Non-Americans who aren’t familiar with the US healthcare system can skip this post. Those of you who are used to national health systems, where costs are mostly identical across providers, are known before treatment, where most necessary medical treatments are covered and a bill never reaches the patient, can take a moment to appreciate your country.
On the other hand, Americans, insured or not, are almost surprised when they receive their health bill. They’re surprised at three levels: the items and procedures that they were billed for, the price of those items and the amount covered by their insurance. There are always surprises: bandaging a sprained wrist is called “surgery,” a splint sold for $15 at the local pharmacy is billed for over $100, and identical procedures for different family members are covered at different rates, and those are just some trivial examples. There is a lack of transparency that is so absurd that it allows providers to charge almost whatever they want. Even if a patient is brave enough to ask their medical professional what the charge will be for a certain procedure, product or medication will be, the provider usually doesn’t know.
There are not that many successful start-ups in the healthcare industry. This is an extremely difficult industry to break into and disrupt. It seems like the medical providers are still in the age of “no one got fired for buying IBM” technology phase. It’s understandable that they don’t want to take a risk on smaller companies when they’re afraid of such companies disappearing, along with tech support, after a long, painful integration with their existing IT systems.
There also aren’t many companies that are developing products for consumers and those that are are trying to build some sort bill management. This helps consumers track costs but it doesn’t help them anticipate them.
Which is why I am hopeful that attempts such as this crowd-sourcing one by KQED will show some success. KQED is trying to build a local database of costs per specific treatments, submitted anonymously. With a simple form that asks only a few questions about the treatment, facility, costs and insurance payment, KQED is hoping to achieve two things:
- Publish prices for identical procedures across providers, removing the layer of secrecy that has hidden them in the past.
- Allow consumers to know before treatment what they are going to be charged.
- Allow consumers to choose providers based on price. Common in any other consumer-facing product, revolutionary in the healthcare industry.
This is such an easy product to make yet it is so hard to market and gain traction with. It is truly a community that needs to come together to help each other not only find the best prices but to potentially pressure providers into lowering prices.
Hats off to KQED for making the effort.