Health care costs more in U.S. than anywhere else in world

MERRICK, N.Y. — Deirdre Yapalater's recent colonoscopy at a surgical center near her home on Long Island went smoothly: She was whisked from pre-op to an operating room where a gastroenterologist, assisted by an anesthesiologist and a nurse, performed the cancer screening procedure in less than an hour.

The test, which found nothing worrisome, racked up what is likely her most expensive medical bill of the year: $6,385.

That is fairly typical: In Keene, N.H., Matt Meyer's colonoscopy was billed at $7,563.56.Maggie Christ of Chappaqua, N.Y., received $9,142.84 in bills for the procedure.In Durham, N.C., the charges for Curtiss Devereux came to $19,438, which included a polyp removal.

While their insurers negotiated down the price, the final tab for each test was more than $3,500.

"Could that be right?" said Yapalater, stunned by charges. "You keep thinking it's free. We call it free, but of course it's not."

In many other developed countries, a basic colonoscopy costs just a few hundred dollars and certainly well under $1,000. That chasm in price helps explain why the United States is far and away the world leader in medical spending, even though numerous studies have concluded that Americans do not get better care.

Whether directly from their wallets or through insurance policies, Americans pay more for almost every interaction with the medical system.

They are typically prescribed more expensive procedures and tests than people in other countries, no matter if those nations operate a private or national health system. A list of drug, scan and procedure prices compiled by the International Federation of Health Plans, a global network of health insurers, found that the United States came out the most costly in all 21 categories — and often by a huge margin.

Americans pay, on average, about four times as much for a hip replacement as patients in Switzerland or France and more than three times as much for a Caesarean section as those in New Zealand or Britain.

The average price for Nasonex, a common nasal spray for allergies, is $108 in the United States compared with $21 in Spain. The costs of hospital stays here are about triple those in other developed countries, even though they last no longer, according to a recent report by the Commonwealth Fund, a foundation that studies health policy.

Routine services

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 might not be the use of extraordinary services, but the high price tag of ordinary ones.

"The U.S. just pays providers of health care much more for everything," said Tom Sackville, chief executive of the health plans federation and a former British health minister.

Colonoscopies offer a compelling case study. They are the most expensive screening test that healthy Americans routinely undergo — and often cost more than childbirth or an appendectomy in most other developed countries.

Their numbers have increased manyfold over the past 15 years, with data from the Centers for Disease Control and Prevention suggesting that more than 10 million people get them each year, adding up to more than $10 billion in annual costs.

Largely an office procedure when widespread screening was first recommended, colonoscopies have moved into surgery centers where they are billed like a quasi operation. They are often prescribed and performed more frequently than medical guidelines recommend.

The high price paid for colonoscopies mostly results not from top-notch patient care, according to interviews with health care experts and economists, but from business plans seeking to maximize revenue; haggling between hospitals and insurers that have no relation to the actual costs of performing the procedure; and lobbying, marketing and turf battles among specialists that increase patient fees.

While several cheaper and less invasive tests to screen for colon cancer are recommended equally by the federal government's expert panel on preventive care — and are commonly used in other countries — colonoscopy has become the go-to procedure in the U.S.

"We've defaulted to by far the most expensive option, without much if any data to support it," said Dr. H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice.

Hospitals, drug companies, device makers, physicians and other providers can benefit by charging inflated prices, favoring the most costly treatment options and curbing competition that could give patients more, and cheaper, choices.

Almost every interaction can be an opportunity to send multiple, often opaque bills with long lists of charges: $100 for the ice pack applied for 10 minutes after a physical therapy session, or $30,000 for the artificial joint implanted in surgery.

Runaway costs

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 Congressional Budget Office has said that if medical costs continue to grow unabated, "total spending on health care would eventually account for all of the country's economic output." It identified federal spending on government health programs as a primary cause of long-term budget deficits.

While the rise in health care spending in the United States has slowed in the past four years — to about 4 percent annually from about 8 percent — it is still expected to rise faster than the gross domestic product. Aging baby boomers and tens of millions of patients newly insured under the Affordable Care Act are likely to add to the burden.

A major factor behind the high costs is that the United States, unique among industrialized nations, does not generally regulate or intervene in medical pricing, aside from setting payment rates for Medicare and Medicaid, the government programs for older people and the poor.

Many other countries deliver health care on a private fee-for-service basis, as does much of the American health care system, but they set rates as if health care were a public utility or negotiate fees with providers and insurers nationwide.

"In the U.S., we like to consider health care a free market," said Dr. David Blumenthal, the president of the Commonwealth Fund and a former adviser to President Barack Obama. "But it is a very weird market, riddled with market failures."

(source: www.denverpost.com)