Why an MRI costs $1080 in America and $280 in France

[kevink]

Why an MRI costs $1,080 in America and $280 in France

 

[REWahoo]

The exchange rate is a killer...

 

[kevink]

The exchange rate is a killer...

THAT explains it!

 

[ERhoosier]

Didn't we have a thread on this a bit ago?

 

[travelover]

Didn't we have a thread on this a bit ago?

Right, at only $8000 per year per person, it really isn't worth discussing.

 

[obgyn65]

Yes, and I can think of at least one thread on a similar topic that got closed.

Didn't we have a thread on this a bit ago?

 

[Koolau]

Yes, and I can think of at least one thread on a similar topic that got closed.

That inevitably happens when folks are so "split" on the "causes" of a certain "problem" in our society. Some think it's the gummint's fault and some think it's business's fault. A few even think it's our own fault (we have met the enemy, etc.). The data is probably there to ultimately tease out what "share" of blame there is to split up. But, no one really wants to use data when "opinion" is so much easier to advance than facts.

For instance, the article is one of the few which puts at least part of the "blame" on the governments (or collectives or whatever you want to call it) of OTHER countries who piggy-back off of US investment and research. You rarely see this piece of the puzzle. It's not the whole story, but it's usually ignored when folks debate the issue (it's easier to just blame those "evil fill-in-the-blank")

But, the "answer" to the issue of health care costs is actually quite simple. Freeze all health care costs. Then, there will be no more innovation and at some point (after the last patent expires) all health care costs will be determined strictly by supply and demand. Of course, there will be no more cancer research, no more drug research, no more innovation which saves more lives or makes lives more worth living. AND, HC services and products will be "honestly" rationed instead of doing it through price or gummint fiat.

I say none of this with "tongue-in-cheek". I don't think it's a good idea, but it would work. Then, we would finally have a chance to see where the real "fault" is. Now, it's too clouded by the difference in "quality" of health care available to us. Who believes that the current level of HC is similar to what it was 40 years ago. It SHOULD cost more when now, you can pop a "purple pill" and prevent ulcers, for instance. In the old days, a surgeon had to slice you open and cut out half a stomach, several nerves, and risk your life. Now GERD pills are so common that they are probably over used. But virtually NO one has surgery for ulcers any more.

There are dozens of other examples where the current "outcomes" are much, much better than they used to be. Unfortunately, the alternatives to the old methods/procedures cost a bundle to come up with in research (and, yes, marketing) costs. Who would have taken the "purple pill" if a drug company didn't hawk it on TV? Is it over prescribed? Yes. Does it cost more than it costs to make it (i.e., profit)? Yes. Could the pill be sold for less? Yes. But, does anyone want to go back to the days of surgical intervention for ulcers? I don't think so. Do we hope for yet more effective (and less side-effect) drugs. I think we do.

So the issues gets very cloudy. There are so many folks involved (docs, drug companies, medical device companies, for-profit hospitals, not-for-prifit hospitals, insurance companies, gummint entities (fed, state, even local), tort lawyers, patients demanding "purple pills" when they don't really need them, etc., etc., etc. Finger pointing is the easiest thing in the world. Understanding the interrelationship of all the factors (even deciding what all the factors are) is not quite so simple. Then, if we could actually "assign" the appropriate "blame" to the various parties, there are still political issues as well as economic issues to deal with. (Who would be the first to "limit" end-of-life intervention "excesses" for instance?)

It's one thing to figure out "what's wrong". It's quite another to figure out how to fix it. AND, so far, we really don't know what's wrong (even though we all have our own opinion of what is wrong.)

Because it's so complex and because we all have way more opinions than facts, can Porky be far behind. I think not. Of course, that's just my opinion so YMMV

 

[explanade]

The coach of one of the schools in the NCAA tourney sold a medical equipment company, cashed out like $100 million, then took up coaching.

Its evidently very lucrative, the US health care business.

 

[jambo101]

I had an MRI last week,there was no charge involved as i just flashed my Canadian healthcare card,same will happen with an upcoming CTscan and peripheral arterial study tests (doppler)

 

[Chuckanut]

There was an interesting story on NPR today about a cancer center that decided to not use a new drug. The drug's cost was double the cost of the old drug ($11,000 versus $5,500) and the effects were just about identical. They wrote an Op-Ed piece about their decision for the local paper. A representative from the drug company contacted them and offered a 50% discount on the new drug.

When A Famous Hospital Didn't Want An Expensive New Drug : Planet Money : NPR

 

[MichaelB]

The OP (excellent link, thanks kevink) refers to an article which in turn references a study. The author is the International Federation of Health Plans. They recently published a survey comparing costs for specific procedures among OECD countries. The results don't explain why the costs are different, just show how much. The results betwen US and the rest are breathtaking.

The study can be seen here http://www.ifhp.com/documents/2012iFHPPriceReportFINALMarch25.pdf

Here is a chart showing comparative costs for one day of hospital stay. In addition an average cost more than 3x the next most expensive, it shows the dramatic range in costs in the US, which doesn't exist in the other countries.

 

[explanade]

Do the other countries have formal rate-setting laws or bodies?

Kind of like there are state commissions which set utility rates for electricity or phone service?

The range in prices in the US suggest a market approach -- charge what the market will bear. Obviously someone is paying those higher prices, paying much more for a bed in private hospital A instead of a bed in community hospital B.

 

[itsmyparty]

I had an MRI last week,there was no charge involved as i just flashed my Canadian healthcare card,same will happen with an upcoming CTscan and peripheral arterial study tests (doppler)

Curious how long you waited to have that mri? Some family & friends love in British Columbia....one of them has been waiting over a year for an mri of their knee/ hip area. They probably will have no co-pay...but there is a physical cost to waiting over a year to finding out what is wrong and how it might be corrected and in the meantime perhaps deterioriating. They said their dr. Is also frustrated about it. Have heard private clinics are being considered so people dont have to wait so long, but might have to pay something....money well spent probably.

 

[kramer]

Just a few data points: My Canadian friend recently got a knee MRI done at Bumrungrad Hospital in Bangkok for about $475. That included a very detailed interpretation and consult. I had a visiting French friend go to Bumrungrad for an emergency 3 years ago and he needed an emergency MRI on his head/brain and it was going to be $600 (presumably with consult included). The wait for both of these procedures was essentially zero time.

Also, as another data point, my Canadian friend above actually injured his knee 3 years ago on a motorbike visiting me. He only spends 5 months per year in Canada, but could not get an MRI in that time during his last two years there (he spends 5 months per year there, the minimum to maintain medical coverage in Ontario). The waiting list is longer than 5 months in Toronto if it is not urgent. That is why he finally got it done in Thailand two and a half years after the original accident, because it was really causing him some pain and inconvenience. Another data point: Canada will pay for this MRI and consult that he got done in Thailand. Also, he is bringing all the medical results back to Canada when he returns and he may get a surgery done in Canada.

 

[travelover]

Just a few data points: ........

So as an extension of your data points, would it be fair to say that most Canadians would rather have our healthcare system as it now stands, than theirs?

 

[kramer]

So as an extension of your data points, would it be fair to say that most Canadians would rather have our healthcare system as it now stands, than theirs?

Most Canadians I know (and I meet many overseas) seem pretty happy with their health care system although some seem to be worried about future funding for the system.

I don't think most countries prefer other country's medical systems or they would have already copied that other country's system.

 

[explanade]

Yeah the Brits grouse about the NHS, which is often cited in the US for having long wait times and other ills of govt.-run health care.

But they wouldn't give it up and no UK politician would ever propose eliminating it.

 

[Mulligan]

You don't even have to venture outside the country to find price discrepancies apparently. I was just reading in morning newspaper, an article that was written about state laws keeping patients in the dark on their costs until afterward, and a need for pricing transparency. In the same California market knee replacement surgery ranged from $15,000 to $100,000 plus depending on the hospital with no discernible difference in quality, according to the article.

 

[eridanus]

Yeah the Brits grouse about the NHS, which is often cited in the US for having long wait times and other ills of govt.-run health care.

This was covered in the other thread. Wait times in most other countries are the same or shorter than the US wait times for both surgery and outpatient visits. (Btw, Canada is an outlier. France and Germany and .ch have wait times equivalent to the US.)

Regarding innovation, the article mentions,

“We pay twice as much for brand-name drugs as most other industrialized countries,” Anderson says. “But the drug companies spend only 12 percent of their revenues on innovation. So yes, some of that money goes to innovation, but only 12 percent of it.”

In other words, it's a great bargain for pharma to charge double and pay out a sliver for R&D and then claim the moral high ground.

The end of the article has this gem:

Even so, Anderson says, “if I could change one thing in the United States to bring down total health expenditures, it would definitely be the prices.”

The elephant in the room -- if we cut the prices, then someone's got to take a hit on their profits. Should we continue acting like someone is going to come along and volunteer to take one for the team?

 

[explanade]

If they were going to take one for the team, there wouldn't be so much noise when there is any talk of health care reform.

Someone is making a lot of money and it's understandable that they're not going to give that up without a fight.

 

[gerrym51]

americans like the speed of our healthcare system but don't like the price.


Canadians like the price of their healthcare system but don't like the speed.



LOL

 

[nvestysly]

Interesting article and it certainly touches on many of the aspects that need to be addressed. There is plenty of room for improvement in the U.S. health care system. IMO we need to understand that medical insurance and health care are two different things and society needs to understand they are different animals although they are very much interrelated.

See the 2009 Atlantic Article for some very good insight into why we spend so much in the U.S. I think there may be another thread on this article but I thought it worth mentioning here.

Now on the to Canadian thing... I recently met a very pleasant, seemingly reasonable couple from Canada. DW and I spent the better part of two weeks working side-by-side with this couple on a volunteer project in N.M. They told me about all the great aspects of the Canadian health care system. They enlightened me on a number of matters but I'm still not buying into their story. Particularly when the woman was going to Mexico to have some dental work performed. I don't care how good the doctors are in Mexico - I have nothing against Mexico - but if the health care is so great in Canada why does a person go to Mexico for dental work?

 

[Meadbh]

Now on the to Canadian thing... I recently met a very pleasant, seemingly reasonable couple from Canada. DW and I spent the better part of two weeks working side-by-side with this couple on a volunteer project in N.M. They told me about all the great aspects of the Canadian health care system. They enlightened me on a number of matters but I'm still not buying into their story. Particularly when the woman was going to Mexico to have some dental work performed. I don't care how good the doctors are in Mexico - I have nothing against Mexico - but if the health care is so great in Canada why does a person go to Mexico for dental work?

Because dental work is not part of Canadian medicare. It should be, but it isn't.

 

[pb4uski]

....For instance, the article is one of the few which puts at least part of the "blame" on the governments (or collectives or whatever you want to call it) of OTHER countries who piggy-back off of US investment and research. You rarely see this piece of the puzzle. It's not the whole story, but it's usually ignored when folks debate the issue (it's easier to just blame those "evil fill-in-the-blank").....

I recall reading something about this recently. What if there were a law preventing US drug and medical device companies from charging any less for their products sold abroad than they charge in the US. On other words, they would be precluded from gouging US consumers to the benefit of non-US consumers and would be required to spread the cost of R&D to all customers who benefit from it. Sounds fairer to me, but I concede that the devil is in the details.

 

[itsmyparty]

Just a few data points: My Canadian friend recently got a knee MRI done at Bumrungrad Hospital in Bangkok for about $475. That included a very detailed interpretation and consult. I had a visiting French friend go to Bumrungrad for an emergency 3 years ago and he needed an emergency MRI on his head/brain and it was going to be $600 (presumably with consult included). The wait for both of these procedures was essentially zero time.

Also, as another data point, my Canadian friend above actually injured his knee 3 years ago on a motorbike visiting me. He only spends 5 months per year in Canada, but could not get an MRI in that time during his last two years there (he spends 5 months per year there, the minimum to maintain medical coverage in Ontario). The waiting list is longer than 5 months in Toronto if it is not urgent. That is why he finally got it done in Thailand two and a half years after the original accident, because it was really causing him some pain and inconvenience. Another data point: Canada will pay for this MRI and consult that he got done in Thailand. Also, he is bringing all the medical results back to Canada when he returns and he may get a surgery done in Canada.

My cousin who lives in British Columbia told me is a Canadian who goes to the US to get tests done like MRIs or sonograms, etc. because they do not want to wait a year+ in that province for a diagnosis, not only will the Canadian govt not pay for the tests, but no Cdn doctors will use those results in their treatment. Maybe its different if the govt actually sent the person for tests, dont know. Anyway...that's what was told to me when I asked why a person in a lot of pain and having great difficulty walking whose Mri was scheduled for about 12 mo. Months in future, wouldnt just drive a few hrs to the US to get the test done quickly, even if it wasnt paid by govt. they could personally afford it...what better use for one's $? This was in Victoria, BC 2012.