Living in the US and having to pay the high deductibles for health care, here is my idea:
- price transparency -
The problem is not easily being able to shop around for procedures and doctors. It is extremely difficult to know how much things will cost. If the prices have to be published in some way so the cost is known up front, the price will go down. Many people's insurance doesn't start paying until after the deductible. Most people just pay the price whatever it is because it is impossible to know how much something will cost until after. Of course, this means that hospitals can charge whatever they want with no recourse. When insurance companies pay, they fight back and get lower prices, but people can't do that. Voting with their feet will increase competition and drive down costs.
Price transparency doesn't help when you don't realistically have a choice. If I'm going to ER or taking an ambulance I can't check prices to decide what hospital to go to. If I'm in hospital and need surgery I can hardly decide to change hospital because their surgery is cheaper. When my I discover on my bill that my doc consulted with an expensive expert, it's too late for me to ask her to use a cheaper one.
When it comes to emergency, you probably right we can't shop around. But when it comes to taking medication, there should be a price. In HK, we can find out the price of a treatment or a surgery from the hospital's website. Maybe not the full exact amount, but close enough for someone to know what to expect. There shouldn't be a "we will take care of the rest of your treatment and send the bill to you" as in your own story.
Even with regard to emergencies, there is no reason you can't shop around in advance so that you already know which hospital you want when the emergency occurs, given that there is more than one in your area.
In short, if you call 911, the operator will call for an ambulance. You can't choose. If you have a minor stroke, you can certainly choose to have a friend to drive you there, or you can call a specific ambulance (I have never done that before and I am not even sure if that's even possible). But risk is on you.
I can't go to Mount Sinai West Hospital (midtown in NYC) if I am in Brooklyn at this moment. You understand emergency means racing with time. I can be transferred to Mount Sinai West later after I am discharged though. Also, I believe there is protocol for how far an ambulance is allowed to serve on active duty, unless another area is requesting additional availability, but don't quote me on this.
> In short, if you call 911, the operator will call for an ambulance. You can't choose.
That is merely a procedural issue. There is certainly no reason why the 911 operator can't honor your request for an ambulance from a specific hospital, provided that it's within their range. In the absence of a specific request, the operator has a duty to look out for your interests, which should include not sending you to a hospital known for over-charging when there are other reasonable options available. (This is the same logic that says they shouldn't just send you to the hospital that pays them the most kickbacks.) Their default balance between cost and care might reasonably differ from yours, but if you have expressed a preference then they have a responsibility to honor it.
Of course, not every emergency is quite as time-sensitive as a stroke or heart attack, and depending on your location, and the locations of the hospitals, the difference in travel time may not be significant. Even if price is not the determining factor in the majority of cases, competition over the patients for whom where it is a factor can help keep costs in check for everyone.
In true emergencies, your coverage works everywhere, although your insurer can request that you move to a facility in their network once you are stable.
The point of emergency care is to get you the quickest competent care. This almost always means the closest facility unless there is a specialization issue (e.g. a severe truama case may be evacuated to a Level 1 rated trauma care facility, even if that means an air ambulance).
