there are so many reasons and there really isn't one primary one that will solve the rest.
things are inherently more expensive in our country for one. the dollar is worth more than a peso and will always be. i am not going to accept the salary of what a doc makes in mexico even though he is capable of doing the same thing. the cost of living here is not the same as in mexico so again it doesn't really make sense to compare countries imo. anyways, science is expensive, which leads to high prices of R&D. united states has the wealth to pay and fund profits for pharma companies so it is more expensive here than elsewhere. prices negotiated to other countries are presumably based on their ability to pay and i'm sure they have analysts that can predict # of consumers and the optimal pricing point. however, after time, other countries make generics from our high investment and sell at a lower cost. our high investment being the assumption we consider these pharma companies US entities even though they do have a lot of offshore development.
the high cost of education that develops US graduates that go into PhDs, nursing, technicians, and physicians has to pay workers at a rate so that they are not in poverty given the high skill level and demand that is required of such professions. the funding in medicaid is also funds residencies across the country. residents are the primary workhorse and backbone of academic county hospitals that treat the indigent, poor, uninsured, and take on the most complex cases. medicaid funding is one of the biggest targets in this election fyi. how much do residents make? 80 hrs/week avg 8-10 bucks an hour depending on what city you're doing your residency.
why are hospital bills so high? every person that interacts with a patient is an employee. for a hospital to run efficiently for the high volume, tasks are specialized to meet such efficiency. but each task has a high minimum requirement of training. phlebotomists, nurses, lab techs etc typically have college degrees, which funnel back to the earlier point, which is the high cost of education. who is often overlooked? patient transporters, cooks, food delivery services, janitors, and a very deep level of support staff ranging from case managers to social workers to physical therapists. on average, each patient is being serviced by at
least 10 different people. it's not just doctors, nurses, and pharmacists.
hospitals are
acute medical centers meaning to get quick turnaround time and faster delivery of health care, things will be more expensive. emergency room bills and receives at 100% reimbursement rate. people who utilize the emergency department for typical outpatient healthcare are one of the biggest drivers of cost per capita. why? because if you come into the emergency dept, doctors are obligated to rule out life threatening diseases that often come with the price of expensive tests. the other reason for high cost per capita? the super sick people that keep getting readmitted to the hospital. i mean people who often have little to no quality of life but are being kept alive by their own wishes or by family members who are unwilling to let them go. (
http://www.theatlantic.com/business...made-up-50-of-us-health-care-spending/251402/) . people bash on the US for spending so much, but let's not forget we still are the gold standard that the elite seek. people complain about how we have the worst system yet we still have the best doctors. in short, we are really good at keeping people alive who probably shouldn't be. the same driver of innovation is also the burden of the country. nobody here accepts less than the best yet 99% of the population cannot afford what i or any of my collegues do out of pocket.
and that brings me to my next point. culture. people here do not accept death so readily. again to reiterate what has been stated above, it has driven both innovation and costs.
high costs are also "inflated". the bandaid you got is probably a 10 dollar charge. sure there's things like paying for it to be placed and stocking fee, but also sometimes insurance companies only reimburse a % of what is charged. so if a hospital wants more money, they just make higher prices. i know it sound stupid and this also is anecdotal and isn't entirely true, but a part of me says it really is.
how does reimbursement work? well when patients are diagnosed and admitted to the hospital, some non-healthcare entity has decided that it should cost X dollars to treat and discharge a patient safely. of course, doctors think these people are idiots and sometimes it takes more than X dollars to treat a patient. multiple diagnoses do give higher reimbursements, but there is a cap on how many diagnoses are reimbursed per admission. and this is not helpful when someone is insanely sick. and this is really not helpful if they return to the hospital within 30 days, which is deemed a "bounceback", and the hospital is penalized for "poor delivery of care" and is reimbursed at a reduced rate. too many bouncebacks in a year will punish the hospital severely and reduce rates across the board. again, rules made by non doctors are really dumb. we are doctors, not gods. some people are destined to get sick again no matter what we do to the best of our abilities. we will treat and do our duty even at a net loss.
on a complete tangent, the current model is designed to pay for how much you do and not for how much you know. primary care pays the least yet is needed the most. on the flip side, patients dont like to be told to suck it up, take dayquil for their colds and want instant relief with antibiotics whether it is indicated or not. a balance between expectations, understanding, and trust is really lacking. to build those things, it takes time and money, which most people don't have. and insurance companies continue to reap profits, which most docs think is at a criminal rate, because lets be honest, insurance companies don't really make anything. they are just a middle man holding the money between the consumer and the provider. ideally the insurance companies should do something positive with excess net profits rather than feeding their own but i guess that's another dialogue.
there are way too many problems with the system with too many conflicts of interest. everyone is at fault, including the docs, who are trying to grind out $ as well. i'm not going to deny that at all. even at 6 figure salaries, many think they deserve more.
