Top Five Reasons to Visit a Urologist

Urology is the specialty of medicine that focuses on the urinary tract—the bladder, kidney, urethra, and associated organs—and the male reproductive organs like the testes, prostate and penis. Because urologists specialize in male sexual organs—among other things—it’s a common misconception that the specialty is simply the male counterpart to a gynecologist. However, this is a false assumption that could prevent many women from receiving the most qualified care for many urinary tract issues.

Men and women can benefit in a variety of ways from the specialized care a urologist can provide. To help understand the scope of their care, here are five common reasons it might be a good idea to make an appointment with a urologist in your area today.

1) Because your primary care physician tells you to

Urologist

This one may seem like a no brainer, but it’s overlooked enough that it bears pointing out. One of the key responsibilities of your primary care physician (PCP) is to coordinate your care among different specialties. Whenever a patient has an issue that requires more specialized expertise, it is the responsibility of the PCP to make recommendations of which specialists to visit and to help coordinate your care among the various specialties.

If your PCP recommends that you visit a urologist, it’s clear that they think there’s an issue beyond their typical scope. So, it’s important to follow that recommendation. In many cases, your PCP’s office may make the appointment with a urologist for you. In other cases, they may leave that up to you. Regardless, it’s important to get the appointment scheduled and stick to it even if the symptoms seem to subside.

2) When you’re having recurrent urinary tract infections

A urinary tract infection (UTI) is an infection that occurs in any of the organs associated with the urinary system. Depending on where the UTI specifically occurs, they can produce symptoms like foul smelling or discolored urine, pain in the lower stomach or back, an increased need to urinate, or pain during urination. UTIs aren’t that uncommon in women—although they shouldn’t occur frequently—and, in men, they’re relatively rare, especially before the age of 50.

While a single UTI is probably not cause to see a specialist, multiple UTIs in a brief time span may warrant the need to make a urology appointment. A urologist will be able to more accurately pinpoint where in the urinary tract the infection is occurring and work to find the root cause of the recurrent infections. If you’ve suffered from multiple UTIs, your urologist can also make sure your frequent and repeat infections haven’t permanently damaged your urinary system – which could be amplifying your symptoms.

3) If you’re a male and notice any change in your testes

Testicular cancer is the most common cancer diagnosed in men between the ages of 20-39 years old. That’s why it’s important for men to familiarize themselves with their anatomy so that they can easily identify any changes that may signal a serious condition.

Testicular cancer is extremely curable, especially if caught early. That’s why if you notice any lumps or bumps on your testicles it’s vital to make an appointment with a urologist who can examine you further.

There are other changes to the testes that aren’t signs of cancer that still should be examined by a urologist. Pain, swelling, or changes in the texture of the testes are all symptoms that merit further examination. When making an appointment with a urologist, be sure to explain the symptoms in detail on the phone—some symptoms are more urgent than others and may necessitate being seen sooner than others. If you’re having trouble being seen quickly, you can often work with your PCP who can help you assess the urgency and, if needed, work with a urologist to get you scheduled sooner rather than later.

4) When your urinary habits suddenly change

Everyone is different, and urination frequency depends on a wide variety of factors. On average, most people urinate between 7-10 times a day. If you’ve found that you always go more or less frequently than average, that’s not necessarily cause for concern. However, if you suddenly find yourself having to go significantly more or less than you used to, then it may be time to see a urologist.

It’s also important to consider more than just frequency. Other urination related changes to look for include:

  • A change in the effort required for urination (a need to “push” harder)
  • A frequent sensation or feeling the need to urinate, with little or no urine produced
  • A harder time controlling urination: accidental urination, or a harder time stopping once started

Each of these symptoms could be signs of conditions that a urologist is best qualified to diagnose and treat.

5) If you’re a man over the age of 40

Once men approach the age of 40, the risk for a variety of urological diseases increases. As a specialist in both urinary systems and the male reproductive system, urologists screen men for a variety of these diseases and talk with you about your family history, diet, lifestyle and other risk factors to consider in your overall health.

Once you hit 40, it’s important to get screened, even without symptoms, so that you and your urologist can understand what’s normal for your body. Even slight changes from a baseline can signal that something may need closer attention.

At 40, you should also begin to undergo regular prostate screenings to check for inflammation and other signs of cancer. As you age, the risk for sexual dysfunction also increases and can be assessed and treated by a urologist.

How to find a urologist

When choosing any doctor there are a number of considerations to keep in mind: location, price and quality are key factors that determine the overall satisfaction you’ll have with your urologist. Use HealthCost to search for a urologist in a specific area, find a price that works for your budget and review quality ratings from other patients.

Any views or opinions represented in this blog are personal and belong solely to the blog owner and do not represent those of people, institutions or organizations that the owner may or may not be associated with in professional or personal capacity, unless explicitly stated. All content provided on this blog is for informational purposes only. The owner of this blog makes no representations as to the accuracy or completeness of any information on this blog or found by following any link on this blog. The owner will not be liable for any errors or omissions in this information nor for the availability of this information. The owner will not be liable for any losses, injuries, or damages from the display or use of this information.

What Goes into Healthcare Costs

If you’ve received any type of healthcare treatment in your lifetime, you know the drill. You visit the doc, you get the procedure and then comes the bill. Really, you have no idea how much any of it is going to cost until you see that dreaded statement and how they came to the final amount is an even bigger mystery. So what are some of the items often seen on a billing statement?

The answer (like many things in healthcare): it’s complicated. There are many key factors that can appear on your bill or contribute to the final amount due. If you’re looking to keep healthcare costs low, familiarize yourself with what goes into your medical bill, research costs beforehand, and—importantly—talk to your doctor about what you find.

What Goes Into Healthcare Costs | HealthCost Blog

Any views or opinions represented in this blog are personal and belong solely to the blog owner and do not represent those of people, institutions or organizations that the owner may or may not be associated with in professional or personal capacity, unless explicitly stated. All content provided on this blog is for informational purposes only. The owner of this blog makes no representations as to the accuracy or completeness of any information on this blog or found by following any link on this blog. The owner will not be liable for any errors or omissions in this information nor for the availability of this information. The owner will not be liable for any losses, injuries, or damages from the display or use of this information.

HealthCost: The Network for Everyone Else

The statistics from the Kaiser Family Foundation and CDC speak for themselves. Too many Americans are left paying excessive costs for healthcare services. They’re either completely uninsured or they fall within a network with extremely high deductibles that force them to pay heavy out-of-pocket expenses for their healthcare needs.

healthcost network

HealthCost is giving the power back to the consumer by providing a searchable database for these families and individuals to make informed decisions.

With HealthCost, you can search for a specific medical procedure, imaging procedure or specialty physician to find the doctor you want at the cost you need.

Any views or opinions represented in this blog are personal and belong solely to the blog owner and do not represent those of people, institutions or organizations that the owner may or may not be associated with in professional or personal capacity, unless explicitly stated. All content provided on this blog is for informational purposes only. The owner of this blog makes no representations as to the accuracy or completeness of any information on this blog or found by following any link on this blog. The owner will not be liable for any errors or omissions in this information nor for the availability of this information. The owner will not be liable for any losses, injuries, or damages from the display or use of this information.

Where to go When the Doc is Out: ER v. Urgent Care Costs

There is often a level of uncertainty when you’re unable to book an appointment with your regular doctor – should you visit an emergency room (ER) or an urgent care facility? Both have their benefits, but the real kicker comes with cost. Of course, if your symptoms seem life-threatening, you should always seek out the ER or dial 911. However, there are often symptoms of non-life-threatening conditions—that always seem to pop up on the weekend or after office hours—that urgent care facilities can treat at a fraction of the cost.

Debt.org, using Medica data, brings some of these cost differences to life in the graph below.

Emergency Rooms vs Urgent Care Centers

In 2013, some of the leading principal reasons for ER visits were stomach and abdominal pains (10 million), coughing (5 million), fevers (4.6 million) and vomiting (2.8 million) – each of which can be treated at an urgent care facility or separate private practice (depending on severity). This information, combined with the graph above, raises the important question: Why you are seeking treatment in the first place? Again, if the answer is for life-threatening symptoms or injuries, go to the ER or call 911. For anything else, the alternative may be your best bet.

Reasons to visit the ER:

  • Severe chest pain
  • Severe abdominal pain
  • Wheezing or shortness of breath
  • Paralysis
  • Intestinal bleeding
  • High fevers (over 103) or rash, especially among children
  • Vaginal bleeding with pregnancy
  • Uncontrollable vomiting
  • Poisoning
  • Severe head or eye injuries
  • Allergic reactions
  • Unconsciousness

When to seek alternative options:

  • Minor abdominal pain
  • Fevers, flu or cold symptoms
  • Vomiting or diarrhea
  • Ear infections
  • Seasonal allergies
  • Bronchitis
  • Sprains and broken bones
  • Cuts and bleeding that may require stitches
  • Breathing discomfort, such as moderate asthma
  • Urinary tract infections
  • X-rays and lab tests
  • Minor neck pain

(Source: El Camino Hospital)

How HealthCost can help.

Even once you deem your symptoms unnecessary for the ER, large gaps in cost between urgent care facilities and private practices can still occur. HealthCost helps you bridge this gap by providing the tools you need to shop for healthcare services in advance. By using HealthCost, you can see specialists, procedures and facilities available in your area in real time with the price tag attached.

Below are some of the most common specialists and procedures searchable through HealthCost.

Specialists:

  • Allergist/Immunologist
  • Infectious Disease Specialist
  • Sports Medicine Specialist
  • Family Practitioner
  • Internist
  • Pain Management Specialist
  • Endocrinologist
  • Vascular Surgeon
  • Neurologist
  • Urologist
  • Gastroenterologist

Imaging Procedures:

  • X-ray (ankle, arm, hand, hip, pelvis, chest, leg, foot, skull)
  • Ultrasound Imaging
  • Breast imaging
  • CT Imaging
  • Radiography sinuses
  • Magnetic resonance imaging (MRI)

With a resource like HealthCost, it pays to stay informed. Start your search today.

Any views or opinions represented in this blog are personal and belong solely to the blog owner and do not represent those of people, institutions or organizations that the owner may or may not be associated with in professional or personal capacity, unless explicitly stated. All content provided on this blog is for informational purposes only. The owner of this blog makes no representations as to the accuracy or completeness of any information on this blog or found by following any link on this blog. The owner will not be liable for any errors or omissions in this information nor for the availability of this information. The owner will not be liable for any losses, injuries, or damages from the display or use of this information.

Let’s Address the Cost of Care

By Douglas Tardio, HealthCost Founding Partner

The Wall Street Journal recently published an article discussing 2018 projected healthcare premium increases. It states that, on average, insurers will ask for a 20 percent increase in premiums, with some asking for over 50 percent. Before we get lost in the numbers, let’s consider a few points:

  1. Annual premium increases are not new
  2. They are not a one-time event while the market re-stabilizes
  3. The lack of clarity on future subsidies are not driving them
  4. “All the healthy people” that haven’t purchased insurance are not to blame for rising premiums

The Kaiser/HRET of Employer Sponsored Health Benefits (1994-2004) provides some clarity. Keep in mind that employer-sponsored plans have little or nothing to do with Obamacare or the Exchanges. These plans aren’t new, and they still cover a majority of the insured consumers in the country (roughly 147 million v. 20 million for ACA exchange plans). Below is a graph from Kaiser/HRET to better understand the changes in premiums over the years.

healthcare premium increases

And yes, while you might not see a 50 percent jump in any one year for employer-sponsored plans, one thing is clear: The true answer lies in the access to and cost of care. By access, I don’t mean access to insurance – I mean access to healthcare services. Let’s look at drugs, for example. Direct-to-consumer advertising of drugs was legally approved in 1985, but rapidly accelerated in 1997 with FDA review. Today, if you watch the nightly news, you understand the impact to access this has made. If not, “go ask your doctor about it.” And second, the cost of healthcare services. Again, drug cost increases lead the way, but they are often followed by inpatient hospital cost increases. For example, aligned with the acceleration of direct-to-consumer drug advertising, the U.S. Bureau of Labor and Statistics found a 195 percent inpatient hospital cost increase from 1997 to 2016.

The problem is that we don’t find out about the majority of these cost increases until after services are performed. At that point, there is little you as a patient can do. But there is a lot Congress can do, if they would only stop for a moment and address the cost of care.

Any views or opinions represented in this blog are personal and belong solely to the blog owner and do not represent those of people, institutions or organizations that the owner may or may not be associated with in professional or personal capacity, unless explicitly stated. All content provided on this blog is for informational purposes only. The owner of this blog makes no representations as to the accuracy or completeness of any information on this blog or found by following any link on this blog. The owner will not be liable for any errors or omissions in this information nor for the availability of this information. The owner will not be liable for any losses, injuries, or damages from the display or use of this information.

Any views or opinions represented in this blog are personal and belong solely to the blog owner and do not represent those of people, institutions or organizations that the owner may or may not be associated with in professional or personal capacity, unless explicitly stated. All content provided on this blog is for informational purposes only. The owner of this blog makes no representations as to the accuracy or completeness of any information on this blog or found by following any link on this blog. The owner will not be liable for any errors or omissions in this information nor for the availability of this information. The owner will not be liable for any losses, injuries, or damages from the display or use of this information.

Talking Costs with Your Doc Shouldn’t be Awkward

By Russell A. Amico, M.D., HealthCost Co-Founder

Healthcare costsWhen it comes to most of the major purchases we make, we readily discuss and often negotiate the cost with a seller. Think, for instance, about used or new cars. We also turn to online resources to find the best deals on a whole host of purchases, from books to hotel rooms. Yet, when it comes to healthcare costs, most of us have somehow come to believe two things—the cost is what it is and it’s inappropriate, or even rude, to talk about anything related to costs with our healthcare providers. Both are inaccurate and don’t do any good.

What you pay for healthcare services⎯be it a doctor’s visit, an imaging procedure or a surgery⎯can vary greatly. Two healthcare providers located on the same block may be close in proximity but miles apart in their pricing. For instance, in one American city, the cost of a diagnostic colonoscopy can range from $1,900 to over $8,000! Which would you rather pay? In some cases, you may want to pay more for an experienced surgeon. In other cases, you may want to know that a more reasonable MRI can be had at a facility a little further down the street. The key is there are choices, and you should be aware of them.

So, when pricing can vary this much, it’s in our best interest to ask about it. Yet, we often don’t talk costs with our doctors and other healthcare providers. We’ve been conditioned to think that it’s somehow wrong to do so. But this just isn’t the case! Our beloved capitalistic system depends on open, free markets with transparent pricing. Besides, every consumer has the right to know just what they’re paying⎯for every single thing they buy, including healthcare. None of us should hesitate or feel the least bit awkward about asking what healthcare services cost. Remember, the answer may mean keeping hundreds, if not thousands, of dollars in your own pocket.

So how do you inquire about costs? Here are some tips:

  1. Clear your inhibitions. As noted above, the first step is to abolish any notion that discussing pricing is wrong. It’s not!
  2. Negotiate. Before you schedule an office visit or procedure, ask about the cost. Regardless of what you’re quoted, ask if there’s any “wiggle room.” For instance, if you don’t have insurance, can they reduce the price if you pay cash?  If you do have insurance, see if they are open to accepting whatever your insurance covers with no additional out-of-pocket costs. Remember, it can’t hurt to ask.
  3. Do additional research. Don’t book the appointment or procedure based on your initial conversations. Instead, tell them you’ll get back after doing some price checking. This sends a signal to the healthcare provider that cost matters and you’re shopping around. Search this site, HealthCost.com, and compare prices from other providers in your area. You’ll likely be able to negotiate a lower payment than what was originally quoted.
  4. Make an informed decision. Armed with this insight, you can then choose a provider based on his or her qualifications and your budget.

Here’s the bottom line: It’s your health and your money. You have a right to know everything the doctor does regarding your health. And you have every right to know what caring for yourself or a loved one is going to cost.

So, ask away.

Any views or opinions represented in this blog are personal and belong solely to the blog owner and do not represent those of people, institutions or organizations that the owner may or may not be associated with in professional or personal capacity, unless explicitly stated. All content provided on this blog is for informational purposes only. The owner of this blog makes no representations as to the accuracy or completeness of any information on this blog or found by following any link on this blog. The owner will not be liable for any errors or omissions in this information nor for the availability of this information. The owner will not be liable for any losses, injuries, or damages from the display or use of this information.

Feeding The Beast

By Douglas Tardio, HealthCost Co-Founder

A recent article in the New York Times identified a concern that “The Health Act Repeal Could Threaten the U.S. Job Engine.” The article suggested that the Affordable Care Act had taken unemployed factory workers and provided them with healthcare jobs.

In fact, the Deputy Mayor for Economic Development for the city of Akron, Samuel D. DeShazior said, “People who used to make deliveries to factories are now making them to hospitals.”

Is this an incredible achievement? Well, let’s take a closer look.

When you subsidize growth you can make just about anything grow. While the government offered money for hospitals to grow and hire more, hospitals were eager to find ways to qualify for these dollars anyway they could. Hundreds of millions of dollars in government subsidies were spread out to any and all takers in the healthcare industry. Hospitals merged and a feeding frenzy to buy up nearly every physician practice ensued—large and small. The mantra seemed to be let’s build, build, build and hire, hire, hire. The government offered money, and hospitals found ways—necessary or not—to accept it.

The result, not surprisingly, is that hospital systems across the country are now the largest employers in many towns. Yet despite this growth, hospitals are no more efficient now than they were before. Quality is no more improved and patient outcomes aren’t much better.

Virtually nothing has improved while hospitals have grown in size and revenues. Those hospitals are still fighting over the same doctors who were already there. Those doctors are still fed up with working ever more hours for ever decreasing returns. Meanwhile, hospitals hired more staff. Lots and lots of staff. Enough to require more space and the need for more buildings. I think by now you get my point: hospitals grew, sure, but what is growing for the sake of growth if nothing else improves?

Government subsidies grew as fast as the buildings erected to justify them and the big healthcare machine grew and grew. Meanwhile, the average American household saw increased healthcare premiums and soaring out of pocket costs. Because someone has to feed the beast…and it’s hungry.

Any views or opinions represented in this blog are personal and belong solely to the blog owner and do not represent those of people, institutions or organizations that the owner may or may not be associated with in professional or personal capacity, unless explicitly stated. All content provided on this blog is for informational purposes only. The owner of this blog makes no representations as to the accuracy or completeness of any information on this blog or found by following any link on this blog. The owner will not be liable for any errors or omissions in this information nor for the availability of this information. The owner will not be liable for any losses, injuries, or damages from the display or use of this information.

Physicians Can Now Use Technology to Set Rates

By Douglas Tardio, HealthCost Co-Founder

The healthcare system is broken—not just for patients, but for providers as well. Until now, there has never been an open or straightforward way for doctors and healthcare professionals to adjust their own fees or share their actual pricing with their patients. The process has been mostly one-sided for decades. Providers participate in health plan agreements to gain access to commercially insured patients. But commercial insurance has held all the cards. Reimbursements to providers are complicated and rate structures are proprietary. In the end, the physician has little to no control over their rates, how they’re reimbursed for the services they perform and, worse, they have no control over what patients they see. Why? Because the uninsured can’t afford the prices dictated by the government and insurance groups, and they’re limited in seeing only patients within the insurance networks they have joined.

We have a solution—a way to open the restrictions and put the physician and the patient back in control.   

Physicians

HealthCost, the first network offering healthcare providers the freedom to set and manage their own network prices, is changing all of this. Through HealthCost, providers join an open, transparent network where pricing data is readily available to any consumer. HealthCost providers then have the freedom to market their own services to new consumers no matter how, or if, they are covered under insurance. Healthcare providers can now expand beyond their current health plan networks and reach new, traditionally unreachable patients. Now providers can reach the millions of uninsured, self-insured small business, out-of-network and other self-pay consumers.

A vet charges more on the weekends. Why isn’t it the same for doctors?

It’s fairly standard that a visit to the vet is more expensive on the weekends and holidays. The same is true for many other products and services. Pricing varies throughout the week and by location when booking an airline ticket, for example. Shouldn’t these free market principles be the same for doctors and medical professionals?

As part of a free market, healthcare providers should be free to entice consumers with fair market pricing, based on value and demand, not predetermined pricing. Why shouldn’t providers have the freedom to flex when they need to? Just like every other category in our free market, providers should be able to offer lower rates for procedures on days when demand is low or higher rates when demand is high.

Register with HealthCost.com Today

Are you a healthcare provider who wants to gain control of your rates and meet new patients? It’s easy to become a HealthCost Networks provider. Simply visit our provider page and click the “Join Now” button. You’ll be able to fill out a simple form to enter our system and begin the registration process. Once registered, you will be able to check your published rate and make changes as you see fit.

There are upwards of 50 million people that aren’t being reached by healthcare providers today. We believe that when providers control their own rates and patients are given the knowledge they need to make the best healthcare decision for themselves and their families, everyone wins.

Any views or opinions represented in this blog are personal and belong solely to the blog owner and do not represent those of people, institutions or organizations that the owner may or may not be associated with in professional or personal capacity, unless explicitly stated. All content provided on this blog is for informational purposes only. The owner of this blog makes no representations as to the accuracy or completeness of any information on this blog or found by following any link on this blog. The owner will not be liable for any errors or omissions in this information nor for the availability of this information. The owner will not be liable for any losses, injuries, or damages from the display or use of this information.

My Penicillin Will Cost What?

By Douglas Tardio, HealthCost Co-Founder

It’s been 75 years since the miracle drug Penicillin has hit the market. This got me thinking. With the media spotlight shining brightly on the cost of drugs in recent months, I wondered just how much this universally known, widely available drug might actually cost today.

My research began where most Americans start their search—Google. After typing “cost of penicillin” into my browser, the first site brings me to a list of what it calls “fair prices,” ranging from $8 for Amoxicillin all the way up to $1,324 for Bicillin. Wow, that’s the difference between buying lunch and making a mortgage payment for many Americans.

penicillin

Maybe a general Google search isn’t the right approach. So, I moved on and went directly to the U.S. Food and Drug Administration (FDA) website.  After all, they are the federal agency with “drug” in their actual name. Surely, they can give me a price, right?  My search resulted in numerous official-looking meeting notes from as far back as 2000. However, after scanning hundreds of pages—nothing on the cost of penicillin.

So why is this so hard? Why can’t we do a simple search to find the cost of a drug, whether it’s Penicillin or its various derivatives? There were so many that I had to find another clinical website just to identify all of them.  By now, I’m more than frustrated that I won’t ever be able to find out the real cost of a single dose of Penicillin. But I gave it one more shot and went straight to a drug manufacturer’s website. Finally, I found a price. But…only for the price of the company’s stock. I give!

So, what is my point? Whether you’re searching for the cost of a drug or a healthcare procedure, the experience is the same. Costs are hidden. No one knows exactly what they’re paying for and everyone gets frustrated. I’ve been in the healthcare industry for 25 years. Understanding why the public is not informed on the costs of healthcare procedures and drugs has baffled me for decades. Which is why my partners and I decided to tackle the issue of bringing price transparency to the market. Although we haven’t tackled the cost of drugs, what we have brought you is a searchable database where you can find the exact cost of a healthcare procedure (from an appendectomy to an x-ray) or an office visit (whether that’s with an allergist or a vascular surgeon) so that you can make an informed decision about who you see and what you can afford.

Any views or opinions represented in this blog are personal and belong solely to the blog owner and do not represent those of people, institutions or organizations that the owner may or may not be associated with in professional or personal capacity, unless explicitly stated. All content provided on this blog is for informational purposes only. The owner of this blog makes no representations as to the accuracy or completeness of any information on this blog or found by following any link on this blog. The owner will not be liable for any errors or omissions in this information nor for the availability of this information. The owner will not be liable for any losses, injuries, or damages from the display or use of this information.

The $0.00 Copay: How the Industry Disassociated Cost from Care

By Douglas Tardio, HealthCost Co-Founder

Enacted in the 70s – and catching on in metropolitan areas by the early 80s – copays, a component of health maintenance organizations (HMOs), may have been a leading factor in the destruction of our health insurance system.

So why are insurance companies trying them again?

Prior to the HMO, most indemnity insurance plans offered through employers had some type of cost sharing between the employee and the employer. Typically, the employer covered the total cost of the insurance premium and paid for 80 percent of the cost of care and the employee paid the remaining 20 percent. Services were rendered, bills submitted to consumers were laid out on the kitchen table, reviewed and paid. Then, as employee benefit costs started to make the American worker too expensive against global competition, new plans emerged to manage costs…welcome the HMO.

To incentivize participation, a carrot was offered to the consumer. It was called a copay. This dramatically altered a consumer’s out-of-pocket expense from a percentage of the bill to a fixed amount. Typical HMOs would charge $5 or $10 for an office visit and typically $50 for an ER visit. The result was improved access to care but also a complete disassociation by physicians and consumers alike for what the actual costs of care were.

Fast forward a decade to the early 90’s. While consumers liked their copays, they did not like the ever increasing “managed” part of their care. Consumers didn’t like being told which doctors they could and could not see. So, the industry responded (with a little help from our government) and “open networks” – or POS (point of service) – replaced the limited-network HMO model.

Life was good again and consumers were happy. But something began to change. The costs for services and premiums began increasing. How could this be?

Well, when you separate the 100 million consumers of healthcare from the actual costs of that care, there is no longer a system of checks and balances. So, without transparency and oversight, costs started on an ever-increasing trend line upward. It wasn’t all at once; there were good years with little upward trending, followed by bad years of significant increases. But one thing you could count on—healthcare costs were outpacing average salary increases.

Sure, consumers saw technology improvement, new medications, etc., but they also saw a bed in a hospital that went from $400 per day to $800 to $2,000. All paid for with a $50 copay. But not really.

Finally, the weight was too much to bear and costs were out of control so the healthcare industry made the desperate shift back to HMO benefit designs from the 80’s but with a twist—adding an out-of-pocket component of a few thousand dollars that a consumer needed to pay first.

The government thought this might be a good idea so they jumped in with the Affordable Care Act and offered similar products on these “revolutionary” exchanges.  I even think a few government health administration leaders stated openly that consumers liked being told which doctors to see.

Let’s make one thing clear…most people I know don’t like being told what to purchase and from whom – especially when it comes to who they see from a healthcare perspective. Being forced into purchase decisions is considered, well, un-American.

The result for consumers was a double whammy of expenses—paying for health insurance and out-of-pocket expenses.  This cost shifting has caused consumers to have no voice and no choice. We all swallowed hard and took whatever we could get with whatever restrictions were with it.

And just as health insurance started to bring back this cost-shifting (and so called cost-sharing to the consumer), another player took a page out of the HMO book: Big pharma with the $0 copay card. Drugs were now free for me and you! Well, at least that was the argument. Why should the average consumer care what the actual price of the drug is or who is actually paying for it? Again, disassociation for the consumer. Simply put, the pharmaceutical industry is playing a marketing game – attempting to buy off the American consumer and about every politician in the process.

I’m not suggesting all consumers should pay the full load of all their medical costs. But the only way anyone sees value of a product or service is to understand the true cost of that service before discounts or subsidies. Through negotiated reimbursement rates between health insurers, hospitals, doctors and pharmaceutical manufactures, consumers are left in the dark on the cost of care and where the tremendous swings in drug and hospital costs occur.

As humorist, P.J. O’Rourke once said, “If you think health care is expensive now, wait until you see what it costs when  it’s free.”

It’s time for open and free market pricing.

Any views or opinions represented in this blog are personal and belong solely to the blog owner and do not represent those of people, institutions or organizations that the owner may or may not be associated with in professional or personal capacity, unless explicitly stated. All content provided on this blog is for informational purposes only. The owner of this blog makes no representations as to the accuracy or completeness of any information on this blog or found by following any link on this blog. The owner will not be liable for any errors or omissions in this information nor for the availability of this information. The owner will not be liable for any losses, injuries, or damages from the display or use of this information.