Tuesday, October 21, 2008

Here are the symptoms ...

Background: Patient presented as a patently healthy 53 yr-old male for a routine physical examination, conducted over approximately one hour, involving two nurses (one for vitals, the other for blood draw) and one physician's assistant.

Symptoms:
Standard Lab work -- $400. (Chem panel, cholesterol, blood count, PSA, urinalysis, thyroid.)

PA and nurses: $350

Total: $750


So what is the disease? How in the heck can it possibly cost $400 to do simple lab work that probably took less than 30 minutes to accomplish? How is it that roughly an hour spent on an individual healthy nearly to the point of offensiveness cost $350?

Granted, there needs to be something extra in the pay packet for the person doing the prostate prodding, but still ...

6 Comments:

Blogger Duck said...

Universal human rights are expensive.

October 21, 2008 1:02 PM  
Blogger Harry Eagar said...

There's a lot of overhead in an analytical lab. Tricia works in one, and the amount of supplies they go through is impressive.

I get a blood panel every quarter and it costs about $100 less than you pay. I don't believe there is a separate charge for the phlebotomist, so the cost to my employer must be about half yours.

October 21, 2008 1:38 PM  
Blogger erp said...

Paying customers pay for the "needy."

October 21, 2008 3:54 PM  
Blogger Hey Skipper said...

First, I need to vent.

I really, really, hate it when the browser (Firefox) has a page load error when submitting a comment (the hotel's router decided I needed to reconnect because in their universe one day equals about 11 hours 22 minutes) and THE F!@#$%^&*()g BACK BUTTON WON'T RETRIEVE THE COMMENT PAGE.

I relearn this lesson about twice a year, whereupon I use a text editor to write the comment, then gradually forget until I get burned again.

Some people are just untrainable.

****

This patient (in order to protect the innocent, I shall refer to him as "me") went to a family practice. So far as I know, the practice does not use the insured to subsidize the uninsured. In order to see how close SFAIK ventures to reality, I should check with their nurse manager (in order to protect the innocent, I shall refer to her as "my wife").

When I was living in Michigan, I got friendly enough with a guy who owned a European car garage so that he allowed me to work on my own car there. The mechanics had multiple certifications, and each owned at least $20,000 in tools -- their roll around tool chests alone hit around $2,000. The shop itself had a fair amount of overhead -- four lifts, alignment rack, and some very spendy diagnostic tools, parts inventory.

Hourly rate: $100

Compared to the family practice, I'd say the shop has more overhead. The mechanic's training is comparable to the nurse's, but a mechanic's training doesn't include graduating from college.

The two activities are, when you get down to it, very similar.

So I have a very hard time understanding how the family practice bills at three and a half times the rate the garage does.

Until, that is, I remember that people pay for mechanics out of their own pockets, and the market for mechanics is almost completely unfettered.

Of course, the medical profession doesn't want to hear this.

There's a lot of overhead in an analytical lab.

Since I have essentially no idea what goes on in an analytical lab, I am completely mystified how they can shove $400 into a few ounces of blood and urine on tests they must do, oh, a hundred times a day.

Returning to the garage comparison, if I wanted to determine the state of my engine's internals, I could get a spectrometric oil analysis -- it tells how much of what is in the engine oil that isn't oil.

$25.

October 22, 2008 11:30 AM  
Blogger Harry Eagar said...

Well, like I say, you seem to be paying a premium rate, hope you got premium service.

A few years ago, I needed an eye test (fluorescin). My eye doctor said the upkeep on the machine would run him $60K/yr, and in his small office he couldn't recover anywhere near that. So he sent me on an airplane to get the test done in the big city.

I forget what the test was billed at, around a thousand probably, but add in a couple hundred dollars in air fares, a cab (except I walked the 8 miles to his office because it was a pretty day), airoport parking etc. and the loss of a whole day of my work, the total cost to the system must have been double what the medical input required.

My eye doctor says, we have 21st century computers and entertainment and a 1950 medical reimbursement system. He doesn't have to work any more and he tells me that if Medicare rates are pushed down again, he'll quit.

I think we tend to forget how little medical care we got in the old days. The disease that leads to my having quarterly blood panels has been with me for 30 years now. I used to get annual checkups for it.

Dunno whether quarterly checkups are 4 times better, but they must be 4 times as expensive.

Best practice standards require quarterly checkups, whether I need them or not.

I blame the lawyers.

October 23, 2008 2:53 PM  
Blogger David said...

Think about all the situations in which one person decides to consume and consumers while another person pays. It always costs more.

My kids shoes cost more than my shoes, expense account meals cost more than meals we buy ourselves and health care costs more than if we had to pay.

Having said that, I'm not really outraged by paying $750 once a year to try to see whether cancer is eating my insides or cholesterol is clogging up my heart.

October 24, 2008 8:48 AM  

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