From: PDX (and now) London, UK
An interesting article on the stresses that this pandemic is adding to an already difficult financial situation for many US hospitals. I had no idea for instance that the US government spending for healthcare per capita was more than is spent in a number of countries with nationalised healthcare.
The US government funds more than half of healthcare spending — but it does not run the hospital system. Instead, it supplies public insurance in the form of Medicare, for seniors, and Medicaid, for the poorest, paying through a fragmented network of healthcare providers. To get by, hospitals must also have enough money coming in from commercial insurers or beg for extra subsidies.
Many are on the brink. More than a hundred have closed in the past decade, and a report last month from consultancy BCG estimated that 20 per cent were at “near-term risk of insolvency” before the pandemic. They now think the figure is between 30-40 per cent.
The high number of uninsured people in the US compounds the challenges of responding to coronavirus. At least 27 million Americans lack any health insurance, and that figure is set to rise as millions more lose their jobs. Without insurance, patients risk getting saddled with high bills from emergency room visits that they cannot pay, forcing bad debt on to the hospitals.
Even though the US spends trillions of dollars on healthcare, much of that is wasted. The funding gets used up by bureaucrats that have to code and bill every action a doctor takes, by doctors and hospital administrators paid far more than their European counterparts and by the soaring cost of drugs. A study last year in The Journal of the American Medical Association found at least $760bn was wasted in unnecessary health spending — more than the US spends on primary and secondary education.
Poorer hospitals that cater to low-income urban communities, or rural areas where population is declining, are dependent on government insurance. They say the payments from Medicaid do not cover their costs as the price of staff, equipment and drugs rises.
Initial data suggests the disease has had a disproportionate impact on communities of colour. In New York, black and Latino people are twice as likely to die as white people. At One Brooklyn, the group has seen a high rate of hospitalisation among its coronavirus-positive patients. “Our community has been very significantly affected,” says Brown. “There is a reality that many of the hospitals that serve low-income communities of colour have the least amount of resources . . . Any public health crisis will uncover inequalities.”
Ten percent of all Medicare and Medicaid spending is for fraud. Some unintended but most intentional. The chance of getting caught is relatively low with businesses going in and out of business under different names at different locations. The ones that stay in business at the same place and location are most likely to be caught. I read where one group home charged for therapy sessions that did not take place. In fact, one individual was in jail during the time that he was supposedly undergoing therapy.
I saw on television where an insurance company would be billed $4000 for a CAT scan, while Medicare/Medicaid would be billed between 2400-2600. If a person offered to pay the bill that day, that person would be charged $400.
In a study, if a person went to a doctor with a lingering chest cold there was the chance of either an average 4 x-rays or less than 1. The difference? Whether or not the doctor's office owned an x-ray machine.
If a person agrees to pay for "out of coverage" medical tests or care, then the bills can really escalate. The doctors don't have to go through the in coverage lab but can go to a different one, like the one that the doctors own.
A few articles recently make me think pharmaceuticals are priced much higher in the States than elsewhere as well. Diabetics pay a LOT for insulin for instance, which of course they need, and is not actually hard or expensive to produce. It's MUCH cheaper in the UK and elsewhere in Europe for sure.
I go here to the pharmacy and pay a surplus of £4.50 for anything I'm prescribed. I have a friend who happened to get the same medication I got here, and he paid $100+ for it. If you do have something long lasting or chronic, that adds up fast.
"Success is the ability to go from one failure to another with no loss of enthusiasm." - Winston Churchill