(2) Elisabeth Rosenthal, The $2.7 Trillion Medical Bill; Colonoscopies Explain Why US Leads the World in Health Expenditures. New York Times, June 2, 2013 (front page; under the heading: "Paying Till It Hurts; A case study in high costs).
http://www.nytimes.com/2013/06/0 ... h-expenditures.html
Quote:
"While the United States medical system is famous for drugs costing hundreds of thousands of dollars and heroic care at the end of life, it turns out that a more significant factor in the nation’s $2.7 trillion annual health care bill may not be the use of extraordinary services, but the high price tag of ordinary ones.
"The United States spends about 18 percent of its gross domestic product on health care, nearly twice as much as most other developed countries.
"The more than $35,000 annually that Ms [Deirdre] Yapalater[, a 64-year-old customer relations specialist for a small Long Island company,] and her employer collectively pay in premiums — her share is $15,000 — for her family’s Oxford Freedom Plan would be more than sufficient to cover their medical needs in most other countries. She and her husband, Jeff, 63, a sales and marketing consultant, have three children in their 20s with good jobs. Everyone in the family exercises, and none has had a serious illness. Like the Yapalaters, many other Americans have habits or traits that arguably could put the nation at the low end of the medical cost spectrum. Patients in the United States make fewer doctors’ visits and have fewer hospital stays than citizens of many other developed countries, according to the Commonwealth Fund report.
"Though Medicare negotiates for what are considered frugal prices, its database shows that it paid an average of $531 for a colonoscopy in 2011. But that does not include the payments to anesthesiologists, which could substantially increase the cost. 'As long as it’s deemed medically necessary,' said Jonathan Blum, the deputy administrator at the Centers for Medicare and Medicaid Services, 'we have to pay for it.'
"The bills [of colonoscopy done at an outpatient surgical center in Long Island, New York and total $6,385] to Ms Yapalater’s insurer reflected these charges: $1,075 for the gastroenterologist, $2,400 for the anesthesia — and $2,910 for the facility fee.
"Ms Yapalater’s insurer paid $1,568 of the $2,400 anesthesiologist’s charge for her colonoscopy, but many medical experts question why anesthesiologists are involved at all. Colonoscopies do not require general anesthesia — a deep sleep that suppresses breathing and often requires a breathing tube. Instead, they require only 'moderate sedation,' generally with a Valium-like drug or a low dose of propofol, an intravenous medicine that takes effect quickly and wears off within minutes. In other countries, such sedative mixes are administered in offices and hospitals by a wide range of doctors and nurses for countless minor procedures, including colonoscopies. Nonetheless, between 2003 and 2009, the use of an anesthesiologist for colonoscopies in the United States doubled, according to a RAND Corporation study published last year. Payments to anesthesiologists for colonoscopies per patient quadrupled during that period, the researchers found, estimating that ending the practice for healthy patients could save $1.1 billion a year because 'studies have shown no benefit' for them, Dr [Soeren] Mattke[, a senior scientist at the RAND Corporation,] said. * * * The Department of Veterans Affairs, which performs about a quarter-million colonoscopies annually, does not routinely use an anesthesiologist for screening colonoscopies.
My comment:
(a) Two maps of the same United States accopanied the report.The first map highlighted: Colonoscopy: Average US Price $1,185; Switzerland $655. The second was headlined "The Cost of a Colonoscopy Varies Across the Country."
(b) You do not have to read the rest of the report, if you do not need to. The graphics are interesting, though.
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发表于 9-28-2013 17:43:55
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