Opinion Editorial

A costly pain in the neck, and what it says about healthcare in the U.S.

After a weeklong stay, the Barrow Neurological Institute in Phoenix sent me on my way on Jan. 5 with five stitches, a titanium alloy plate in my neck and a hard plastic Össur Miami J cervical collar that will remain on my neck until late March. A few weeks later, I learned what I'd been charged for the Miami J: $447. Had I been given the chance, I could have purchased the brace online for less than $100. Allowing that sort of comparison shopping is one small thing policymakers could do to slow the growth of healthcare spending. But like seemingly everything related to healthcare, it wouldn't be that simple.

I wound up in Barrow after the car I was riding in overturned on Interstate 10 just east of Quartzsite, Ariz. I suffered what one neurosurgeon blithely described as a "hangman's fracture" — a break in the second vertebra below the skull. After the surgery, my doctors decided that the first neck brace I'd been given wasn't a good fit, so they ordered a new collar — the Miami J — to be delivered later in the week by Hanger, a publicly traded supplier of prosthetics and orthotics.

This sort of transaction occurs countless times in hospitals as patients are treated, medicated, fed and rehabilitated. Most take place with little or no patient input, and appropriately so, given that few patients have the necessary expertise. But healthcare providers often care little if at all about how much a device, drug or nutritional supplement costs. They simply pass on the charges to the patient.

Patients may not care about the cost either, if they have insurance with low deductibles and co-pays. But such policies have become less common as premiums have risen, leaving more consumers responsible for the first few thousand dollars' worth of medical bills. Newly sensitive to the cost of care, these consumers could push for more efficiency and competition if offered the opportunity — for example, if they were allowed to shop around for medical devices the same way they do for prescription drugs. That won't happen, however, unless they can see the price of a device before it's handed to them as a fait accompli.

Admittedly, asking doctors and hospitals to go this route would help a relatively limited number of patients. I was exceptionally lucky — my spine wasn't damaged in the accident, so I could poke around the Internet on an iPad the day after my surgery. What would help patients across the board would be new payment systems that give doctors and hospitals a real incentive to cut treatment costs without compromising on quality. Employers, insurers and providers have been experimenting with ways to do this for at least three decades, and they've yet to find a magic formula. So perhaps we can start with a baby step: telling patients what device they need and how much it will cost, then letting them look for a better deal.

— Jon Healey

Copyright © 2014, Los Angeles Times
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