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TechnoratiUS Hospitals Charge Uninsured More, Study Says
U.S. hospitals are charging uninsured patients about two-and-a-half times more than those with health insurance, a mark-up that has been steadily rising despite pressure to level prices, a study released on Tuesday found.In 2004, the most recent year for which data was available, hospital patients without health insurance and others who pay for medical care out of their own pockets were charged an average 2.57 times more than those with health insurance, according to the study published in the May-June issue of the journal Health Affairs.
That number has been rising steadily since 1984, but has jumped more quickly since 2000, the analysis of government data said.
Hospitals in the United States have come under fire from patient groups and lawmakers for marking up prices for those lacking the negotiating clout of a health insurer. But the price discrepancies are steadily worsening despite some reform efforts, the article said.
"The mark-up on hospital care for these individuals, especially for those who can afford it least, is unjustifiable," said Gerard Anderson, director of the center for hospital finance and management at Johns Hopkins University's school of public health, and study author.
The American Hospital Association (AHA), which represents most of the nation's 5,000 or so hospitals, said the report was out-of-date and methodologically flawed.
The group said it is misleading because the study predates U.S. Centers for Medicare and Medicaid guidance, which hospitals say they needed before they could give discounts to uninsured patients.
"Before that, there was a lack of clarity as to whether hospitals could charge differentially," AHA policy analyst Carmela Coyle said.
Hospitals set rates based on a list called the chargemaster, which is generally believed to inflate prices substantially, in the belief that prices will come down during a negotiation process.
For-profit hospitals had the highest discrepancy between costs estimated by Medicare and prices charged, the study found.
UNINSURED WEIGH
But patients without health insurance, about 45 million people in the U.S., lack the ability to negotiate. As it stands, hospitals only collect about 10 cents on the dollar charged to uninsured patients, Anderson said.
"When a hospital presents a bill that has charges on it, those charges are the same for everyone. What is different is how much insurers may negotiate in terms of discounts with hospitals," Coyle said.
More than 60 class-action lawsuits have been filed against U.S. hospitals over the issue. Anderson has been an adviser on some of them. About a year ago, the American Hospital Association enacted a voluntary policy for poor and uninsured patients.
But that policy has yet to show an impact and it is unclear how many hospitals are abiding by the price suggestions, Anderson said.
Anderson recommends pursing the ongoing class-action lawsuits and having the government set a maximum amount that hospitals can charge as prescriptions to remedy the problem.
Several states are exploring the issue, including Illinois and Ohio, Anderson said.
There is one element in the debate in which Anderson and Coyle agree. Both say efforts to provide health insurance to greater numbers of people would ease the problem.
"The real problem of course, is that we live in a country where we don't guarantee coverage for everybody," Coyle said.
Copyright © 2007 Reuters Limited
18 Comments so far
Show AllThe first paragraph, which is only one sentence, has 92 words. This diminishes the credibility of whatever the author intended to say.
As a person who just recently joined the insured class, this is no surprise to me. The hospitals and doctors complain about uninsured people going to emergency rooms for treatment, but I can say from experience that ERs do not expect payment up front, will bill for meds given and don't treat the patients like they are nonentities because they don't have insurance. This country needs healthcare reform NOW. ER "insurance" costs all of us in the long run in terms of health and money. Even though medical lobbyists don't want socialized medicine, it's going to have to happen in this country for us to keep up with the rest of the developed and developing world.
I was amused by the American Hospital Association's defense of their behavior since from my own experience I can assure you that it is continuing. You will notice that their defense never once stated that the reports were untrue. All the AHA said was that they were out of date, but never claimed that the behavior was not continuing into the present. And they couldn't make that claim without facing charges of perjury.
Maybe we can make soylent green out of all you malcontents. Shut up watch FOX news and vote Republican. King George is on the job.
As an insurance itermediary, I find it interesting that these billing practices should now be news. Hospitals have for years been charging those least able to pay the highest fees. Discounts are given based on "reasonable & customary" in insurance policies and on preferred provider discount arrangements. An uninsured individual simply has no claim adjuster working in his behalf. Hospitals superficiously pursue payment from the uninsureds; instead, they sell the bills at a discount to bill collecting agencies. The larger the bill is inflated the greater payment to the hospital. Bankrupting the uninsured. It is all about profit and greed.
Over the last fifteen years - and multiple surgeries - I've racked up more than $170K in uninsured medical bills...and all at "retail" prices in spite of my having researched what the negotiated HMO rates were and requesting that I be billed at those rates. The best I ever got was a 10% "cash discount." Now, ten years cancer free, I've finally qualified for catastrophic insurance coverage and I bill EVERYTHING (even if I'm not clear that my current coverage will cover it) through the insurance carrier; even if they reject it, I'm responsible for the balance that was billed at the negotiated rate between the doctor/hospital and the HMO. Is this right? No. But I've spent more on medical bills in the last few years than most of my friends have in their retirement accounts...
"That number has been rising steadily since 1984, but has jumped more quickly since 2000," the analysis of government data said.
We can thank Regan and Bush who think a military empire is more important than anything else. I notice both were provided health care via the taxpayer. Both were lifers too. How do they justify letting people get sick and die? More of their selective morality I guess.
All of the corporations want big money-people only have so much. What will the corporations do?
Some day, those in charge will HAVE to admit that the system is broken in ways that require FIXING - not just "hey look we did something" colorful bandages. However, I don't think that's going to happen before the uninsured and under-insured are actively rioting. Certainly not at the current rate...
Not only do hospitals charge more for the uninsured, but an awful lot of doctors won't see an uninsured patient (outside of charity care) if they can't put up a cash deposit in advance that's based on a worst case scenario and developed using inflated prices. Then there's the matter that in a growing number of areas accessing PUBLIC health (esp. any of its specialties beyond ob/gyn - and that access iss often limited to pregnant women) will require having INSURANCE.
And people wonder why we all line up at the local ER...or why so many of us with pre-existing conditions that require specialist care end up on SSI or SSDI just to get the "insurance".
That said, Medicare, as it stands isn't something I'd wish on my worst and healthiest enemies - esp. not Part D. PLEASE don't make it a single payer system based in Medicare or Medicaid without FIXING that system first.
To the credit of these corporations, they do not discriminate in their implementation of this policy. I found this out during my 4th year of medical school while doing a surgical rotation at a hospital outside Detroit. During my daily trips up and down the stairs, one of my knees became inflamed. I was seen in the ER—the costs for being seen plus an x-ray, $650 ( for doing their scut work.) Medicine will even eat their own.
Jon
Connecting the dots: from human behaviors to ecosystem decline
http://StudentsForTheEarth.org
Nietzsche May 8th, 2007 1:46 pm
"When the poor finally have had enough there will be hell to pay."
That day will come, but meanwhile, if you own a home, be sure to see your lawyer and record (at the Registry of Deeds) a HOMESTEAD which will protect you from creditors until your death. You can owe hospitals up to your eyeballs and they can't take your house from under you if you cover your ass from these or any other predators.
Ghostbuster's comments illustrate how rapidly neocon cancer is spreading. As I write this, I am watching the fueling station across the street raise prices for the fortieth time in the past two months. The fuel price increases are occuring at a time when crude prices remain stable or drop. The extra oil company profits will be used to keep Harper and the American neocons in power for years to come.
Conyers and Kucinich have co-sponsored a Medicare for All Single Payer bill, H.R. 676. www.citizensforhr676.org (or maybe it's ".com" I don't recall off hand). The bill provides a 15 year transition to single payer, includes funding to train those who would lose employment as the insurance companies disappear. Check it out, then contact your congressperson to co-sponsor and you senators to introduce a companion bill.
And here, in Canada, we have a Bush-lite that is trying to destroy our medical insurance system by pretending it doesn't work or is too costly--it is less costly than the private insurance system and if it is not working as well now as before, it is because the government has withdrawn significant funding in favor of lower taxes to corporations and the wealthy. In short, the government, bought and paid for by the the elite, create the problem of under-funded national healthcare, wait for the public to scream bloody murder, especially about wait-times, then offer the solution--privatization.
It is and will be a form of economic abuse against the poor and middle class--indeed, a holocaust for the poor elderly unable to afford decent care and medication, as well as families living at or slightly above minimum wage and even for the middle class trapped in debt.
Is anyone listening? They say the cream-of-the-crop rises to the top---so does scum.
Call it PREDATORY HEALTH CARE Inc.
jon
Connecting the dots: from human behaviors to ecosystem decline
http://StudentsForTheEarth.org
Everyone screws the uninsured. I was in a car accident. One opf my prescriptions was $200 a month. I now have insurance and my receipt says my plan saved me $80.00 and I paid a $40.00 co-pay. What happened to the other $80? If you're down and out you will have them lining up to screw ya.
Let them eat cake.
When the poor finally have had enough there will be hell to pay.
This is news? Anyone without insurance is very well aware of this. And not just hospitals, but doctors, dentists, labs, the entire health care system.
But if politicians consider social Security a third rail with voters, then single payer health care is a third rail with their corporate paymasters. The chances of single payer health care coming from this bunch of bottom feeders is equivalent to the likelihood of the MSM noticing the existence of Dennis Kucinich. Not happening on their watch.