“In Dr. Linda Burke-Galloway’s own words, ‘it is a unique and humbling experience when a physician becomes the patient.’ Her ophthalmologist (eye doctor) recommended a surgical procedure that would be necessary to preserve her vision. As a public health physician with 23 years of experience, Dr. Burke-Galloway thought she knew what to expect when she went to the hospital. And she did. It’s what happened after the hospital and routine recovery that floored her.
One day after work, she opened an envelope containing a medical bill for $13,298.02. After blinking to make sure her vision was indeed working, she went through the individual line items and noticed equally astounding prices. $78 for a $4 antibiotic called gentamycin. $863.20 for a $192 pair of disposable forceps. And on it went.
Assuming a mistake occurred, she first verified the discrepant prices and compared them to those listed by medical supply companies. She then contacted the hospital only to find that no one knew how to address her concerns: not the auditing department and not the CEO’s office. Ultimately, she received a jolting final response to her appeal: ‘When you sign consent for a procedure, you’re allowing us to charge anything we want to.’ How could this be right1?’”
It is important to understand the basics of health care financing in the US, including private and government insurance. If you are not familiar with the general structure of Medicare, Medicaid, VA/Tricare, and individual and employment-based insurance, then you should review this brief mini-module (“Basics of Health Care Financing in the US”) now and then return to this module—or you can choose to check it out after completing this module.
Medical bills are a leading cause of personal bankruptcy in the United States,2 and increasingly medical insurance does not necessarily protect patients from the high costs of medical care. More Americans than ever before are now enrolled in high-deductible insurance plans, meaning they have to pay thousands of dollars out-of-pocket prior to their insurance company covering any of the costs of their care. At the same time, many routine health services are arbitrarily expensive, so seemingly simple decisions that physicians make about testing, like ordering name-brand antibiotics, could directly lead to significant costs for patients.
This has been described as the “financial harms” of medical care. In the oncology world, financial harm is increasingly being recognized and measured as “financial toxicity” of chemotherapeutics.3
Part of our goal here is to define and discuss these harms so that you are prepared to address them in your role as a medical professional. In this module, we are building the framework for understanding basics of health care costs. The background provided in this module will provide you with the necessary foundation that we will expound in future modules.