Patients as Consumers

July 7, 2017 By e-Patient Dave 7 Comments

Hospital advertises “Private suites. Caring staff. Room for family.” Bring it on! :-)

“Private suites. Caring staff. Room for family.” Woohoo!

On the way home last night I drove past this billboard, turned around, and went back to snap this photo. See, hospitals know that if we have a good maternity experience we’re more likely to come back when sick, so they offer this.

Fine with me, but when we DO come back, shouldn’t we get what they promoted?? Let’s ASK them to provide it, for ALL healthcare! Otherwise it’d be kind of a bait & switch, now wouldn’t it. :)

Empowered patients & families praise ’em when they do well, and when they don’t, we ask for what we need. Do it!

Edit: In a comment below, @MightyCasey points to another factor I should have noticed: while hospital marketing departments are promoting the service provided in their maternity suites, the grim reality remains that the US has the worst maternal mortality rates in the developed world. Here’s the chart from one of the NPR posts Casey links to, which uses data from a big (38 page) article in Lancet last year. Look at US healthcare’s performance in the past generation – this is the number of dead mothers per 100,000 live births; :

In short, while the marketing is ramping up, actual delivery of maternal care is getting much worse, especially compared to what other developed nations are doing.

China, for instance (not shown in this graph) has improved since 2000 from 85.2 maternal deaths to 17.7, while we’ve gone from 17.5 to 26.4. This matches my recent post on the e-patient blog about “amenable mortality,” which is whether a system actually delivers the care that it knows how to do.

June 16, 2017 By e-Patient Dave 3 Comments

The effectiveness of the US health system, in one graph

I’ll leave you with this thought for the weekend.

After years of study of healthcare around the world, listening to an immense number of arguments about what’s important and what works and doesn’t, it’s all summed up in this one picture. The Y axis is life expectancy; the X axis is cost. This graph has been tweeted furiously and often lately by health journalist @DanMunro. (More on him below.)

You can easily see that US health costs per capita are way, way, way out of whack with the rest of the world. And, the life expectancy we get for it is years worse than the countries that cost 2-3x less.

Some will argue bitterly that the facts aren’t relevant, or a hundred other arguments. I’ve lost interest in those arguments, because they’re all about rationale, and no rationale is worth a damn if the outcomes they’re trying to explain don’t match the rationale.

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April 10, 2017 By e-Patient Dave Leave a Comment

Do you understand your healthcare costs? See what New Orleans is finding.

For years I’ve blogged about the difficulty of shopping responsibly for healthcare. Well, late last week some big news broke – big enough that I did an overnight makeover of my home page and added a new page to my site. This is the first chance I’ve had to blog about it.

The news is that the work of my longtime friend Jeanne Pinder at ClearHealthCosts is finally getting the widespread attention it deserves: in New Orleans, award-winning investigative reporters at both Fox 8 TV and the Times-Picayune newspaper have dug right in and started using the ClearHealthCosts software system both to report the insane price variations and, importantly, let the public submit more to flesh out how much is known.

Fox 8 reporter Lee Zurik fired the first salvo, a 7-1/2 minute long segment – which, as you know, is a huge length of time for an evening news piece. Then Times-Picayune investigative reporter Jed Lipinski posted his separate piece – see screen capture above.

Here’s my page on the series with links to both pieces and all my past posts: Cracking the Code.

More to come, and here’s hoping many cities follow. We, the suffering consumers, danged well deserved to know where our money is going, and we deserve to know what our options are, before the bill arises.

April 12, 2016 By e-Patient Dave 6 Comments

The difficulty of shopping when they hide the facts: that skin cancer RFP in the NY Times

$5,000-$7,000? $1200-$1500? $868? What should it cost to remove a simple skin cancer? What if you can’t find out?

Long-time readers know that in 2012 I was on high deductible insurance – and I don’t mean Obamacare-style $3,000 deductible, I mean $10,000 deductible. I chose that gladly, because I had laboriously analyzed the five plans available to me. I know insurance is a game of sharing risks, so I analyzed (it took all my Excel skills) and chose.

What happened next is described in a column in today’s NY Times by Tina Rosenberg, Shopping for Health Care: A Fledgling Craft: within months I discovered I had a skin cancer on my face. I became a highly motivated shopper, and quickly discovered nobody could tell me what would be on my bill.

The details are in several skin cancer posts here. But Tina Rosenberg writes about social problems, and I want to draw attention to the nature of this social problem: it withholds power from the person whose health is at stake, and that’s just plain wrong.

Here’s the World Bank’s definition of empowerment, from a January post:
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September 15, 2015 By e-Patient Dave 8 Comments

Article in USA Today soon with my opinion on costs, and online advice

Photo of e-Patient Dave — Photo by Zack DeClerck for USA Today. (Click to link to article)

I was interviewed recently by USA Today reporter Laura Ungar of the Louisville Courier-Journal. The story ran Monday 9/14 in that paper and will be in the national USA Today soon. (I expected it on Tuesday 9/15 but it’s not there.)

The subject is summed up perfectly by the headline: Wildly varied health costs a national mystery.

Regular readers of this blog are familiar with my years-long series of posts Let Patients Help: Cost-Cutting Edition, especially my efforts to shop responsibly to get a skin cancer treated. If you’re not familiar with it, and you have the stomach for it, sit back with a cup of your favorite beverage and start digging. (For a shorter version, read the final post, which is pretty unsettling.)

Why do I ask you to read it? Because I believe this is important to the future of health(care) in America. We must put an end to this crap. Providers, give us the facts! Tell us what things will cost, so we can decide what’s important to us!

Good providers who are trying to do a good job at a good price simply cannot win our business in an environment that, 9 years after the original article in Health Affairs, is still best described as that article’s title did: “Chaos behind a veil of secrecy.”

Can you believe that this situation is tolerated and nobody is getting busted? As I told Laura in the interview:

There can be no explanation other than some secret malarkey going on. …

I feel disempowered and disrespected, because aside from the incredible cost crunch we’re all experiencing, it’s a downright sin that my family can’t readily find out what the options are and what the costs are.

Remedy: information!

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February 10, 2015 By e-Patient Dave Leave a Comment

I’m on Medicare! Here’s how I made it easy.

Here’s the punch line: Get a good insurance agent. Mine is Wendy Reed Johnson [right]. She didn’t cost me a thing, and saved me a ton of angst.
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For years in my cost-cutting edition series I’ve been blogging about my experiences as a highly activated shopper for medical services, most recently six months ago when I announced:

Six month countdown to Medicare!
What do I need to know?

Well, it’s six months later, I’m turning 65 this month, so on the first of the month I went on Medicare. (In some situations you can wait, but I opted not to, so I had decisions to make.) Considering how much I blogged in that series about insurance shopping in the past, including the difficulty of figuring out the right plan for my needs, you can imagine that I was anticipating more misery. But Wendy asked the needed questions, laid out all my options, and in short, made it easy.

I highly recommend that before you approach 65 you hunt for a Wendy. Find someone who’s a delight to work with – for you, because people are different – and who, when you ask questions, is happy to hear them and can answer in a way you understand.

IMPORTANT: Medicare is not one big system that you just sign up for. It still has many many options and flavors. Plus, you have to pick one plan to cover doctors, another to cover hospitals, and another for prescription drugs. Frankly, I refuse to get into explaining here the perverted and needlessly complicated terminology (Part A, Part D, blah blah blah). I prefer to pay my agent to understand it. (Except I don’t have to pay her.) [Read more…]