This past weekend, the New York Times launched its new “Paying Till It Hurts” series, which will be examining the underlying economic and other reasons Americans pay so much more for ordinary health services than residents of most other developed countries.
The inaugural article focuses on colonoscopies, which, as Times reporter Elisabeth Rosenthal notes, “are the most expensive screening test that healthy Americans routinely undergo — and often cost more than childbirth or an appendectomy in most other developed countries.”
“Their numbers have increased manyfold over the last 15 years,” she adds, “with data from the Centers for Disease Control and Prevention suggesting that more than 10 million people get them each year, adding up to more than $10 billion in annual costs.”
According to European studies, reports Rosenthal, colonoscopies cost about $400 to $800 to perform. In the United States, however, the price tag for the procedure averages $1,185 and is often much, much more — as much as $4,090 here in Twin Cities, according to Healthcare Blue Book data provided by the Times. That’s less than New York City’s $8,517, but much more than Baltimore’s $1,908.
“The U.S. is paying way too much for too little — it leads to opportunistic colonoscopies,” done for profit rather than health, a European expert told Rosenthal.
Indeed, as I noted here in March, a recent study found that almost a quarter of Medicare recipients aged 70 and older may be undergoing colonoscopy screening for colon cancer unnecessarily.
Driven by profits
Much of the U.S.’ rapid rise in colonoscopy procedures can be attributed to a desire among some medical professionals and institutions for higher salaries and profit margins.
Largely an office procedure when widespread screening was first recommended, colonoscopies have moved into surgery centers — which were created as a step down from costly hospital care but are now often a lucrative step up from doctors’ examining rooms — where they are billed like a quasi operation. They are often prescribed and performed more frequently than medical guidelines recommend.
The high price paid for colonoscopies mostly results not from top-notch patient care, according to interviews with health care experts and economists, but from business plans seeking to maximize revenue; haggling between hospitals and insurers that have no relation to the actual costs of performing the procedure; and lobbying, marketing and turf battles among specialists that increase patient fees.
While several cheaper and less invasive tests to screen for colon cancer are recommended as equally effective by the federal government’s expert panel on preventive care — and are commonly used in other countries — colonoscopy has become the go-to procedure in the United States. “We’ve defaulted to by far the most expensive option, without much if any data to support it,” said Dr. H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice.
‘Turf battles and lobbying’
Rosenthal’s article discusses in depth some of the specific “turf battles and lobbying” that have kept colonoscopy prices so high in the U.S., including the lobbying efforts of gastroenterologists, the specialists who perform the procedure. They earn an average of $433,000 a year, she reports, making them among the highest paid doctors in the country.
Rosenthal also describes how frustrating it is to find anyone who can explain the pricing behind the various charges associated with colonoscopies.
“Even doctors often do not know the costs of the tests and procedures they prescribe,” she says. “When Dr. Michael Collins, an internist in East Hartford, Conn., called the hospital that he is affiliated with to price lab tests and a colonoscopy, he could not get an answer. ‘It’s impossible for me to think about cost,’ he said. ‘If you go to the supermarket and there are no prices, how can you make intelligent decisions?’”
You’ll find the article on the New York Times website. I recommend you read through some of the comments, too. Many are heartbreaking accounts of how Americans are struggling to cope with rising health-care costs.