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

[zeos3]

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/03/15/why-an-mri-costs-1080-in-america-and-280-in-france/


On Friday, the International Federation of Health Plans — a global insurance trade association that includes more than 100 insurers in 25 countries — released more direct evidence. It surveyed its members on the prices paid for 23 medical services and products in different countries, asking after everything from a routine doctor’s visit to a dose of Lipitor to coronary bypass surgery. And in 22 of 23 cases, Americans are paying higher prices than residents of other developed countries. Usually, we’re paying quite a bit more. The exception is cataract surgery, which appears to be costlier in Switzerland, though cheaper everywhere else.

“Other countries negotiate very aggressively with the providers and set rates that are much lower than we do,” Anderson says. They do this in one of two ways. In countries such as Canada and Britain, prices are set by the government. In others, such as Germany and Japan, they’re set by providers and insurers sitting in a room and coming to an agreement, with the government stepping in to set prices if they fail.

In America, Medicare and Medicaid negotiate prices on behalf of their tens of millions of members and, not coincidentally, purchase care at a substantial markdown from the commercial average. But outside that, it’s a free-for-all. Providers largely charge what they can get away with, often offering different prices to different insurers, and an even higher price to the uninsured.

Health care is an unusual product in that it is difficult, and sometimes impossible, for the customer to say “no.” In certain cases, the customer is passed out, or otherwise incapable of making decisions about her care, and the decisions are made by providers whose mandate is, correctly, to save lives rather than money.

[Courtesy Flush]

1. I'm an amputee, and just got a new prosthesis this week.

MSRP= $62,000 Insurance paid $38,000 which was accepted as payment in full (thank goodness).

I'd love to know what the same leg costs in other countries.

[SomeGuyInEagan]

13. Or the next person who gets it at the same hospital.

From my understanding, if you have insurance, hospitals bill what the insurer will pay. Nobody's coverage is the same.

That is why the costs are all over the place (and why hospitals have large billing staffs and insurance companies have large claims staffs - it is an ongoing negotiation for everything). So some folks overpay, some underpay and the hospital is trying to re-coop enough to meet business expenses plus profit.

[AtheistCrusader]

15. Probably the biggest driver in cost differential right there.

In other countries, especially with single-payer, the hospital doesn't have to engage in cost recovery for people who can't pay.

And probably the biggest argument in favor of single-payer.

[csziggy]

32. Insurance companies conspire with hospitals in price fixing

Uninsured people pay much higher rates than the insurance companies pay for their insured clients.

After my first knee replacement last year, I was billed over $70,000 for three days in the hospital, the use of the surgery suite, etc. Once all was settled with the insurance company, the hospital accepted much less than that for BOTH of the knee replacement surgeries and hospital stays (two separate procedures, two months apart).

An uninsured patient would have been expected to pay the $70,000 per procedure and been in debt to the hospital for the cost of a house (in this town).

[Wellstone ruled]

2. My friends--------It's G.E. Duh!!!!!

[bettyellen]

3. try $ 7,000. fucking ridiculous.

[Ed Suspicious]

14. My insurance company recently paid just over 6 grand to have my knee mri'd. Crazyness. nt

[dipsydoodle]

22. I had my shoulder scanned privately here in the UK

two years ago and that was £220 including having the report and copies of the scans on CD.

Obviously would've been nil on our NHS but I wanted the results quickly. All subsequent treatment was NHS anyway.

[gateley]

4. Because we have the best health care in the whole wide world??

The answer to ANY question -- money. It's always the money.

[Initech]

5. I can sum it up in four words: profit, profit, more profit.

[lovuian]

6. it is why Universal coverage is the way to go

our healthcare is a JOKE and a bad one
where Americans pay more for LESS care

[riverbendviewgal]

7. grateful to live in Canada

We all get health Care. Our government negotiates and set fees.

[Dryvinwhileblind]

8. "In America, Medicare and Medicade negotiate prices on behalf of their...

...tens of millions of members". Really?! Negotiate?!, so THAT is what its called. And here I naively thought it was collusion on both sides to grease the palms of both sides, you know, playing both sides against the middle. Maybe the "tens of millions" should "negotiate" this top heavy, thieving syndicate into oblivion, yes?

[Botany]

9. Mine was $3,200 and my insurance picked up $150

n/t

[Arugula Latte]

18. Holy crap.

What a country.

[fredzachmane]

11. Not a defense of the cost

but it seems dishonest not to point out that the average wait for an MRI in France is 30 days in the US the average wait for MRI is 2 hours.

[Ed Suspicious]

16. Yeah, I might be inclined to accept that as fact, but they triage. It's not like an emergency care

is so untimely. Many people who get MRIs are dealing with chronic pain who's cause really won't be exacerbated by a few weeks wait.

It's disingenuous to claim that people who need immediate care are wait-listed as you imply.

[fredzachmane]

21. On average

European countries possess 17 MRI machines per one million people. With only 9.4 MRI machines per million people, France ranks between Portugal and Turkey, putting it among the least well-equipped in Europe, according to the Société Française de Radiologie.
It’s not a flattering assessment and quite a paradox that in the MRI stakes its rank is so lowly, considering that France is the European country that spends the most on healthcare.
France has four times less MRI machines than neighbouring Germany and two times less than Spain or Italy.
The wait time averages 30 days & up to 75 days in in the most underprivileged areas (Pays de la Loire, Poitou-Charente or Alsace).
After having repeatedly pointed out the French backwardness in terms of equipment, in recent years ISA has been even more preoccupied by the increasing geographic inequalities.
So it's ok because the poor people have the longest wait. I think to someone suffering "chronic pain" a 30-75 day wait is very significant.

[theKed]

27. What's the average wait time

on an MRI for an uninsured American? Still '2 hours', or is it closer to 'HAHAHA fuck you, peasant! Never!' I know it's kind of apples & oranges, since there are no uninsured French citizens, and millions of uninsured Americans.

[OwnedByCats]

29. So not being able to have it done

at all because you can't afford it is acceptable or having to file chapter 11 from the medical bills is ok, instead of needing to wait? At least Europe they are more compassionate about your pain issues and will give you something to get you through if there is something that works.

My disclaimer here is I have never lived in France, but I did live in England for some time. My husband needed an MRI urgently and he got one urgently, even though he had to go to a different hospital than the one he was staying in. Eventually however, our local hospital did obtain one later. Yes people wait for non urgent cases, but it varies. Something like a hip replacement had long waits because apparently the British have some unusually bad hips as they age lol. However with some things it doesn't mean you'll always get it faster here.

In the UK I needed to see a neurologist, I had to wait 2 months. Then after I moved back here, I needed to see another one. Guess how long I had to wait? First of all, the original one wouldn't make an appointment for me until they saw my medical records from the UK. So I had to get those and by the time I got them to my PCP, who had trouble translating the file type, the neurologist were no longer taking new patients. I had already waited several weeks while I got my records transferred, then I had to wait a further 4 months for an appointment for the next one I found. In
the UK any doctor can see your medical records by looking at the NHS database. It's awfully convenient when you don't have to try and organize it yourself all the while wasting time. All they need to do is search your name and NHS number.

So no, it's not always faster here than say in Europe. With the way things are right now, I'd give anything to have what England has because even with it's flaws, it's a hell of a lot better than what we have here. I wish I never left there now because I don't have any insurance (offered through work that sucks) and can't afford to see a doctor at present. Single payer would be better.

[Skittles]

40. so you use your first three posts

to post repuke talking points???

PLEASE tell us what the average wait is for Americans WITH NO INSURANCE

[progressoid]

41. Nice cut and paste job. Got any references for your "stats"?

Those quotes always go to the same un-sourced website. Wonder where those numbers really came from?

[idwiyo]

42. FFS, stop disseminating RW talking points because you have not a friggin idea what you are

talking about.

I'll give you a clue - helical CT (or CAT) scan.

I have not a slightest idea what the fucking "average waiting time is" in UK no do I bloody care.

My last visit to the hospital (me total moron who let pneumonia run untreated because as I said I am a moron): because of high fever and obvious signs of lung infection I had chest XRay about 15 min after admittance to A&E, CT scan an hour later (consultant was waiting for blood work to arrive first), second CT scan next day to confirm there was no infection in abdominal area. Is that bloody fast enough for your standards?

One more thing to remember, CT scans are used instead of MRI in lots of the cases now because they are much much faster and provide a continuous image of the scanned area that can be "sliced" later where it's needed and in whatever direction is needed.

BTW, my waiting time on NHS for CT scan on my knee (to diagnose a chronic pain problem) was 3 days and that's because while my knee was hurting it wasn't bad enough to go through emergency scan and I had painkillers anyway.

Forgot to add, there is no set appointment time for CT scan anymore. At least not in Royal Berkshire Hospital. You get a letter from your consultant (next day after the visit, because Royal Mail rocks) or they will give you referral during the appointment.
You walk in, you get your scan done in whatever time it takes to prepare you for one.
A little bit more than an hour for abdominal area if isotopes are delivered through liquid you drink.
4 hours later after injection when whole body scan is done for bone cancer detection
I think 2 hours later after injection for brain scan for brain cancer detection.
Within an hour if injection is done during the scan (lungs infection check like in my case).

Hopefully it's fast enough?

[csziggy]

34. Unless you have to wait for two month for insurance to approve it

My husband's doctor recommend an MRI in January. We still have not been able to get approval from our insurance company to get it. Since we expect that he will need surgery, we don't want to pay out of pocket for the MRI - we'll need that money for the co-pay for his surgery.

[Egalitarian Thug]

35. I find that statement to be dubious at best.

[zeos3]

38. Why is it "dishonest" not to mention something irrelevant to the point? n/t

[City Lights]

12. America's system sucks.

Our health insurance premiums are so high we can barely afford health care. I absolutely detest our system of dispensing health care. It's a rip-off and a sick, sick joke.

[Floyd_Gondolli]

17. Sort of OT but we had an MRI done our dog last year

They did his head and neck only and it cost about 800 bones. Craziness.

[BlueStreak]

20. Right. But unfortunately they don't let humans pay in bones.

(Sorry, I couldn't resist.)

[BlueStreak]

19. If a reporter from WashPo can't find out the price, how the hell would a patient ever find out?

People talk as if pushing more of the costs onto the consumer would ignite the blessings of the unseen hand of competition.

BALONEY !!!

No consumer could ever do an effective job of price shopping for anything more complicated than a pair of glasses.

I had a colonoscopy recently. I read where the "average" price was around $1200. The bills on mine (which was practically routine) came in 5 times that much, and the insurance company seemed to whack that down to about $2000, but that is still almost twice the number I had seen. If I asked the doc, he'd say he doesn't manage the billings. If I asked the office manager, she would say that she only does the billing for the proctologist, and she really doesn't know what he'll charge because they charge by the polyp or by the inch or some such nonsense. And I wouldn't even know where to call to find what they would charge for the anesthesiologist, the operating room, the recovery room and whatever. And then there are all the charges for prep things: the EKG, blood double redundant work, the laxative solution and consulting, etc.

This is nothing like a free market.

(And how come "proctologist" isn't in the spell checker? Proctologists get no respect.)

[xtraxritical]

23. Butt, butt...

[zeos3]

37. Nice...

[fredzachmane]

24. Part of the problem is that the consumer never knows the cost

Hospitals charge $100 for a band-aid because it is insurance or medicare paying it, not an individual. A band-aid doesn't cost $100 and an individual would never pay that. I had a medical emergency a few years ago and had no insurance. I received the treatment that I needed and then got a bills totaling $20000. I made calls to all of the places who billed be and asked for a complete summary of what I was being charged for and explained that I was uninsured and would be paying cash. My bills magically reduced to $3000.

[BlueStreak]

31. When you have a car problem

Mechanics will always give you an estimate when asked. There are times that they have make conditional estimates, as if "When I get in there, if I can clean it out and adjust the bands, then it will be about $400 but if it is too far gone, I'll have to rebuild the tranny and that will run about $2400." People understand conditional estimates. We understand that if a surgeon runs into unexpected problems, there could be extra costs.

But what we don't get at the car repair shop is 7 different bills., none of them intelligible by a lay person. We don't get an extra bill from the guy who test drove it or the guy who washed it. We don't get billed for the use of the diagnostic machine. We don't get charged for the time the car was on the hydraulic lift. We don't get charged for the compressed air used to blow dirt off the parts. That is just part of the cost of doing business. No car dealership charges $100 a quart for transmission fluid you can buy at Pep Boys for $2.98.

In any other industry, the medical billing practices would be considered criminal, but we just accept it without any questions. And that is why we pay so much more than any other country for what is not even mediocre outcomes.

[freethought]

25. I don't think France was a good example to lead off with.

France's health care system is nationalized. The government is the provider. It almost sounds the article is making sound like the government negotiates with itself. Germany, or Japan were better examples.

[Chuuku Davis]

26. $2656 here

+ $980 radiologist fee

[JEB]

28. Never had onr and likely never will.

Way beyond my means. Maybe if I make it to Medicare. Just pass the Hemlock.

[Progressive dog]

30. NPR 2009 Japan $160 us $1700+

Same MRI machines (GE, Siemens) are less than 1/2 the cost in Japan--accounts for part of difference.
Everybody is getting rich off US health care, because it is a non competitive over priced product.
There is no "free market" solution for this, which may be why all the other advanced countries do not supply it through the free market.

[olddots]

33. medical tourism is booming

Paris has hundreds of book stores -L.A. has maybe 14 and 6 of them are Barnes & Noble .
Greed is ruining this nation and the people who own don't even live here most of the time.

[colsohlibgal]

36. Our Health Care Costs Are Ridiculous

The Time Magazine piece about it a few weeks ago was shocking even to someone like me who knew we get ripped off big time. One facility even billed somebody for the ink used in the pen the doctor used. Just a joke, I'm sure the doc could still buy mansion or 2 without that.

It was noticeable during the push for Obamacare that price was very rarely brought up, it was all about inclusion. To make sure it wasn't brought up much the bill was strangely given to a committee that didn't seem to fit, run by jerkwad DINO Max Baucus. When professional nurses and doctors broke into the committee to try to have their voices heard (they weren't invited) old Max leered and sneered while he had them hauled off to jail. I never really liked him before this, but after that Nazi like action I despise the man. He's a democrat like I'm Joan Of Arc. Oh and I blame Obama and dem leadership for steering it to Baucus.

People are going in droves to other countries, primarily Canada and Mexico, for health and dental care. It's just us, for profit health care - which means often making investors happy is at loggerheads with smart, good health care for us. It didn't use to be like this in the US but it sure is now.

[zeos3]

39. Amen!

[shcrane71]

43. Thank you for this thread.

Keep them coming!

[aint_no_life_nowhere]

44. My cousin needed an echocardiogram and his insurance refused coverage

His doctor wrote out a prescription but the facility said they would bill an uninsured person $3,000 for it. He finally went to Mexico and found a European educated cardiologist with top credentials and it cost him $300 for the doctor visit and the procedure.