Source : NewYork Times
The write-up is based on the case study “Paying till it hurts” and exemplifies colonoscopy for explaining the reasons behind high healthcare costs in the United States. We first talk about the American health care system exorbitant prices and some of the reasons behind the high price anomaly. Going ahead, we elicit the how colonoscopy has become the tritest screening procedure in the last 15 years. In the concluding comments, we try and figure out the reason behind the increase in the price of colonoscopies and why the general principle of economies of scale does not work in the health care industry.
American healthcare industry generates a revenue of 2.7 trillion dollars every year. Even though, the Healthcare system is known for providing high-quality services to those in their old age most of this expenditure comes from the exorbitant prices of the procedures and medication that are not directed towards healing the old. Instead, these repeat procedures and medication are an ill effect of the preventive care methodology that is pervasive in the American healthcare system. The American populace has a mindset that the more they pay, the better services they get. The mindset might be true for other industries but has not fared well in Healthcare. Even though, people in America pay more for healthcare service than any other developed country the services and healthcare provided are still not observed at the same quality as other developed countries. Foremost, the reason behind the exorbitant pricing is the fact that Healthcare is considered a free market in the United States. In all other countries healthcare is considered as a commodity, and hence the prices are capped. Thus, making services cheaper and affordable.
A case in point for the high priced services and overuse of procedures is a colonoscopy. A procedure that was deemed effective by researchers for deducing early symptoms of colon cancer. In the last 15 years, the umber of colonoscopies conducted has risen to 10 million generating a revenue of $ 10 billion. Many heath associations have tried to inform patients and providers about the unnecessary use of the procedure when other cheaper and easier to implement procedures, for deducting colon cancer, exist in the market. A colonoscopy might not even be the most effective way of detecting colon cancer as it has never been directly compared to other procedures that are present in the market.
The number of colonoscopies conducted has increased by 50% from 2003 to 2009. An increase in this proportion, in any commodity market, would have created economies of scale, leading to a decrease in the price of the commodity. Instead, the price of colonoscopy has skyrocketed, like all other procedures people in America, pay more for a colonoscopy than anywhere else in the world. Even the most expensive colonoscopies around the world cost a few $100 in the US the minimum price for undergoing a colonoscopy is around $1000.
A major reason for the high price of colonoscopy in the US is that the price for colonoscopy like any other procedure is set by negotiations between provider and insurer and the insurer, with none of them having the patient's interest in mind. Another reason for the increase in price is that colonoscopies are now conducted in surgical centers, where providers can charge an extra service fee.
The main issue with the Colonoscopy is that it is a very expensive affair.The normal middle class households with well styled houses in suburbs and having all the amenities of life are also finding the colonoscopy very expensive. The situation is not the same in other developed countries.In those countries the cost of colonoscopy is very less compared to United States. The situation is not restricted to healthcare in particular it is same all across the platform of healthcare related issues. A study has shown that United States came very costly in 21 categories.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.This difference in numbers is huge.
ReplyDeleteTalking particularly about Colonoscopy. It is not that there is an unavailability of Federal govt. recommended test for detection. But the problem is that the colonoscopy has been made default exercise. This is very faulty. The other recommended test can also be taken instead of the colonoscopy alone as studies have shown that colonoscopy has not shown any special results.
One of the major reason for the colonoscopy to have become a prevalent affair is that a market has been created. Directly quoting from the article the following."Until the last decade or so, colonoscopies were mostly performed in doctors’ office suites and only on patients at high risk for colon cancer, or to seek a diagnosis for intestinal bleeding. But several highly publicized studies by gastroenterologists in 2000 and 2001 found that a colonoscopy detected early cancers and precancerous growths in healthy people.
ReplyDeleteThey did not directly compare screening colonoscopies with far less invasive and cheaper screening methods, including annual tests for blood in the stool or a sigmoidoscopy, which looks at the lower colon where most cancers occur, every five years." This tells that the issue is such that it has become a fashion to go for colonoscopy. Earlier it was not the case. Doctors would carry out colonoscopy on those patients only who faced the maximum risk of cancer. But as it has become a short of business now for minute hint of cancer also colonoscopy is being recommended.
Great discussion. This is related to having a mammography to prevent "the chance" of breast cancer. Unless you have a predisposition (or gene) that makes the risk higher, you don't need a test every year. This is the recommendation of many health and public health scientists, but the push from the industry is still "requiring it." Of course, for colonoscopies, you can't really do a self-test, but as you say, blood tests can indicate a concern.
ReplyDeleteWow, what an amazing information!! Thanks so much.
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