In a ground breaking study, researchers at Johns Hopkins University discovered hospital emergency departments overcharge. I know… Who would have thought ER prices are high? The study looked at 12,000 billing records for emergency medicine doctors nationwide.
The United States spends about $3 trillion on health care annually, nearly $10,000 per capita — accounting for about 18 percent of gross domestic product. Medical technology is costly, but it is not the only reason medicine is expensive. A variety of factors are to blame for what makes health care expensive in this country and abroad.
Apparently medical care is bad for you!
According to data from the British Medical Journal, in an article brought to us by Vox, a quarter of a million people died of medical errors in 2013. Medical errors were exceeded as a cause of death only by cancer (585,000 people) and heart disease (611,000 people). Death from motor vehicle accidents paled in comparison (34,000) – as did death from firearms (34,000) and suicide (41,000).
The U.S. Food and Drug Administration (FDA) just announced it is taking steps to make hearing aids available over the counter. The FDA plans to immediately stop enforcing a requirement that patients must have a medical evaluation prior to obtaining a hearing aid. The Agency also hopes its move will stimulate a new category of OTC hearing aid products that cost less. In this regard, hearing aids will function in a manner similar to reading glasses. The move was likely due to prodding by Senators Elizabeth Warren (D-MA) and Chuck Grassley (R-IA), who recently introduced legislation along these lines.
The drug fentanyl — which is up to 50 times stronger than heroin — is available in generic form. It is also a highly addictive street drug, manufactured in back-alley labs and laced in heroin to boost its potency. Fentanyl is used to treat extreme chronic pain that is unresponsive to other opioid pain relievers, such as breakthrough pain cancer patients often suffer. A fentanyl transdermal patch costs from $5 to $12 depending on the dose per hour. A 12 micrograms (mcg) per hour patch retails for about $5 and offers 72 hours of pain relief, whereas the 100 microgram per hour patch is about $12 with GoodRx coupon. Sounds like a bargain; pain-free bliss for $2 to $4 a day. That works out to about $50 to $125 per month.
How long should you have to wait to see a doctor? Why not just call a doctor?
The patient in the photo was able to get a same-day appointment within 15 minutes of the request and was seen within 10 minutes after arriving. But that is an exception in the United States. A recent article in the American Journal of Managed Care estimated the average physician visit takes two hours (121 minutes). That includes travel time (37 minutes), waiting time (about an hour) and treatment time (10 to 20 minutes). Of course, that’s once you get an appointment.
A new survey by the Physicians Advocacy Institute and Avalere Health, a consulting firm, shows a significant increase in the number of physicians leaving independent practice and joining hospital-based health systems:
Good or bad? Well, color me skeptical. This acquisition spree is driven by new payment models which seek to reward providers for “accountable” care (which I suppose is better than unaccountable care.) So far, the results of payment reform in Medicare have been trivial.
Physician is arguable the profession with the highest average pay for all those pursuing it. Yes, some doctors lament that investment bankers often earn much more. But investment banker isn’t a profession; it’s a high-paid specialty in the area of banking. The average banker does not enjoy the income the average physician has come to expect.
Before he left office, then-Montana Gov. Brian Schweitzer decided Montana’s 11,000 state workers, retirees and their dependents needed an employee health clinic. Before leaving office he had one created without consulting the legislature. For those of you who have not heard of the concept, it’s sort of like the school nurse, except there are doctors and real medical equipment involved. At most employee health clinics, physician visits are either free or involve no cost-sharing. Montana employees aren’t required to use the clinic; they can continue to see their own doctors with the normal cost-sharing.
About six years ago I wrote about the merits of a 3-year medical degree. This involves medical students essentially skipping the rotation that occurs in their fourth year of medical school and beginning residency training. At the time, there were only three universities in the United States and Canada that offered a program that allowed doctors to begin residency after only three years of medical school. Now there are about a dozen according to Robert Grossman and Steven Abramson, writing in the Wall Street Journal. Nearly one-third of medical schools have (or are) considering ways to speed up medical training programs. Is probably a good idea.
