Do people purchase health care the way they purchase everything else?

[hedgehog]

In all the articles I've rad, the implicit assumption is that people will try to save money even when health care is concerned. That's why we have co-pays (do I really want to spend $15 to find out what that funny patch of skin is about?). I saw another article suggesting that people will select a cheaper treatment over a more expensive one. IMO, people look for the best health care they can (and sometimes can't) afford. Who is thinking of price when told they have cancer?

[MyUserNameIsBroken]

1. Complicated question

One example:

Do people shop around for cancer treatments after they find they have it? I doubt it. But is it possible to shape that choice before the discovery? Someone must think so--they have billboards for various cancer treatment sites festooning the interstates in the state I live. So while normal market forces may not apply, there is some elasticity associated with the decision--it's just not always cost elasticity.

On the other hand, one of the reasons my father chose not to have his stage IV colon cancer treated was because he didn't feel like bankrupting his wife for a handful of extra months, during which he would be pretty miserable.

An example at the other extreme:

I don't know about you, but I get generic formulations when I can, and store brands for OTC meds. So when it comes to non-critical care, I think market forces and price elasticity DO apply.

Somewhere in between those two poles, the model changes, and it may depend on the individual involved in the decisions. Like I said, complicated.

typo edit

[hedgehog]

2. I've seen those ads, but the ones I've seen emphasize quality of care,

not cost. As you note, cost does enter the picture when discussing end of life care, but generally it's a case of why pay a bundle for a few more weeks of misery. When people have a loved one in ICU, the question isn't usually about cost but about potential outcome. If they think there is a chance, people tend to demand the doctors try everything.

I've said it before, but the way to control medical costs is to do extensive studies so people can know likely outcomes ahead of time. It might be worth another 10 years of good life to aggressively treat a healthy 80 year old while it might be best to let a fragile 70 year old slip away quietly.

[MyUserNameIsBroken]

3. I agree it's not cost they're pushing

But perceived quality is part of the market equation too--as is brand recognition. If someone thinks a place is a high-quality care provider, they are even less likely to complain about price, perhaps?

[supernova]

4. No, I don't think we do

And that's the problem.

Arranging for your health care and that of your family is not inherently the same thing as buying a new house or a new car, though now the prices are roughly similar in importance on a person's budget, i.e. one of the biggest expenses of your life.

Somewhere in our present system is the belief that, if given the opportunity (say with UHC which is free at POS) that most people would use too much health care.

That's what all the copays and so forth are about. Getting you to self-limit your use of the service. But honestly I don't know anyone, barring a psychiatric illness, who hangs out at the hospital for fun getting seen and having tests and experiments performed on themselves. Do you? So, the idea that people in general use our healthcare services too much is a bogus wish of the Ayn Randians and other conservative elites who hate the masses.

I think routine things may be sorted out along a kind of economical model. There might be some elasticity there as the poster above me says. For instance, due to my damaged heart valves, I have to take antibiotics every time I visit the dentist. No biggie, and generic antibiotic is fine in that situation.

But when you have a serious illness, you just don't have the time, and often not the mental capacity for shopping around. You need treatment. Here's where the pull of the market place falls completely down. For example, some cancer patients do shop around and get 2nd and 3d opinions and look for the best place to have treatment. As a cancer patient, you want to be the best informed you can be about your condition. So you read up and find the best places that treat your cancer. But you aren't looking for the lowest-priced treatment. In fact, you aren't thinking about money at all. You are looking for the most beneficial treatment. That very often translates to the most expensive place around.

[hedgehog]

7. I think part of that attitude comes from back when England

instituted National Health. There was a presumption that the lower classes were lazy malingerers.

[hedgehog]

5. I'm not sure to express this , but the latest and greatest

treatments tend to cluster in wealthier cities, but that's where the medical schools are. I think a poor man in NYC is more likely to get the latest and greatest than a well-off person in my little town upstate. By the same token, we get a lot of doctors who trained overseas.

[supernova]

9. Exactly right

If you have a serious illness (cancer, heart attack, stroke and so on), you are more likely to survive at a huge research and teaching hospital.

I'm not saying there aren't good community hospitals, there are. And for most things they are fine. But they often lack people who have seen severe cases or unusual presentations of ailments. The best ones know their limits and send you to the big hospital in the nearest big city if there is something they don't know.

edit; there, not their.

[Jennicut]

6. As a diabetic who has to see an endocrinologist every 3 months I just bite the bullet and do it

Yeah the copays add up after a while but I need to know my AIC level (overall blood sugar level), I need my cholesterol and blood pressure checked more often. Its something that would cost more money in the long term if I don't stay on top of the diabetes.
Heath care companies don't give us enough credit for making intelligent choices.

[hedgehog]

8. It's not health care companies that are the problem, IMO.

It's experts working out of think tanks sifting data to support their beliefs.

[MyUserNameIsBroken]

10. How many of those think tanks...

...are independent of the influence of providers or insurers? Or even if they have no financial ties, are composed of people whose views were shaped in institutions with agendas? Those beliefs come from somewhere. As noted above, there were assumptions based on class prejudice built into the National Health Service--there are equally pernicious assumptions built into the US patchwork system.

But there are also accurate assumptions: even a tiny ($5 or less) co-pay seems to be effective at keeping people from making spurious office visits.

[supernova]

11. How many office visits

would you label as "spurious?"

I don't believe that many are. And those that do, as I said, have a mental problem.

[MyUserNameIsBroken]

15. Office visits when phone calls would do

Or emails. Or common sense: if your kid has had the sniffles, but no fever, for a day, you don't need to go in. Not so much hypochondria as overreaction.

The flip side of this, though, is that the insurance "system" in place in the US now can encourage visits, as opposed to phone calls or emails. The latter take up office time but aren't covered, and so some offices encourage you to come in.

YMMV.

[supernova]

16. Um, really isn't that simple

A lot of people don't know to distinguish between what's worth a look and what's fine to talk about over the phone. Think about a worried first-time parent with a sick baby. Maybe it's nothing, maybe it's something. You don't have the experience nor the training to make that call. The Dr's office does.

It's a judgement call and often the MD's office will err on the side of seeing someone in person rather than try to diagnose a situation over the phone, unseen.

[MyUserNameIsBroken]

17. I've BEEN a worried first-time parent with a sick baby

So I understand the worries. And yet charging even a little for something seems to activate some sort of self-screening capability in people. People treat something that's free differently.

But this is all beside the point I was really trying to make: health care cannot be treated as a monolithic economic entity. It's not one market, it's a collection of a lot of related markets that have different parameters. Preventative care is not critical care is not elective care.

That inspires a thought experiment: under a single payer plan, what, if any elective care should be covered? And can a list of what elective care is be determined medically, or only politically?

[hedgehog]

18. This illustrates how we can benefit by standing back and re-thinking

health care instead of just financing what we have now. What if .....



Every expectant mother got several in-home visits by a nurse before the baby came to review her nutrition and the preparations for the baby? What if the nurse visited in the hospital and then several times the first few days the baby came home? What if there were follow-up visits to see how the baby was doing and answer any questions? What if the nurse was able to immunize the baby on those visits?


The same thinking applies at the other end of life. A lot of elderly people would benefit by regular check-ups in their home by a nurse who could help them eliminate tripping hazards, advice them on what they should be eating, etc.

[MyUserNameIsBroken]

19. Preventative care like that

saves much pain and some money--but it doesn't MAKE money for anyone in the current system, so it's been comparatively neglected. It's a public good, but we don't have a system built for public good.

One way or another, that needs to change. It's slightly encouraging that employers who provide health care are pushing preventative care, for their own reasons of course, but it's by far the most efficient use of the health care dollar. Now if we can figure out a way of making it competitive with another drug for erectile dysfunction or a laser vein care center on the provider side...

[supernova]

12. It's the same ole stupids at these "think" tanks

AEI, Heritage Foundation.

God, I wish they'd had their bequests with Madoff!

I would be perfectly happy to never hear from them again.

[Jennicut]

13. These think tanks do very little thinking. And many of them have ties to the health care industry

[supernova]

14. Oh yes, agreed

They exist to push Scaife pre-approved "opinions" on the American public.

And those morons I saw picketing against our picketing of Kay Hagan's office last week for a public health care option exist to lap it all up. So gullible.

[sandnsea]

25. I only get mine once a year

Have you just been diagnosed or is it Type I or some other reason for more frequent blood tests? And does your doctor seriously require you to pay for a visit when all you need is to know your number? Mine doesn't. Well, I refuse to go into the office, lol. We can do this over the phone, thank you very much. Then just send me my numbers in the mail.

[Vinca]

20. I would think of price if told I had cancer.

Since I can't afford insurance, there is no way in hell I could afford a full course of treatment for a curable cancer. That being the case, I might opt out of any treatment if the end result of partial treatment was going to be death. The last thing I would want to do is have my family living on the street in a box having spent every dime and sold every asset for my unsuccessful treatment.

[quidam56]

21. "the best health care system in the world"- FNN

As a former health care giver, I am shocked and saddened to see what has become of health care in America. $ 1. 4 million is being spent per day in DC by the health care lobbyists so your elected representative is getting taken care of and has quality health care we pay for and can't afford ourselves for our families, I know what is deemed, defended and supported in Tennessee and Virginia as quality health care and clearly profit care comes ahead of patient care. http://www.wisecountyissues.com/?p=62 MRSA ( methicillin resistant staphylococcus aureas ) is infesting our communities because filthy, uncaring hospitals and emergency rooms are breeding them and spreading them into our schools, homes, restaurants. How many more Americans' will be diseased or die while 74 % of Americans' are begging for health care reform ? More people died in America last year from MRSA complications than AIDS. When MRSA and a flu bug start mixing, it won't be pretty and we are being infected by the very health care system we depend on and trust to keep us safe and healthy.

[Mimosa]

22. Yes. And when we can't afford it we postpone or go without

I guess the answer is yes. DH and I have 70/30 BC/BS policies with $10,000 deductibles each. We each have excluded conditions. I've been advised to have a couple of things checked out which might be cancerous but I'm afraid to.

[tranche]

23. Don't you insure against cancer?

I've had to purchase insurance and I look for catastrophic protection at the lowest price possible while going with a group that has a decent reputation. I am fearful that I'll be screwed if I ever need to call upon it.

I want the price brought down. So I do support a public option for that reason.

[boppers]

24. Can I buy 20 dollar "health-care gift cards" at Wall-Mart?

I'm not sure the general question even makes sense.

So no, people don't purchase and use it in the same way.

[sandnsea]

26. Give it 3 years

If they pass a law that all business has to provide health insurance, and Walmart gets their instant clinics going, I bet you will be able to buy health care gift cards to cover the co-pays.

[boppers]

27. LOL

Is it a sad, or good, thing that I totally believe you?