The Uninsured: You're in your 20s. Why should you care?: That's Why They Call It An Emergency

Friday, March 7, 2008

That's Why They Call It An Emergency

Without insurance, people have more to worry about than covering a co-pay or a deductible. They have to pay for all of their procedures, tests, drugs and physician fees. If someone without insurance needs a procedure done, they now have a few online resources that may help them choose where to have that procedure done. I searched around the web for comparison sites, found a few, but the one that was the most comprehensive and user-friendly is Vimo.com (http://www.vimo.com/)

At Vimo.com patients can search for prices by procedure (even with or without complications), by hospital, doctor, and can also find competitive prices for drugs, dental work, and quotes for personal/group medical insurance or health savings account. Not only that, but they have an informational subset to their site where people can inform themselves on health care issues.

I decided to take Vimo.com for a test run. I wanted to find the facts for what an uninsured 20-something would pay if they had to have an emergency appendectomy. Mayo Clinic’s website says that appendicitis is an inflammation of the appendix; the appendix often becomes infected and requires surgery. Before or during surgery an appendix may burst and cause peritonitis, a serious infection. Vimo.com allows patients to get price estimates for surgeries that have no complications, mild complications or serious complications. I searched for a surgery with no complications and here are the results:

Average price for an appendectomy nationwide: $18,500
Number of hospitals in this average: 2,063

Spectrum Health Hospital in Grand Rapids, Michigan offers the lowest cost on average for an appendectomy at $7,800.

Spectrum Health performs about 14 procedures a year.

However, if the doctor at Spectrum Health found it difficult to diagnose the patient’s condition AND there were surgery complications during the appendectomy the total cost would skyrocket- it would cost about $24,800.

Now lets compare that to if the uninsured patient went Fairview University Medical Center, the ER of choice for many students at the University of Minnesota.

At Fairview, a patient can expect to pay about $18,000 for a general appendectomy and $38,200 for an appendectomy with a tough appendicitis diagnosis and surgical complications.

There is no reasoning for the price variations and Vimo.com didn’t break down what is included in the price they quote. Does it include anesthesia, doctor’s fee, Emergency room costs, antibiotics, pain medications? That is something that I, as a patient, would want to know before I gave the estimates any more credibility.

Of course, I wanted to see who was behind Vimo.com. Here is their “About Us” segment from their website.

“[Vimo.com was] Founded in 2005 by Internet industry veterans from WebMD and Valicert, Vimo is funded by Bessemer Venture Partners, Trinity Ventures, and Partech International. Vimo operates out of headquarters in Mountain View, California.”

I found that Bessemer Venture Partners has a hand in Sirtris Pharmaceuticals, Restore Medical, Endonetics, Circe BioMedical, Epic Therapeutics and CHD Meridian Healthcare among others. Unsure, but this may cause some conflict of interest issues.

Vimo.com could be used as a good tool for patients to gauge medical costs but should not be used as a definitive decision making tool . Still it is very important that uninsured people at any age understand how expensive an emergency medical procedure can be- and that’s why they are emergencies- unplanned and unfunded. Could you imagine spending somewhere behind $8,000-$38,000 tomorrow?

- Alex Harkness

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Facts about Health Care: www.kff.org/uninsured

Study Shows Uninsured Receive Less Care and Experience Worse Outcomes
A new study featured in the March 14, 2007, Journal of the American Medical Association theme issue on Access to Care documents that people who are uninsured receive less care and have worse outcomes following an accident or the onset of a new chronic condition than those with insurance.

Health Insurance Coverage of Women, 18-64 by, 2005-2006
Minnesota
Private Insurance: 81%
Medicaid: 10%
Uninsured: 9%

10 myths about uninsured:
Myth 1: The uninsured go without coverage because they believe they do not need it or don’t want it.
FACT: The majority of uninsured, regardless of how young they are, say they forgo coverage because they cannot afford it, not because they don’t need it.
Myth 2: Most of the uninsured do not have health insurance because they are not working and so don’t have access to health benefits through an employer.
FACT: Most of the uninsured are either working full-time or have someone in their immediate family who does — the problem is that the majority of the uninsured are not offered benefits through their employers.
Myth 3: Most of the growth in the uninsured has been among those with higher incomes.
FACT: The majority of the growth in the uninsured since 2000 has been among people earning less than $38,000 a year for a family of four (commonly considered low-income).
Myth 4: Most of the uninsured are new immigrants who are not U.S. citizens.
FACT: The large majority of the uninsured (79%) are American citizens.
Myth 5: The uninsured often receive health services for free or at reduced charge.
FACT: Free or even discounted health services are not common and when the uninsured are unable to pay the full costs, the unpaid medical bills add to their providers’ costs.
Myth 6: The uninsured can get the care they need when they really need it and are able to avoid serious health problems.
FACT: The uninsured are more likely to postpone and forgo care with serious consequences that increase their chances of preventable health problems, disability, and premature death.
Myth 7: Buying health insurance coverage on your own is always an option.
FACT: Individually purchased policies — vs. job-based group policies with similar benefits — are more expensive and coverage can be limited or even denied to persons in less than good health.
Myth 8: We don’t really know how large the uninsured problem is and many are only uninsured for brief periods.
FACT: Depending on whether we count the number of people who are uninsured during a specific month, for an entire year, or just for short periods, the numbers will differ; and all measures are useful.
Myth 9: The health care the uninsured receive, but do not pay for, results in higher insurance premiums.
FACT: The large majority of uncompensated care is subsidized through a mix of federal and state government dollars not cost-shifts to private payers.
Myth 10: Expanding health insurance coverage to all, or even a large share of the uninsured, will cost far more than the country currently spends on health care.
FACT: Because both the uninsured and government subsidies pay for a good share of their health care costs already, the amount of additional healthspending to cover all of the uninsured is relatively small.

Health Insurance Coverage of the Nonelderly, 2006, United States
Adults 19-24: 31.2 % uninsured
Adults 25-34: 27.1 % uninsured
Adult males, 19-34: 32.6 % uninsured
Adult females,19-43: 24.7 % uninsured

The Uninsured: You're in your 20s. Why should you care?

Friday, March 7, 2008

That's Why They Call It An Emergency

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