by: Sharon McReynolds
In reading articles of late, my interest in healthcare transparency has been triggered, one topic I am particularly passionate about. For the many years I have spent in the employee benefits industry, I have been an advocate of transparency. But for so many reasons, the concept is lacking in our current healthcare system. The insurance carriers identify costly conditions and go further to state those conditions account for 50% of overall medical spend. Being insurance carriers, on would think they would enable us with tools to combat the costs?
Cancer leads with more than 200 types and an average cost of $100,000 to $200,000. Females lead with the diagnosis of breast cancer. The costs vary widely determined by the type of tests, procedures, chemo, prescription drugs, radiation, follow up scans and hospital admissions. The costs can also be dependent upon where your treatment is received not only where you live in the United States, but even within a particular city. Why wouldn’t an insurance carrier give you tools to shop for prices on scans and chemotherapy, and maybe even educate you to ask if your doctor if they are participating in the profit of the administration of the scans or injectables?
Coming in a close second are claims classified as musculoskeletal, often involving knees and hips. While there is a higher incidence in the female population, there is also a noted higher than normal claim level coming from children ages 13-17, most likely sports related. They consist of joint wear and tear, neck and back pain, torn rotator cuffs, knee injuries and hip pain to name a few. Again, with one article stating that knee replacement surgery is five times higher in Dallas and Houston than in Cleveland or Pittsburgh, why isn’t this information common knowledge so that consumers can question it?
The articles written by insurance carriers often offer solutions such as encouragement of regular physical activity and adding elements of a cardio health program to any wellness programs being offered by employers.
I am of the belief that we need to add in some form or fashion a true consumer experience in healthcare, helping employees understand that our healthcare goes far beyond the doctor office copay, or the deductible we pay. If we do not all become active consumers, we may find ourselves not having choices.