(no subject)

From: Smigrodzki, Rafal (SmigrodzkiR@MSX.UPMC.EDU)
Date: Thu Sep 27 2001 - 16:20:04 MDT

Tiberius Gracchus <cryofan@mylinuxisp.com>wrote:

Well, why do you think they would save money? The medical profession.
like any other, charges whatever the market will bear. Tumor removal,
whether at stage 2 or stage 4, is something that even if the charges
go up, the market will not change that much.
Why would finding a tumor 2 months earlier save the insurance cos any
money in the long run? So if the hospitals/doctors can no longer get
on average 45K for a tumor because X percentage of tumors are now at
stage 2 instead of stage 4, then hospitals/doctors just increase the
price for stage 2 tumor removals. They have the money to buy
corp-gov-media and so the status quo will not change...

### Removing a tumor at stage 2 frequently results in a cure or a prolonged
remission, during which the patient continues to pay insurance premiums.
There is much less morbidity from complications, the hospital stay and
additional therapy (chemo, radiotherapy) is usually not needed, overall cost
is lower. In the long run the insurance wins because they have a
(relatively) healthy patient staying longer on their policy, even if later
other problems eventually kill the patient. Of course, the ideal patient
(from the insurance point of view) is perfectly healthy until age 90, then
suddenly drops dead.

Hospitals can't just increase the price for a procedure because a large
fraction of their patients are covered by Medicare, with the HCFA setting
reimbusement levels - no matter what you charge, you will only get what the
HCFA thinks they need to give you. And very few health care providers can
afford to drop their Medicare patients and still survive.

Private insurance companies have also their pre-set reimbursement levels and
raising prices won't change them. It takes a powerful institution with a
good bargaining position to force them to adjust reimbursements. The other
method is dropping plans which give especially low reimbursements but only
the best institutions in any area can do such cherry-picking.

You would need almost unlimited funds to buy "corp" *and* "gov" *and*

Rafal Smigrodzki, MD-PhD

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