Living in Leftlandia
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What is it about the Netherlands that allows it to provide apples to apples healthcare cheaper than the US.
Medicare reimbursement is still higher than the the average "fee" for other countries. How is it possible? Do the other countries know that at that fee rate the providers are recouping less than 87% of their costs?
I wonder how much the increased prices of supplies, diagnostic imaging technology, pharmaceuticals, and insurance have contributed to the rising costs of providing care.
You aren't paying for direct healthcare costs. You're paying capitation for your potential costs and the costs of others. In many cases, healthy people would incur almost no healthcare costs in a year, certainly much less than you would pay in premiums.
And when you are price taker rather than a price setter, those things can get out of control. Which has been my point.
Total insurance premiums = Total insurance payments to providers + insurance profits
The "report" you provided discusses "fees." What does it actually cost a provider to do a CT in the US? A delivery? An MRI? Since most other countries have a primary payer system that actually covers the costs of providing service and the US doesn't, the US "fee" in that "report" includes charge inflation.
I'm not sure about their Medicare reimbursement sources. They use "Portland CMS" and in the cases where information wasn't available, they used "global consulting firms and actuaries." I just looked up the 2019 reimbursement for CPT 74150, CT, Abdomen, w/o contrast, on Novitas and Medicare reimbursement is $140.36. If we apply the 13% average underpayment by Medicare, the cost to the provider would be about $158.61. And that's 2019 dollars, not the 2009 dollars in the "report." That Medicare reimbursement includes the technical and professional components.
Often CTs of the abdomen include a CT of the pelvis since they are a contiguous body cavity, but they are billed and reimbursed as two different scans unless the CPT code for the combined scan is used. Medicare reimburses 75% of the cost of the individual scans if the combined CPT code is used. That's a moot point though since the "report" you linked was from 2009 and the combined abd/pelvic CT CPT wasn't created until 2011. I have no idea where that "report" got $400 Medicare reimbursement for CT abdomen from. Do you know where they got $400 from?
That brings me to the question... Is the "report" you linked and are using for your thesis actually comparing apples and apples?
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They make less than US doctors. Is there a difference in physician training in the Netherlands vs the US?
99 percent of U. S. pharmacy employees have no clue what a liter of water weighs. 99.9 percent of pharmacy employees in South Africa will tell me what a liter of water weighs and will look at me as if I'm an idiot for asking the question.
I wonder if emergency room utilization is similar between the Netherlands and the US...
I wonder if the Netherlands has an agency similar to the FDA with similar rules on medical devices and pharmaceuticals...
It is because you are trying to ascribe meaning from manufacturing to an industry you flat don’t understand.
Instead of using a questionably sourced report from 2009 to discuss Medicare reimbursement rates, here's the link to Novitas, the CMS contractor for the Oklahoma region. You can look up any CPT code you'd like. You can even download the entire fee schedule.
https://www.novitas-solutions.com/webcenter/portal/MedicareJH/FeeLookup
I might also offer that healthcare costs in Europe have also increased since 2009. Do you have anything more recent than 10 years ago?
The US "fee" is based on payments not invoices
Is CPT 74150 the typical Abdomen CT administered?
It says they got it from Medicare
Yes.
I am pretty sure I understand it better than the guys who think that costs are fixed and set in a vacuum for all time.
I got 2015, but it is all graphs and I prefer tables. https://fortunedotcom.files.wordpress.com/2018/04/66c7d-2015comparativepricereport09-09-16.pdf
Exactly what I said. It isn't based on provider cost. We've already agreed that US healthcare charges are inflated to recoup losses from Medicare and Medicaid.
Yes, without contrast. There's also a CPT for with contrast and for with and without contrast. There's CPT codes for pelvic CTs with, without, and with/without contrast as well. There's also CPT codes for abdomen/pelvic CTs with, without, and with/without contrast. If you want to break any of those down further, the modifier "26" indicates the professional service reimbursement and "TC" is the technological component.
Based on what I actually see from real Medicare reimbursement dollars, there's no way they got that from Medicare. Sorry.
You tell me.
I know why it's different. Do you?
If you're actually using that 2009 "report" as the basis of your thesis, there's zero sense wasting my time with you. 2009 data and inaccurate Medicare reimbursement dollars aren't germane to a discussion of Berniecare in 2019. If US hospitals were actually receiving the Medicare dollars in that "report," there'd be nobody bitching about Medicare underpayments. $400 reimbursement on a $156 procedure would be a handsome profit, no?
Bernie and AOC talking points isn't exactly "understanding" it. Nobody is discussing fixed costs. Your ultimate answer is healthcare providers get paid too much and we just cut the pay and everything works. That's the perspective I'd expect from a socialist. As I asked you previously, what are you willing to give up? If it's physicians and nurses, good luck getting the "free" healthcare you need.
I suspect, scratch that, I know you don't have a clue what goes into training healthcare providers of any level of licensure, what it takes to maintain that licensure, and the amount of continuing education required to practice evidence based medicine. That isn't surprising coming from a guy who is in a business that can be shipped to China or Mexico tomorrow and not a single person besides you and the people you work with would give a shit or notice any difference.
74178 $370.67 $352.14 $404.96
70470 $196.58 $186.75 $214.76
71552 $508.91 $483.46 $555.98
99213 $75.48 $71.71 $82.47
59400 $2,123.50 $2,017.33 $2,319.93
59510 $2,348.49 $2,231.07 $2,565.73
44970 $611.91 $581.31 $668.51
66982 $813.93 $773.23 $889.21
27130 $1,382.88 $1,313.74 $1,510.80
Yep, now tell us what each of those CPT codes are for. Not a single one of them is for CT abdomen without contrast. That's 74150. And before you claim that 2009 "report" is based on 74178, it actually lists abdomen and pelvic CTs separately.
US average fee include medicare and medicaid charges. Average Fee * total procedures = cost of all the procedure + profit.
Uhh yeah it is.
No
Prove it
There is also the 2015 data I posted and you have Novartis to compare those prices to medicare reimbursement rates if you wish.
Sorry,
The are the abdomen scans to replace 74178
74150 $153.59 $145.91 $167.80
74160 $245.52 $233.24 $268.23
74170 $277.33 $263.46 $302.98
and these are the pelvis exams to go in between 70470 and 71552
72192 $149.35 $141.88 $163.16
72193 $240.82 $228.78 $263.10
72194 $268.00 $254.60 $292.79
We've already established that the average US "fee" is inflated because healthcare providers inflate prices to squeeze as much money as they can out of the small percentage of patients that are privately insured because Medicare and Medicaid don't reimburse enough to cover the actual cost of providing care. I can't do finger painting on here to make this any easier for you.
No, it isn't. I posted the reimbursement for CT abdomen without contrast. It's in Novitas for you to verify.
LOL
I love it when you flail when your narratives fall apart. Do you remember Obama claiming that ER visits would go down with the ACA because more people would be insured and have access to primary care? I got a good laugh out of that.
Your 2015 "data" doesn't even include your gold stsndard the Netherlands. It's also pretty wide open on things like "MRI." You can scan a hand or the entire himan body. The cost and charges for those would be worlds apart.
What happens to costs if all care was on the medicare reimbursement schedule?
That and the profits and administrative costs from the insurance industry.
or anyone with a basic understanding the concept of supply and demand and pricing power.
Give up? Do you think we have to give up physicians and nurses to go from $35 trilion spent on healthcare in the next ten years to $33 trillion?
All that training and liscensure to get same quality of care that European grill cooks provide.
I doubt anyone is reading this thread anymore, but just in case.
https://www.investors.com/politics/...nsured-cdc-data-private-government-insurance/
https://www.investors.com/politics/...nsured-cdc-data-private-government-insurance/
Yeah, uh, 74178 is still a CPT code. It's for abdomen and pelvic CT without and with contrast. The combined abdomen and pelvic CT CPT codes (there are 3) were created in 2011 to address the cost issues of the abdomen and pelvic CTs being billed separately even though they are a contiguous body cavity. The combined codes reimburse 75% of what the abdomen and pelvic CTs would reimburse separately.
Healthcare providers would be operating in the red.
I'll agree with you there. Obamacare sure allowed for a very handsome health insurer profit.
Healthcare isn't manufacturing...
You're going to have go without something if the only payer source is Medicare and it only covers 87% of costs. You aren't going to find many US doctors willing to work for Netherlands pay. You also aren't going to find nurses willing to work for $15 an hour.
Really? Interesting.
Do you know how averages work?
I couldn't find 2009 in Novartis.
Still waiting on you to answer the question of why ER utilization is different in NL than the US
Speaking of flailing.
What about all the things that aren't wide open?
