$72 for a 4-mile ride: Make sense?

John Taylor: July 16, 20130 Comments

The overall ambulance experience – which was a good one, a rescue vehicle for a loved one in need – came with a bill of nearly $900. It included a $72 charge for the four-mile drive from house to hospital.

An undated policy brief on the California Ambulance Association website shows: Emergency medical services firms say It costs about $600 per ambulance transport, but Medicare (the leading user of services) pays $426; Medi-Cal (No. 2 user) pays only $150;  private payer (or self-pay, the third leading user) averages $233; and commercial clients (us private-insured folks, No. 4) reimburse about $1,274.

It’s a snapshot of “cost shifting.” It doesn’t resolve a definition that healthcare providers, especially nonprofit hospitals, are struggling with – “What is price transparency?”

Hospitals around California are puzzling out what options consumers want on determining the true price for care they receive.

  1. Do you want to shop around, like on a travel site, where the best deal for gallbladder removals might be after noon on Tuesdays, like when some airlines dump their unsold seats?
  2. Do you want the Yugo price for your heart surgery, or the Lexis price? And do you care if the Yugo hospital is having an off-year in its outcomes as long as the price is within your range? How about a Kelley Blue Book or Edmunds.com for prices in your geographic region?
  3. Do you want a website that will show you comparable area prices and allow you to negotiate with the physician or hospital, especially if you pay cash, or barter work on motorhomes or air conditioners?


Of course, anti-trust and anti-racketeering laws factor in. So does the “cost shifting” where the insured pay some costs of the have-nots, and some have-nots pay higher prices than the insured whose plans get discounts. So, should there be a region-specific “sick tax”?

The more we talk about “cost transparency,” the more confusing and often-times infuriating it can become. Because the more you know, the less you understand. Some hospital chief financial officers feel the same way.

We want good access to good healthcare at a fair price.

Just as I wanted that ambulance to come by, swiftly as it did, delivering good care first before speedily delivering a bill which like many others, makes you scratch your head.

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