Physicians

It’s all about the billing

Sean Neill is a South African-born, British-trained anesthesiologist, who recently relocated to Midwestern USA. He blogs regularly at OnMedica about his cross-cultural experience, frequently pointing out oddities of American health care.

Having arrived to see the last of the winter snow, we were amazed at how quickly spring and summer evolved.  Frozen pavements evolved to lush green grass in a matter of weeks.  Work is a 10 minute cycle away and most Americans find it humorous to see you arrive at the hospital in cycling gear.  When asking for directions, the reply is always in terms of driving, even if it is just around the corner.  One quickly learns to cycle on the wrong (right) side of the road as the vehicles are so large you would not want to make a mistake.

Another noticeable difference between health care in the UK and the USA is in terms of billing. A UK patient can go into an NHS hospital for a big procedure and may not be asked for another penny. It is completely different in America, where charges start from the minute you walk in the door. Each hospital specialty has its own large team of dedicated professionals diligently chasing every possible expense. A short visit to a primary health care facility will be followed by a bill within days.

The patients themselves tend to be sicker than what we are used to in the UK. A lot of them (and there are a lot of them) are simply huge! Nobody bats an eyelid at a BMI of 60.

Of course they all have OSA (obstructive sleep apnoea) and GERD (gastro-oesophageal reflux) and “mild” CHF (congestive heart failure). Clearly, there is nothing mild about having heart failure with one heart and two bodies, you can do the math. Abbreviations are the order of the day and the more abbreviated co-morbidities on the patients’ lists, the more they are charged. No matter how sick you are in the US it appears that if you have insurance you will get your operation.

Current estimates put US health care spending at approximately 16% of GDP. Total spending on health care in the UK rose to an estimated £120bn in 2006, representing 9.4% of GDP — up from 7.1% in 2001.

Perhaps one reason for NHS budget deficiencies is the fact that its billing structure is nowhere near as efficient or organized as the US. If UK citizens were allowed to forgo their National Insurance contributions in lieu of private health insurance, would they receive a better service or simply be charged more?

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  1. Parents of primary school children are to receive an official letter from UK government intended to warn them if their child’s weight is above the healthy standards on the basis of their age under new plans complied by the Department of Health, UK.
    Schools regularly measure child’s height and weight at the age of 4-5 and again when they are between the ages of 10 and 11; however parents can opt to exempt their children from this process. The output of these measurements are used to calculate the body mass index (BMI) — an rough measure of fat in the body which determines whether a person is underweight, a healthy weight, overweight or clinically obese.
    The letter will inform parents about their child’s results and will recommend them to contact their local GP or practice nurse if they seek further help. But ministers have banned the use of any wording which could be seen as unpleasant in nature — such as “fat” or “obese” — fearing that such unethical descriptions could isolate overweight children from others and cause parents to dismiss the letter out of hand. Instead, children who are clinically overweight will be referred to as “very overweight”.
    Figures from 2006-7 reveal that just over one in five children — 22.9 percent — aged 4-5 were either flabby or obese, with that number rising to almost one in three — or 31.6 percent — by the age of 10-11. Will Cavendish, head of health and wellbeing at the Department of Health, said the term “obese” was unhelpful. “Use of the word obese shuts people down,” he said. “We have not banned (it) but we have chosen not to use it. There’s no point giving them a letter that does not have any impact on their behaviour.”
    Health Minister Ivan Lewis said most parents are eager to know if there was any concern about their children’s health, but studies showed many parents are unclear about when weight was becoming a serious issue to be tackled carefully. “Research explains that most parents of overweight or obese children believe that their child is a healthy weight,” he said. “This important move isn’t intended to point finger on obese children and telling their parents that they are overweight. Instead it’s about acquainting parents with the information which is indispensable to help their children live sound and healthier lives.”

  2. Readers of THCB:
    Billing and restrictions on medical procedures can sometimes get out of hand in the US. Now this crisis is endangering the life of a promising young woman in Florida.
    Caitlin Jackson is a 19-year-old woman from Florida that is suffering from a rare brain disease called “Quiari Malformation.” The disease, which will eventually rob her of all motor functions, requires immediate surgery. On the day of her scheduled surgery, Aetna failed to approve the operation in time, and the hospital was forced to reschedule it to July 21st. Now, Aetna is openly refusing to pay for the surgery, claiming Caitlin’s benefits have run out.
    THCB community, we must act. Please continue staying active with THCB and sign the petition here http://www.collegeotr.com/college_otr/aetna_denies_woman_life-saving_surgery_this_petition_may_save_her_life_9977

  3. Health care in the US is nearing an implosion tipping point. Admitted quality and access inequities in the bloated so called “system”, while somewhat masked by a here-to-for buoyant economy, have less cover as the financial and housing market meltdowns gain momentum and infect the general economy.
    We have much to learn from the UK, Germany, France and our neighbors to the north, au Canada.
    The arrogance to patently dismiss these models as government run, inefficient bureaucracies without merit to average Americans, will lose ground as more and more of us lose health insurance and join the ranks of the uninsured.
    Thanks for the cross cultural reporting and contrasted perspectives!

  4. I know your post was about patient facing issues but I am surprised that you didn’t mention the billing problems that anesthesiologists in particular have to face. If you are a faculty member of the hospital it’s not your problem but if you have privileges then you have to fend for yourself.
    The first issue is mechanical, in the States you can’t bill for your services until the surgeon has done his or her billing. Then we have the particularly arcane time based coding that anesthesiologists have to submit to get paid. This paper chase is part of the reason that healthcare as a percentage of GNP is higher when compared to other countries.

  5. “If UK citizens were allowed to forgo their National Insurance contributions in lieu of private health insurance, would they receive a better service or simply be charged more?”
    If they used the NHS with private insurance I would think they would jump to the front of the line and pay more for the privilege. On the other hand those that could not afford private insurance would end up further down the line with less resources available to spend on their care. Don’t let Britain and the NHS get on that slippery slope.
    Your observations on the U.S. BMI are dead on and now you see why we spend about double on healthcare – it’s sickness mining. Feed them crap til they get fat and sick, then bill the bejesus out of them to keep them alive.

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