Based on our own experience during our visit to the US, this bill is basically in the normal range of US medical bills, although the average medical bill in the Los Angeles area, where the hospital is located, is among the highest in the country. We ourselves had friends who were billed $1,800 for a squirrel bite and went to the hospital on their own to get a rabies shot, and this was in a small town in the Midwest.
What's wrong with such an expensive bill? Let's take a look at what makes up a medical bill in the United States.
First, the charges
The U.S. medical bills are very detailed (practically all of them are), and include the following major blocks:
1. LeDad's bill came to $200, which is roughly equivalent to the average registration fee for a regular office visit. As for whether you should be charged this much for a simple manual repositioning of the radial tuberosity (a common childhood subluxation, which is extremely simple to reposition), I'm sorry, but even if the doctor told you to go home, drink some hot soup, and get some rest (a lot of people who go to the doctor for a cold get that kind of prescription), and did nothing else, you'd still be charged this much. Even if the doctor tells you to go home and drink some hot soup and get some rest (which is what many patients with colds are "prescribed" to do) and nothing else, you are still charged. This fee is justified not only because of the long hours of study and training behind the doctor's simple action, but also because of the commitment of responsibility behind the medical staff's handling of the situation, and, of course, the generally high cost of human resources in the United States is also an important factor.
2. Hospital costs. This is because the patient used the hospital resources and the costs incurred, the general emergency bill will include beds (Le father this time may not have), emergency care, drugs, a variety of medical materials, tests, etc., which the cost of emergency care is very high, including all the manpower involved in the service, those who seem to be high remote translation ah, medical records copying, medical guide and other services, and even a variety of administrative The cost is spread out to each specific case. According to Dr. Lok's father, the first two doctors who "did nothing" (I guess they were low-level residents who had just entered the hospital) were also charged for their visits, only that they were probably included in the total service fee. So the golden rule of economics, that there is no such thing as a free lunch, is also extremely appropriate here. I'm not going to speculate on what else is involved, so I suggest the original blogger post the bill so we can all learn from it.
Some people may ask why doctors are charged separately for their services, but this depends on the type of contractual relationship between the specific doctor and the hospital. Unlike doctors in public hospitals, who are "salaried employees" of the hospital, many doctors in the United States work in partnership with the hospital, and the hospital does not pay them a fixed salary, but rather collects their fees directly from the patient, "according to the service program". The hospitals do not pay them a fixed salary, but charge them directly from the patients "according to the service program". The first two doctors that LeDa encountered "did nothing" (in fact, they did something: they observed and evaluated the condition, which ultimately led to a specialized orthopedic surgeon being called in to deal with it), as residents, were paid by the hospital on an hourly basis, and their fees were billed from the hospital, while the last specialist, obviously, was paid on a per-service basis. obviously took a fee-for-service approach rather than an hourly rate, so the bill for treatment was separate.
Second, the reasonableness of the cost
While we have made a little defense for the $200 treatment fee, but more out of righteous indignation at the status quo of the domestic hospital medical staff labor is not worth it, I more than a decade ago when I was still a doctor, an appendicitis surgery, the value of the two doctors' labor is only $8, my teacher lamented that I might as well go to the market. My teacher lamented at the time that I might as well go to the market and specialize in killing chickens and plucking their feathers, and the two chickens would earn back the operation fee. Whether the situation has improved now is unknown, but I never dare to have high expectations.
As for whether the cost is too high for Americans, we must say that just counting the $200 is a huge burden for poor people, many of whom don't have health insurance or are only eligible for "Medicaid," the government's health-care program for the poor. Many patients who do not have health insurance or are only entitled to "Medicaid", the government's medical assistance program for the poor, are forced to wait until they are seriously ill to go to the emergency room of a large teaching hospital because they cannot afford to pay for the private doctor's office visits - mainly for the doctor's manpower, and the medicines are usually purchased by themselves at the pharmacy with a prescription, at no cost to the doctor. Crammed into the emergency room of a large teaching hospital, you can get by until a doctor takes over and then you can basically forget about the cost, and all the doctor and hospital costs are handled by the hospital and Medicaid. Patients with private health insurance and Medicare for the Elderly (Medicare) are in a much better position, but because the total bill is so high, the deductibles for the various insurances vary, the insurance coverage is not good enough, or the costs are likewise enough to be unaffordable when using new treatments or medications that have not been accepted by the insurance company. Statistically, more than half of the families that went bankrupt in the U.S. in '08 did so because they were hit with medical bills they couldn't pay.
The cost of health care in the U.S. is among the highest in the developed world, and the portion that you pay for yourself, including insurance premiums, deductibles (beyond which insurance begins to pay -- Deductible, a word we all are advised to memorize), and a sliding scale of out-of-pocket payments (Co-payment, a word best remembered), is the highest in the world. payment, a word best memorized as well), etc., are also climbing. 2010 statistics say that 33% of Americans are unable to seek medical care because of the cost, which is the highest of any developed country. There are also reports of patients going to Europe to pay for knee replacements out of pocket, and the entire cost, combined, is cheaper than it would be in the U.S. with insurance to back it up. (**** has a reporter, Elisabeth ROSENTHAL, who has a series of reports on the high cost of health care in the U.S. Comrades with good English can try to find them themselves.) Therefore, although Americans do not resent the high income of doctors, and also believe that pharmaceutical companies and medical service organizations should make money, but when it comes to the cost of health care is always complaining. The reasons for this result are very complex, and we'll have a chance to tell you more about them later.
Third, the type of payment
I'm sure anyone who receives a bill from LeDay is crushed inside, but don't worry, because the last part of your wallet that you'll have to dig into is just the premium + a pro-rata share of the out-of-pocket expenses. How high that portion actually is depends on the insurance you purchase, so we're going to repeat LeDad's profound experience here one more time, "When traveling abroad, always, always, always buy insurance." But as far as we can see, the amount of insurance coverage purchased by LePa's family is still too low, and the author's own accident and medical insurance coverage is usually around $300,000 when traveling poorly in the United States. Mind you, it's easy to charge you $20,000 a day if you really need to be admitted to the emergency room for a more serious accident.
For a foreigner, we can only buy commercial insurance, as to how exactly to buy, buy domestic or foreign, is another complicated issue, we will talk about it later. This time we'll just talk about how the bills should be paid in the US if you have a regular health insurance policy.
First of all, the bill you receive will list four different numbers for each charge (basically, different hospitals or insurances vary slightly, but the basic categories don't vary much), which are:
1) The hospital-approved price for the item (AmountCharged). As the United States is not similar to our price management mechanism, the cost is how much according to our American friends is "hospitals arbitrarily set", depending on the hospital and the region is different, the same project may be worse than two times.
2) The item's insurance-approved price (AmountApproved). This is a price negotiated between the insurance company and the hospital, in which the human labor cost discount is a little lower, one-third of the very good, equipment, inspection and so on discount is larger, large insurance companies in many items may be cut to less than 10% discount, on the contrary, small insurance companies and large hospitals will be negotiated discounts, but the overall will be to the "U.S. Seniors Medicare-Medicare", which is the most popular insurance plan in the world. -Medicare" (the largest public health insurance program in the U.S.) as a benchmark. At this point, the domestic insurance companies may be a little disadvantage, such as LeDa need to negotiate discounts with hospitals, and the final 60% discount is a good result. But their total payment is not necessarily more than if they hadn't purchased insurance from a U.S. company, because there are still the last two numbers!
3) What the program's insurance paid (PlanPaid). This is the number the insurance company pays inside the price agreed upon by the second insurance company. The exact percentage varies depending on different insurance plans and different medical programs, with the general principle being that the higher the premium you pay, the higher the percentage the insurance company pays. For our student health insurance, it pays 80% of the remaining cost after our own payment reaches the deductible (Deductible, if you remember the word) standard of $500. For university faculty coverage, the deductible is lower, $200/year, and the out-of-pocket percentage is also low, 10%.
4) Out-of-pocket expenses (AmountYouPay). That is, the last remaining cash that needs to come out of your pocket, mainly including the annual Deductible + the proportionate out-of-pocket portion (Co-payment, remember now?). Normally, if you are hospitalized, even for one day, your deductible is basically met.
In summary, once you get a US medical bill, the actual final payment you'll have to make is the fourth number, which is quite different from the one you initially saw.
Of course you can include money for insurance if you like, but living abroad usually counts it as a general day-to-day fixed expense. I remember when I was applying for my visa, when the US side was calculating the amount of funding, they counted lodging, meals and insurance as basic living expenses, and anytime I went out for even one day during my visit to participate in official school activities, I bought an extra day's insurance, which is a big enough gap with the insurance awareness of our residents.
Insurance provides coverage in relation to the premium you pay, and expensive insurance coverage is higher. How to buy is of course personal freedom, but I still can't help but nag a few words: please carefully consider your own and your companion's physical condition, travel arrangements and living habits and other factors, carefully estimate the size of the risk, because the U.S. health care costs are really too high, especially if there are old people and children, don't want to save money and buy too cheap insurance, or else face the huge bill and then cry it's too late.
Finally, following the principle of saying important things three times, we emphasize again:
When you go abroad (whether you are traveling, visiting relatives or studying abroad), you must buy insurance!