How expensive is the medical bill in America?

According to our own experience in visiting the United States, although the average medical expenses in the Los Angeles area where the hospital is located are the highest in the United States, this bill is basically the normal price of medical expenses in the United States. Our own friend went to the hospital for rabies vaccine after being bitten by a squirrel, and was billed $ 1800. This is a small town in the midwest.

What's with such an expensive bill? Let me show you how the American health care bill is formed.

First, the charging items

American medical bills are very detailed (in fact, all bills are like this), generally including the following:

1. The doctor's medical service fee. Le Dad's bill is $200, which is roughly equivalent to the average registration fee for general clinics. As for whether you should charge so much money just for a simple manual reduction (in the picture, it should be a common subluxation of the radial head in children, and the manual reduction is extremely simple), I'm sorry, even if the doctor tells you to go home and have some hot soup and rest more (many patients who go to see a cold get such a "prescription"), you still have to spend so much money for nothing else. The rationality of this charge is not only because of the long-term study and training behind the simple operation of doctors, but also because of a series of responsibility commitments behind the handling of medical staff. Of course, the generally high human resource fee in the United States is also one of the important factors.

2. Hospital expenses. This is because patients use hospital resources. General emergency bills will include beds (Le Dad may not have them this time), emergency treatment, medicines, various medical materials, examinations, etc. Among them, the cost of emergency care is very high, including all the human services involved. Those seemingly lofty services, such as remote translation, medical record copying, medical guidance, and even various administrative costs, will be allocated to each specific case. According to Le Dad, the first two doctors who "didn't do anything" (I estimate that they are residents with low qualifications who just entered the hospital) also charge for this visit, but it may be included in the total service fee. Therefore, the golden saying in economics-there is no such thing as a free lunch, and it is also extremely appropriate to put it here. Besides, it is not easy to speculate on any other expenses here. It is suggested that the original blogger post the bill directly for everyone to learn.

Some people may ask why the doctor's service fee should be charged separately, depending on the specific contract relationship between the doctor and the hospital. Different from doctors in public hospitals in China, they are all "employees who earn wages according to service hours". Many doctors in America have cooperative relations with hospitals. The hospital does not pay them a fixed salary, but directly charges the patients according to the service items. The first two doctors Le Dad met "didn't do anything" (in fact, they did something: observed and evaluated the condition, and finally got the result of asking a professional orthopedic surgeon to handle it). As residents, they received hourly wages from the hospital, and the expenses were charged from the hospital bill. In the end, the specialist obviously adopted the method of charging according to the service item, rather than charging according to the hourly salary, so the treatment bill was listed separately.

Second, the rationality of the cost.

Although we defended the treatment fee of $200 earlier, it was more out of indignation at the current situation that the labor of medical staff in domestic hospitals is worthless. When I was a doctor more than ten years ago, the labor value of two doctors for an appendicitis operation was only 8 yuan. My teacher sighed at that time, I might as well go to the market to kill chickens and pluck their hair, and two chickens earned back the operation fee. It is unknown whether this situation has improved now, but the author never dares to have too high expectations.

As for whether this cost is high for Americans, we must say that just counting this $200 is also a huge burden for the poor. Many patients who don't have medical insurance or only enjoy Medicaid, the government's medical subsidy program for the poor, can't support the outpatient expenses of private doctors, mainly the labor expenses of doctors. Drugs are usually bought in pharmacies with their own prescriptions. The cost has nothing to do with doctors-they have to wait until they are seriously ill before being squeezed into the emergency room of a large teaching hospital. As long as doctors take over, they can basically forget about the expenses. All doctors and hospital expenses are handled by hospitals and Medicaid. The situation of patients with private medical insurance and medical insurance is much better, but due to the high total bill, different self-payment ratios of various insurances, the insurance coverage is not good enough, or the cost is unbearable when using new treatments or drugs that insurance companies do not accept. According to statistics, in 2008, more than half of bankrupt families in the United States encountered medical bills that could not be paid.

Among the existing developed countries, the medical expenses in the United States are the highest, and the self-funded part, including insurance premiums, deductibles (after which insurance begins to pay-deductibles, I suggest you remember this word) and the self-funded part (co-payment, the word is best recited) are also rising. According to the statistics of 20 10, 33% of Americans can't see a doctor because of the cost, which is the highest among all developed countries. It has also been reported that some patients go to Europe for knee replacement at their own expense, and the total cost is even cheaper than that of the United States with insurance support. Elizabeth Rosenthal, a journalist from The New York Times, made a series of reports on the high medical expenses in the United States. Comrades with good English can try to find out for themselves. Therefore, although Americans don't resent the high income of doctors and think that pharmaceutical companies and medical service institutions should make money, they all complain when it comes to medical expenses. The reason for this result is very complicated, and we will explain it in detail later.

Third, the payment type of expenses.

I believe that anyone who receives the bill faced by Le Dad will collapse, but don't worry yet, because the last part of your wallet is only the insurance premium+the proportional out-of-pocket part. How high this part is depends on the insurance you buy, so we should repeat Da Le's profound experience here: "When traveling abroad, you must buy insurance." However, as far as we are concerned, the insurance coverage purchased by the Da Le family is still too low. When I was traveling in the United States, the accident insurance and medical insurance I bought were generally around $300,000. You know, if you really need to be sent to the emergency room after a serious accident, it is easy to charge you $20,000 a day.

For a foreigner, you can only buy commercial insurance. How to buy it, whether it is domestic or foreign, is a complicated problem, which will be discussed later. This time, we only say that the United States has universal health insurance, and how to pay the bill.

First of all, the bill you receive will list four different figures for each charge (basically different hospitals or insurances are slightly different, but the basic categories will not differ much), namely (English words in it are recommended to learn):

1) The price approved by the hospital of this project (the amount charged). Since there is no price management mechanism similar to ours in the United States, according to our American friend, the cost is "set by the hospital at will". According to different hospitals and regions, the same project may be worse than twice.

2) The approved amount of insurance for this project. This is the price negotiated between the insurance company and the hospital. Among them, a lower discount on labor costs will be good, while a larger discount on equipment and inspection will be possible. On the contrary, small insurance companies will get less discount when negotiating with big hospitals, but the overall price will be "-Medicare" (the largest public medical insurance in the United States at present). At this point, domestic insurance companies may have some disadvantages. For example, Le Dad needs to negotiate a discount with the hospital himself, and the last 60% discount is a good result. However, their total payment did not buy more insurance from American companies because there were the last two figures!

3) Insurance for the expenses paid for this project (planned payment). This is the amount paid by the insurance company within the price agreed by the second insurance company. The specific proportion varies according to different insurance plans and different medical projects. As a general rule, the higher the premium you pay, the higher the proportion paid by the insurance company. For the student medical insurance we bought, it pays 80% of the remaining expenses after we pay the deductible of 500 dollars. The deductible of college teachers' insurance is relatively low, 200 dollars/year, and the out-of-pocket ratio is also low, 10%.

4) The amount you paid. That is, the last remaining cash you need to take out of your pocket mainly includes the annual deductible+proportional payment (co-payment, remember now? Under normal circumstances, as long as you are hospitalized, even if it is only one day, your deductible will basically be reached.

To sum up, when you get an American medical bill, you actually end up paying the fourth number, which is completely different from the bill you first saw.

Of course, you can also count the insurance money if you want, but living abroad usually counts it as a general daily fixed consumption. I still remember that when applying for a visa, when calculating the amount of subsidies, the United States counted accommodation, meals and insurance as basic living expenses. During the visit, as long as you participate in the official activities of the school, even if you go out for one day, you will buy an extra day of insurance. This is really far from the insurance awareness of China residents.

The protection provided by insurance is related to the premium you pay, the higher the insurance amount. Of course, how to buy is personal freedom, but I still can't help nagging: Please carefully consider your physical condition, itinerary and living habits, and carefully estimate the risks, because the medical expenses in the United States are really too high, especially for the elderly and children. Don't buy too cheap insurance to save money, otherwise it's too late to cry in the face of huge bills.

Finally, following the principle of saying important things three times, we emphasize again:

When going abroad (whether traveling, visiting relatives or studying abroad), you must buy insurance!