Elizabeth Rosenthal’s piece in yesterday’s New York Times is generating backlash. “In many other developed countries, a basic colonoscopy costs just a few hundred dollars and certainly well under $1,000″ we are told. But a map of the 50 states shows that the U.S. prices several thousand dollars or more and varies widely from state to state. A reader at Austin Frakt’s site responds this way:
In this article, the primary problem was not that we pay more for colonoscopies, we’re buying different things! The colonoscopy was a little more expensive, but the real difference in Europe was that we also buy an anesthesiologist and a surgical center along with it.
An email I received from a doctor had this to say:
Twelve years ago, when I had my first colonoscopy, it was in my local GI doc’s office, a private practice in Manhattan. It cost a few hundred dollars, took an hour, and I was back at work within two hours total.
Two years ago, when I tried to make another appointment, he said that the regulatory burden had made it impossible to continue performing colonoscopies in his office. He referred me to a trainee he had worked with, one who happened to be in my med school class. This doctor works at a medical center and was happy to provide me with his service there…The charges for the colonoscopy at the medical center were about 10 times the charges from ten years before, largely because of the additional overhead, anesthesia (which I didn’t want or need but which they require), and so forth. I also had to sign a document stating that I wouldn’t drive for 24 hours after the procedure. So I was stuck missing a day of work and spending another night in the hotel.
So why are colonoscopy charges ten times higher than they were ten years ago? And why are my own costs for going through the process also about ten times higher (considering the number of hours of lost time in the office, travel, hotel, etc.)? It’s not because of anything physicians have done. It’s because of regulatory changes that prevent small practices from practicing and that reward the higher overhead facilities (medical centers) for, frankly, having higher costs.