Socially responsible healthcare consuming?

The Boston Globe is looking into the dirty little secrets of the healthcare world around here in a two-part Spotlight series ("Spotlight Team members [are] Scott Allen, Marcella Bombardieri, Michael Rezendes, and editor Thomas Farragher, as well as Liz Kowalczyk and Jeffrey Krasner of the Globe staff. It was written by Allen and Bombardieri."]

The first article, which ran a couple of days ago, "A healthcare system badly out of balance," discloses that the same tests and procedures receive wildly different reimbursements from insurers depending on where they're done. Look and ye shall see:

So why am I posting this? Because I need an MRI. This is not an unusual situation for me - as previously revealed, I have MS and MRIs are one principal way of tracking whether more plaque is building up in the brain, which is, like plaque on your teeth, not a good thing. My wonderful, beloved, attentive (and suffering from the flu) neurologist promptly returned my call yesterday, listened to my symptoms, and said the expected, that I should subject myself to the impossible hammerjack procedure once again (painless yet intensely annoying, for those of you who haven't had it - and not for the claustrophobic, i.e. take the Valium, if they offer it).

Then I remembered the chart, where I had instantly gone to the column with the MRIs earlier this week. If I go to his hospital, it will cost my health insurer roughly twice what it would if I go to the hospital just across town. Both are excellent hospitals - though this series has lifted up another blind, i.e. in many regards, the less expensive hospitals have superior results. I don't know about MS or MRI comparisons so I won't comment. What I do now is that I have a truly superior relationship with my neurologist and that I've been astonishingly healthy under his care, i.e. why tamper with something that works?

But...here's where the socially responsible reflex comes in. Can I in good conscience cost our overburdened healthcare system another half a thou to get the results of a pretty standard procedure? Now that the info is out there, it's really hard to know how to proceed. What would you do?

Comments

[Steps]

Go with the folks you and your doctor already have a relationship with. While I admire the impulse, this isn't the time to try and personally fix the health care system by cutting costs. MGH and the Brigham are two of the best for imaging. Having worked with the Brigham folks doing MS MRI studies, I know they're good. It may be a routine imaging procedure, but you still want the best doing it.

Hope all is well.

--B

[Joe Wehr]

Jessica

I would get the care, specifically doctor and hospital/facility, that I think is in going to provide me the best health outcome. To me that's the only consideration in my decision.

How much an insurance company is going to reimburse my health care providers is irrelevant.

[jessica lipnack]

Thanks, B. I value your advice, especially that it's first-hand. Likewise, Joe, appreciate your opinion. I do wonder, though, about our responsibility as consumers. My long-standing relationship with my doctor does tip the scales but in truth I could have the MRI done in the less expensive facility and then have the results shipped to my doc. Sort of like shopping at Filenes Basement then having the clothes tailored or something :) ... nah, that doesn't work but there's an analogy out there.

[steps]

J,

You could have the MRI done at a cheaper facility and your doctor could easily get the results. I just don't think this kind of consumer behavior is going to have a big impact in the short-term. Most people aren't going to think this way. And by the time you educate them to think that way, they'll recognize there are more effective ways to reduce health care costs and they'll press for those.

In fact, you can probably do more to impact the health care system in your professional capacity than as a consumer.

Although, it would benefit us all if everyone was a better health care consumer.

[Lilly]

It is clearly a question of market pricing and asymmetric pricing that is changing with the publication of costs. Once they become known, the hospitals can not exploit the ignorance of the patients.

Other elements come into the decision-for instance, your hospital may offer immediate scan at the time it suits you while the other may be less flexible. If it does not matter to you, go for the cheaper option, especially if your specialist has no problem with the source of data. In fact, you would be expanding his professional network by doing so and lying ground for other patients to take the same option in the future.

In short, my inclination would be to go to cheaper hospital, if nothing else, to show the one you normally use that people like you take action on new information.

Glad to hear that treatment is working. Look after yourself!

Best from deep night in Virginia Water, UK

Lilly

[Jessica Lipnack]

Thanks, Lilly. Take a look at the Globe article that prompted this post, referenced there. The hospitals don't exactly set the prices; they have some position in the market that enables them to negotiate with the insurers. And one group dominates in the Boston market. In truth, all the hospitals in Boston are pretty darn good but the sweet deal that one group gets is irritating to the other good ones and rightfully so. We need your complexity thinking on solving this problem!