to reducing health care costs. Simply put, it’s not working and it’s unlikely it will ever work. In order to make medical expenses reasonable, the current system needs to be changed significantly.
No progress has been made on the issue for a long time and it does not appear to be a top priority for parliamentarians. I think the newly raised deductible amount will continue in the future.Will medical costs continue? spirally.
Can we stop this cycle and make real change? I’m not holding my breath. After all, that might cost me a trip to the hospital, but I can’t afford that.
Andy Larsen Data columnist for the Salt Lake Tribune.you can contact him [email protected].
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