Most of us try to be smart shoppers when we’re planning a major purchase. We check consumer guides, compare prices online, and try to get the most for our money. But when we try to do the same for health care services, it’s next to impossible. Why is it that you can compare prices on everything from autos to refrigerators, but can’t get a reliable quote on what an MRI will cost?
There is no single price.
While a hospital, surgery center or clinic will probably have a list of charges, this list (called a chargemaster) bears no relationship to what most anyone will pay. What a health care provider will actually receive depends on government regulation (in the case of governmental payers like Medicare or Medicaid) or on the contract between the health care provider and the insurance company. Practically the only ones who will actually pay list price are people without insurance (who can probably least afford it) and people who go to a health care provider that does not have a contract with the insurer.
The month of November brings crisp fall weather, colorful leaves in Northern climes, and for many people who get health care through their jobs – open enrollment! Some are finding a different set of choices facing them this year.
While the pace of health care inflation has slowed a bit in recent years, prices of health care and health insurance are still going up – just a little more slowly than in the past. The rising cost of health benefits is still a major headache for employers. For several years, employers have tried one technique after another to try to hold down health care costs: self-insuring to cut back on the profit margin of health insurance companies, favoring plans that aggressively manage expensive services, and increasing employee cost-sharing. Now, some employers are trying to see if a technique that most use for employee retirement benefits could work for health insurance too. They’re moving away from a defined benefit approach – where the employer pays for health insurance, minus employee premiums and cost-sharing – toward a defined contribution approach. They are offering their employees a fixed dollar contribution toward health insurance and leaving it to employees to pick the plan. This is analogous to moving from a pension plan to a 401(k).
Choosing health insurance involves lots of tradeoffs – between lower cost versus more choice, and between lower premium cost versus higher deductibles and copayments. Say you have a choice between an HMO and a PPO. How do you choose?
Pros and cons of HMOs
HMO stands for health maintenance organization. The original idea behind HMOs was that if a group of doctors was responsible for the whole cost of health care for a group of people, they would have an incentive to provide preventive care that could help people avoid expensive medical problems, and provide good care for people with chronic conditions like high blood pressure and diabetes so they could stay out of the hospital. This would be good for people’s health, and good for cost control.