Study Highlights High U.S. Medical Costs, Groups Alter Doc Guidelines
The cost of medical services, tests and prescription medicines in the U.S. far exceed those in at least eight other industrialized countries, according to a report from the International Federation of Health Plans, the Los Angeles Times reports.
For the report, researchers examined health care prices in:
- The Netherlands;
- New Zealand;
- Switzerland; and
- The U.S.
The researchers calculated each country's health care prices by surveying the health plans available in each country and, for the U.S., collecting data about price negotiations between private health insurance plans and health care providers.
The report found that the average one-day hospital stay in the U.S. cost $4,293 in 2013, six times more than the stay would cost in Argentina and almost 10 times more than it would cost in Spain. Meanwhile, various health care procedures were also priced higher in the U.S., including:
- Heart bypass surgery, which cost about $75,345 in the U.S., about $15,742 in the Netherlands and $16,492 in Argentina;
- An MRI, which cost about $1,145 in the U.S. and just $138 in Switzerland;
- Knee replacement surgery, which cost $25,398 in the U.S. and about $8,100 in Spain;
- Vaginal childbirth, which cost $10,002 in the U.S., $2,251 in Spain and $2,237 in Argentina; and
- Caesarean-section births, which cost $15,240 in the U.S. and $2,844 in Spain.
According to the study, the U.S. offers slightly more affordable cataract surgery than other countries, coming in at an average of $3,762, compared with Australia, where the procedure costs $3,841.
IFHP CEO Tom Sackville noted that the "price variations bear no relation to health outcomes," adding, "[T]hey merely demonstrate the relative ability of providers to profiteer at the expense of patients, and in some cases reflect a damaging degree of market failure" (Pfeifer, Los Angeles Times, 4/17).
Docs Factor Pricing Into Treatment Plans
In related news, several medical societies are developing guidance for their members that for the first time takes into account the cost of various medical treatments and procedures for treatment recommendations, the New York Times reports.
For example, the American Society of Clinical Oncology aims to release by the fall a scorecard that evaluates drugs based on cost, value, efficacy and potential side effects. Meanwhile, the American College of Cardiology and the American Heart Association recently announced that they will start to use cost information to rate the value of various health care treatment plans included in their joint clinical guidelines and performance standards. Specifically, ACC and AHA will rate the value of treatments based on the cost per quality-adjusted life-year, a common measurement used in Britain and by health care economists.
According to the Times, the societies' decisions reflect a larger nationwide trend. A review conducted in 2013 found that 17 of the 30 largest physician specialty societies explicitly integrated cost data into their clinical guidelines, up from just a few such groups identified in a separate review in 2002. In addition, several medical societies are participating in a campaign called "Choosing Wisely," for which they submit a list of the top five procedures, products or tests that they consider wasteful.
However, several medical societies are still issuing guidance without incorporating such cost considerations. For example, the American Association of the Study of Liver Diseases and the Infectious Diseases Society of America recommended the costly new hepatitis C drug, Sovaldi, without mention of cost. Similarly, Medicare in general is not supposed to consider cost effectiveness when calculating coverage decisions.
According to the Times, the efforts to incorporate cost considerations have produced a mixed reaction from physicians. Martin Samuels, chair of the neurology department at Brigham and Women's Hospital, said, "There should be forces in society who should be concerned about the budget, about how many MRIs we do, but they shouldn't be functioning simultaneously as doctors."
Daniel Sulmasy, a professor of medicine and ethics at the University of Chicago, said, "In some ways, [escalating health care costs] represent a failure of wider society to take up the issue" (Pollack, New York Times, 4/17).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.