What if shopping for healthcare was like shopping in a grocery store. Would healthcare transparency exist in the aisles? Recent improvements to the healthcare system have made transparency better. But shopping for healthcare can still be a lot like shopping for groceries in the dark.
Baking a Cake
Imagine this. You decide you want to bake a perfect cake for your daughter’s high school graduation. In order to complete this task, you consult an expert chef; Rachel Ray perhaps. Based on her suggestions, you decide on the exact ingredients and specific processes needed to bake the perfect cake. When you go to the grocery store to buy the ingredients, the lights are off and you are left to shop in the dark! After many struggles, you finally head home with the necessary ingredients. Plus some unnecessary ingredients because, well, you were shopping in the dark. All things considered, you baked the perfect cake and everyone at the graduation party loved it!
One week later, you receive a bill from the grocery store with unexpectedly varying costs for the ingredients you purchased. For example, a dozen eggs cost $3; pretty normal. But you were also charged $50 for one pound of flour. Ridiculous! You would have NEVER paid that much for flour if the lights were on! In addition, the grocery store 10 miles away had flour for $20 per pound, and if you would’ve known, you probably would’ve bought flour at that store instead. Luckily, you have a supplemental payment plan to help you pay for part of the bill. Nonetheless, you could’ve saved some money if the lights were just turned on!
At this point, you can probably see where I’m going with this, but I’ll continue anyway. Substitute a doctor for the expert chef (Dr. Oz perhaps), medications and treatments for the ingredients and baking process, a hospital for the grocery store, and the outcome of your medical treatment (hopefully positive) for the perfect cake. Similar to the grocery store in the dark, hospitals have the ability to set prices however they see fit. Even if it leads to significant markups. Also, many hospitals in different markets across the U.S. have the ability to set a wide variety of prices for the same treatments. For example, according to a study reported by Blue Cross Blue Shield, the average episode for a total knee or hip replacement cost $60,000 in New York City, but only $16,000 in Montgomery, Alabama.
If the grocery store analogy doesn’t work for you, here’s the current healthcare system summed up in 140 characters or less.
Imagine a restaurant with no prices (u find out only after u order) & a bill that fluctuates based on where you sit — that's healthcare.
Flipping the switch and turning on the lights in the healthcare store will contribute to the evolution of the healthcare system in the United States. The healthcare consumer experience can be vastly improved with healthcare transparency. Specifically for joint replacements, you can shop for replacement products, choose a surgeon, and pick a hospital based on estimated costs. Shopping for a knee implant can even be like shopping for golf clubs! With the movement towards healthcare transparency, never hesitate to ask your provider for estimated costs regarding your medications and treatments.
We are in the season of shopping. Whether you already have your holiday shopping completed, or you usually wait until the last minute, we should all be proactive when shopping for healthcare. A recent trend has been developing over the last few years about shopping for healthcare in the U.S. Maybe you have noticed the same trend or maybe you haven’t; either way, shopping for healthcare will better equip you to take control of your health. Here, we will investigate the problem, explore a solution, and even discuss how shopping for golf clubs could prove to be a similar experience as shopping for healthcare.
The Problem with Healthcare in the U.S.
The current problem with healthcare is the correlation between cost and quality, or lack thereof. This study, published in 2013 by the American College of Physicians, concluded, “the association between healthcare cost and quality is inconsistent and most studies found the association between cost and quality is small to moderate.” Or take this 2014 study, published by the American Medical Association, which states, “one reason why spending is not highly correlated with quality is that the price of the same service varies.” The study goes on to explain, “Medicare pays physicians and hospitals using prices that are adjusted based on a variety of factors, but little based on quality” and that “variation in prices paid by private insurers is due to bargains struck with doctors, rather than quality of care.” Lastly, consider this 2016 investigation by Amino, who used doctor experience as a measure of quality. Amino was “surprised to find no correlation between cost and experience for doctors who perform ACL surgery.” As in other industries, you would think that a higher price means higher quality, but that is not the case in healthcare. The lack of correlation between cost and quality calls for consumers to take an active role in shopping for healthcare by evaluating quality, price, and treatment options.
Shopping for Healthcare – Fixing the Problem
(image from flaticon.com)
The most obvious trend regarding healthcare shopping is a push for transparency. Not only price transparency, but quality as well. This is important because the healthcare industry operates differently from other industries when it comes to consumerism. Shopping for healthcare will allow consumers to find the highest quality for the most reasonable cost. Transparency has been a non-issue in the past for healthcare consumers because they weren’t usually paying the bill at the point of service. This is not the case anymore as the role of the healthcare consumer is changing. Rising deductibles are a major contributing factor to this changing role. A high deductible health insurance plan usually means lower monthly premiums. This also means the beneficiary will pay more out of pocket costs at the time of service before realizing their full insurance coverage for the calendar year. In addition to a high deductible health plan, the extended use of Health Savings Accounts (HSAs), as future President Trump has proposed, will put more responsibility on healthcare consumers to take control of their health. Price transparency is critically important as consumers take on more costs at the point of service.
There has also been a push for quality transparency. But what differentiates a high-quality healthcare experience from a low-quality experience? Some quality factors to consider when you’re shopping for healthcare are:
The surgeon
The quality of medical equipment and technology at the facility
The opinions of your friends and family about their healthcare experiences
By pushing for transparency and utilizing tools making price and quality information available, healthcare consumers can take control of their health.
How Transparency Affects Orthopedics
Another quality factor to consider when you’re shopping for a knee or hip replacement is the actual implant product that will be placed in your joint during surgery. Although your surgeon is the most important factor for your surgery, you are the one that must live with the implant. You may never see the product you’re buying, but you must live with it every day of your life. Many companies design and manufacture knee and hip implants, each with distinct functions and characteristics that may better serve different people. Here you can learn more about 7 Characteristics of Knee Replacement Products. When shopping for a knee or hip replacement, consider these key decision factors:
Surgeon
Facility
Implant
Cost
Shopping for Golf Clubs and Shopping for Healthcare
(image from azgolfhomes.com)
How could shopping for healthcare be anything like shopping for golf clubs? Let’s say you’ve been golfing for many years but recently you’ve run into a bit of trouble as you can’t cure a nasty slice that has taken over your game. After trying to work through it yourself, you decide it’s time to look for a change. You seek out the advice of an expert golf pro during a handful of lessons. The expert tips help for the short term but after a year, you’re back where you started with the slice; and this time, you decide your game needs a drastic overhaul.
You begin shopping by testing different clubs from a variety of manufacturers, each with different characteristics. Forged metal or cast metal, strong loft or traditional loft, steel shaft or graphite shaft, regular flex or stiff flex. Each new set you test comes with expert feedback from a golf pro you trust. While continuously testing golf clubs, you are also exploring prices for all options available to you. After educating yourself and testing many sets of golf clubs, in conjunction with the expert golf pro, you decide on the set that’s right for you. You then work with the golf pro for many months to change your swing with the goal of accommodating your new style of play. This leads to renewed faith in your game and many years of great golf.
Now let’s write the story for your knee replacement shopping experience. Let’s say you’ve been an active person all your life but you’ve recently run into a bit of trouble as you have been experiencing knee pain. After trying to work through the pain with rest and ice, you decide it’s time to look for a change. You seek out the advice of an orthopedic physician and you are prescribed non-surgical treatments. Your pain is mildly relieved for about a year but your knee pain is generally getting worse and you decide it’s time to shop for a permanent solution.
You begin shopping for your knee replacement by researching many different products from a variety of manufacturers, each with different characteristics. Fixed bearing or mobile bearing, cruciate sacrificing or cruciate retaining, cement or cementless fixation, unicompartmental, bicompartmental, or total replacement. Although you won’t be able to “test” the products, each product you learn about will be open to expert feedback from an orthopedic physician you trust. While learning about all available options, you are also exploring prices for costs you may incur during your surgical experience. After educating yourself about the many options available to you, in conjunction with your orthopedic physician, you decide on the knee replacement that’s right for you. You then attend physical therapist for a few months with the goal of accommodating your lifestyle to your new joint. This leads to renewed dependence on your knee and many years of pain free living.
Conclusion
The lack of correlation between cost and quality leads to the importance of shopping for healthcare. We saw what the future may look like with consumers shopping for healthcare and even took a practical approach through the comparison between knee replacement and golf. 360 Orthopaedics will continue to provide quality information about diagnosis, treatment, and healthcare costs. As you continue your holiday shopping, consider a bright future of healthcare shopping leading to high quality at reasonable prices.
