Monday, September 07, 2009

That Cost Me What?

I'm in the IT field, so I can readily appreciate that the value I provide is not only in pressing buttons on a keyboard, a task which any monkey can do, but in knowing which buttons to press and when. Likewise, I expect to pay a neurosurgeon a lot of money for the knowledge that he brings to the operating table in addition to the physical task that he performs.

Even with that caveat, I'm astonished at some of the prices I've been charged for health care procedures. Here is a sampling of some of the costs that blew my mind. I don't want to come across as ungrateful since I literally owe my child's life to the people who have cared for him.
  • $2,693: U of U Neonatal ICU room: My son was born with spina bifida. That meant that part of his spinal cord was poking out of his back in a little bubble when he was born. Obviously a touchy situation right after birth. After he was born, they passed him through a window from the delivery room into the neonatal ICU room. (We knew about the condition before his birth and were in the right place to be prepared to deal with it.) He stayed there for 90 minutes. They kept his back clean and safe in preparation for transport to Primary Children's Medical Center (PCMC).
  • $237: IHC Life Flight Service: This was the cost to roll my son through a hallway/tunnel that connects the U of U hospital (where he was born) into PCMC. Sure the gurney was like a space capsule, but it was obvious that it was massive lawsuit-avoidance overkill in transporting him between the two facilities. The task took about 15 minutes with two attendants. There was no helicopter involved. My part of the monthly premium (though my employer pays the lion's share) for health insurance is $277. If this tiny part of the care for my child is consumed with a pretty mundane task, how can we hope that I'll ever pay in enough to cover all the rest of this stuff?
  • $5,291: Neurosurgeon's bill. The surgery took a couple of hours. The quality of this surgery will affect the rest of my son's life. From what I can tell, it was done flawlessly. I list the price here for comparison with the neonatal room above. Sure, the surgeon made more in two hours than I earned in the month, but some things are worth paying for. I think this was one of them.
  • $161: Pediatrician visit in hospital. The doctor moves from room to room, checking on each child and answering questions from the parents. Each time he visited us for 5-8 minutes, they billed the same $161. I realize that I'm paying something for his availability and skill, but for a visit that was so brief, the price seems exorbitant. For an 8 minute visit, that works out to $20/minute. Most people feel good about making that much per hour.
  • $3,966: Neurosurgeon's bill. This was a shunt placement a few weeks after birth. It was literally brain surgery that inserted a tube into the middle of my boy's head and then down his body, underneath the skin, into his abdomen. I don't remember how this one compared in time to the previous surgery on his spine. This one will probably be performed a few times in his life as these tubes frequently fail. Remember that this is just the surgeon's bill. The hospital, drugs, anesthesia, and so on are all billed separately. (My wife reminds me that the plastic shunt valve itself also cost a small fortune... and has since been recalled. Does that mean we should get a refund?) I don't know why the price of this surgery was different from the previous one. It was the same surgeon, though obviously a very different procedure. I suspect both were equally complex, but I wouldn't really know.
The above list also proves that I have a very poor ability to gauge the value of the service that is being provided to me. Because the prices are so hidden at the time of service, we haven't developed any intuition for them like we have with other items we spend so much money on.

Would health care be different if we all knew the price up front? Would that necessarily be a good thing in every case? Would it even matter? I should note that nobody ever asked me whether we should do anything for my child. It was only a question of when, if even that. More on that in a future post.


The Lady Logician said...

Connor - I am going through the same with my own hospitalization last spring. I was billed several hundred dollars for a "hospitalist" to visit with my twice during my 6 day hospital stay. Each time she was in my room for maybe 5 minutes max.

I also discovered that there are certain "rules" that are set up that make no sense at all. For example, because my infection was the direct result of a car accident, I had to go to the EMERGENCY ROOM every time I needed someone to look at it. At $800.00 a pop (before insurance payments) 5 visits to the ER added up fast! And that was just the hospital's portion - the doctors billed above that. It would have been nice to know, in advance, what and WHO to expect bills from. That has been the frustrating thing for me. I have separate bills for each doctor that saw me plus the hospital plus radiology plus the hospitalist plus.....even for someone as obsessively organized as I get with things like this (I am the spreadsheet queen) it's hard to keep track of it all.

This is why reform is needed. Unfortunately what has been proposed will not fix any of this.


ShelleyG said...

This should be a state's issue. I am extremely alarmed at the creation of new government. As an employer who buys health care for their employees, we are alarmed at the skyrocketing costs. But there should be a free market solution. We have to know what we are paying for our care and we should pay out of pocket for the normal stuff and have insurance for the big, unexpected stuff (Like Gid). I have heard that this bill won't even go into effect until 2013-is that true? I don't know, but wouldn't be surprised. I know health care needs to change, but it is not the federal gov'ts place to do it!!

ShelleyG said...

I have obviously become very cynical lately-I honestly don't believe any of our politicians care at all about helping us have better care, I think they just want to get re-elected. BUG! Have I mentioned I am now a Libertarian? :)