Why is it that costs of medical care and medical insurance have been skyrocketing?

Posted by XenokRoy 12 years, 3 months ago to Economics
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My family doctor, a few years ago, switch from a family traditional medical practice to a combination practice of elective medical procedures and a holistic medical practice. Why, because it removed his need to deal with insurance companies and reduced liability coverage needs making his practice more profitable and there was far less government regulation to deal with when working in these areas of medicine.
Why have elective medical procedures dropped drastically in costs while at the same time those that go through insurance and government regulations have skyrocketed. Why is it that a doctor can make more money doing elective medical practice, or a holistic medical practice than one that is regulated more heavily?
Why has auto insurance not seen the same kind of costs increases that medical insurance has. Both are subject to the same kind of liability, both have the primary expense (in total dollars) they pay for in the area of medical and legal liability
Why is it that Wal-Mart, ShopKo and other pharmacies can bring in drugs from other countries and sell them to me for less than my co-pay if I used my insurance if I just pay cash for them?
Is the problem with the medical industry really a medical problem or perhaps something the government’s involvement there is causing?


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  • Posted by beherethen 12 years ago
    I think that just having insurance encourages doctors to pad the bill. As a young man a buddy and I spent 3 days partying. My friends family had very good insurance and it was decided he needed therapy. He was locked up for a year in a mental ward. On the very day the insurance ran out, he was pronounced cured. I didn't have any insurance, so slept for 24 hours, grabbed a candy bar and got on with my life. Color me cynical.
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    • Posted by 12 years ago
      Its like I read somewhere in a business book (would love to give credit but cant remember the source and I am paraphrasing). When its your money your motivated to watch every penny and spend only what you need to. When its the businesses money and your the one who is accountable for its use, you are motivated to make a proper accounting of the money, When its someone else money and are not the accountable party for its use, your motivation is only to spend.

      The insurance system falls in the last category when the purchaser of the insurance and the person getting the care are two different people.
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  • Posted by iroseland 11 years, 8 months ago
    My enod in Milwaukee was a private practice. He was a good Doctor working on his own. He employed 1 nurse, 1 lab tech, 1 front desk person, and 3 billing people to deal with insurance. The insurance companies have set themselves up for a fall on this one. They, or at least the smarter ones really need to standardize their billing procedures and make medical billing look more like EDI. Eventually some idiot in Washington is going to figure this out and they will have some new mess rammed down their throats. I also spent some time working at GE Med. Wow, FDA regs seem to mostly be designed to make money evaporate.
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  • Posted by Fair_Trade_Lady 12 years ago
    I have good insurance through my job. Needed to have a cataract removed, and my eye surgeon thought I should have an EKG first to determine if I would withstand the surgery. (This is an absolute hoot, because most people take me for my son's age, and I am by no means a sickly woman.) I had the EKG, and a short time later I received a non-bill in the mail, just as a courtesy to see what they were billing my insurance company. They billed for TWO EKGs, spaced two days apart! I called my insurance company immediately. I guess they figured with my cataract, I couldn't read...
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    • Posted by 12 years ago
      This brings to mind the part of Atlas where Ragnar talks (I believe) about the only honest men being those that are thieves as the laws protect the dishonest and not the honest.

      Doctors are being forced to charge specific rates. Then being forced to hound insurance to get paid (additional expenses). Then being forced to do extra testing to avoid frivolous law suites.... All these expenses push them beyond the ability to make a profit unless they do things just like this.

      I have a good friend who was our family doctor for a long while. He quit his practice as he did not want to do a co-op and only does things that pay cash up front. His checkup price is now $49, it was $250 before and he was going broke doing it. There are a lot of things he cannot get you and has to use holistic for the most part because its the only way he can avoid the regulation. He is more profitable now than he was then.
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  • Posted by cruiseladytexas 12 years, 3 months ago
    The smart doctors will move into concierge medicine and go from 3500 patients to 1000 patients. They will spend more time with each patient, they will eliminate the insurance company from the mix, reduce staff and overhead, and have more time for golf.

    If you think insurance reduces costs, then look at lasik eye surgery. The techniques have gotten better and the costs have gone down not up.
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  • Posted by $ jmlesniewski 12 years, 3 months ago
    The main problem is that doctor's have to purchase so much malpractice insurance due now-a-days, a cost which is then handed down to the consumer.
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    • Posted by 12 years, 3 months ago
      I use to think that as well. My brother-in-law practiced medicine in a family practice that he owned. He quit because it became to hard to make money at it. He moved to doing hunting and fishing guide work. More fun and he actually makes more money.

      According to him (and the family doctor I described above, as well as two other doctors I have talked to about this) the primariy problem is health insurance and the cost of actually getting the money out of them, combined with the fact that you pay in the rears. My brother in-law said that on a basic checkup visit $100 of the $250 he got was used to pay interest and the people who did the billing in his office. I have had others specify around half goes to those two things. If this is true on a larger scale then nearly 1/2 of our costs could be eliminated by paying the doctor out of pocket for these check up type services rather than having to bill and then be paid in the rears by an insurure. The 5 doctors do not make a good study but I do wonder how much breaks down to this. Malpractice, according to the bit of first hand conversations I have had with doctors is the second largest factor.
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      • Posted by $ jmlesniewski 12 years, 3 months ago
        I am not knowledgeable on what you're talking about. What interest is the $100 being used to pay?
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        • Posted by 12 years, 3 months ago
          Two parts to this expense, so bear with me as I provide some background.

          When a doctor takes a patient for a checkup, the insurance does not just fork over the money because the doctor files a claim. The insurance company has people who attempt to insure that there is no fraud and in doing so delay payment. The doctor must also have people who attempt to collect payment.

          My data may be a bit dated as I have not really asked about this for a few years, but doctors from multiple offices have said, when I have asked "How much do you have someone spend to get the money for this visit out of the insurance?" I get a response something like this. About 20 minutes, if they pay on the first claim, which they rarely ever do and then its about another 20-40 minutes before we actually get paid. When you ask "How long on average does it take for you to get paid?" the answer is typically in the 5 month range.

          So first the doctor has to pay someone to file the claim, at about 20 minutes per case. and then has to float the costs of providing the services for 5 months or so on average before getting paid. The costs that are floated until a payment is received are usually in the form of a loan which bears interest. Eventually I am sure some offices get enough operational capital to no longer have a loan, but its still money tied up that is either gaining less interest than it could or costing the doctor more than it should.

          Side Note: My Sister works as a freelance claims processor, attempting to process the claims that have been refused to be paid for doctors offices. She gets about 80% of them paid and makes about 60k a year doing this. She hates it when I attack this process because it is her livelyhood but the fact is, its an unnecessary cost as we pay for the office workers, people like her, and the people on the insurance side of things with the premiums for insurance. And then we pay the interest on the delayed payments.

          In a holistic practice they do not have this problem, you pay cash when you get the service. The same is true in an elective practice. Both are still subject to lawsuits, but yet both have decreased in cost (look at lasik or a brest augmentation for a couple of elective procedures and the difference in costs over the last 10 years. Then look at whatever insurance covered procedure you want to and compare. Both have the liability problems, but the two procedures just mentioned dont have insurance involved and all the regulation that comes with it.

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          • Posted by $ jmlesniewski 12 years, 3 months ago
            I've always wondered what a medical biller does. Thank you for this information. The notion of doctors receiving loans until insurance companies pay them is odd, as you would think insurance companies would be better at their jobs so it would take much shorter than 5 months.
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            • Posted by 12 years, 3 months ago
              Think about the money they make from the interest on deferred payments

              Lets say an insurance company has the cash in an account bearing 3% interest, and they have 10 million they will pay out in a month. That would be 25k per month for 5 months off that months deferred payments. If they do average 5 months behind that is 125k per month they are making by deferring payments. We the consumers have to then pay that. I think these numbers on the conservative side as well.
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