Dr Val Jones has done an excellent job with a four-part Grand Rounds this week, which was published on the USA Today site. My favorite is Part Four, as it focused on one of my favorite subjects – healthcare costs. This post from Common Sense Family Doctor is especially good, particularly if you’re a fan of consumer directed health insurance plans and HSA-qualified policies. The author and his wife are both family practice doctors and have delivered hundreds of babies. And they diligently tried to find out how much it would cost them to have their own baby in the months leading up to the birth. But in the end, they just had to make an educated guess about how much money they would need to set aside to cover their 20% coinsurance, because nobody at the hospital could tell them how much it was going to cost, even assuming there were no complications.
We had an HSA qualified health insurance policy for our family for years, until we switched to a less expensive “Core Share” policy from Anthem Blue Cross Blue Shield last fall (still a high deductible plan, but not HSA qualified). We’ve written about how difficult it can be to really shop around and be a “consumer” when it comes to healthcare. And how even when you think you’ve dotted all your i’s and crossed all your t’s and asked all the right questions, you can still end up with unexpected charges.
I’m still a fan of consumer directed health plans, high deductibles, and HSAs. I think that they can be useful tools to help people keep their health insurance premiums as low as possible and also (if an HSA is involved) set aside pre-tax money to cover potential future medical bills. But they are not a panacea. They are probably not a good solution for anyone who has a chronic illness that needs ongoing, expensive care. They don’t work so well for people with very little money who would struggle to cover the relatively high out-of-pocket costs and would not likely be able to fund an HSA. And no matter how great the actual consumer directed health plans are, the fact remains that transparency with regards to healthcare costs is still quite elusive. For some procedures, it can be relatively easy to get a set figure up front in terms of how much it’s going to cost. But much of the time that number can be difficult or impossible to pin down. Obviously, complications can arise in any medical situation (and the resulting increase in costs would make earlier estimates irrelevant). But even without factoring in complications, “shopping around” for healthcare is often an exercise in futility. In order to make consumer directed health plans more effective, there is much work to be done with regards to cost transparency.