Wellness GM via Flickr Creative Commons
A lot of people consider health insurance to be a necessary evil.
Yes, it can be expensive and frustrating to use. But when patients need medical care, they're generally glad they're insured.
Some doctors, though, are bypassing insurance all together.
These physicians are setting up cash-only offices with the goals, they say, of regaining financial control over their practices and spending more time with their patients.
"Medicine can become so much more accommodating to the consumer when you get all of the strange effects of the way the payer system works out of the way," says Tom Blue, chief strategy officer for the American Academy of Private Physicians, the professional society for cash-only doctors.
What is a cash-only office?
This model comes in several names and forms. It's sometimes known as concierge medicine or direct primary care. It's most common among primary care doctors, but some specialists are going this way, too.
Adrianna Williams/Getty Images
Last week the New York Times reported that a drug company, Turing Pharmaceuticals, had raised the price of one of its drugs from $13.50 a tablet to $750.
The drug, called Daraprim, is used to treat a deadly parasitic infection. It's been on the market for more than 60 years. So why did the price skyrocket overnight?
The Washington Post reported that the company’s 32-year-old CEO, Martin Shkreli, defended the price hike on Twitter, saying, "it's a great business decision that also benefits all of our stakeholders."
In other words, the company raised the drug's price because it was good for business.
The price increase – and Shkreli's defense of it – sparked outrage online. It also put a spotlight on how drug prices are set in America.
Drug prices today
In the United States, experts say, drug companies essentially have free reign to set prices. Those prices are generally based on what the market can bear. The market, in this sense, is not consumers but intermediaries who buy large quantities of drugs, like insurance companies, employers and the government.
Greg Black/Flickr Creative Commons
Each fall, as pumpkin-flavored items start hitting store shelves, doctors implore people to get a flu shot.
This has been a major public health push since 2010, when the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices updated its flu vaccination recommendation to recommend that everyone 6 months and older should get the shot each year.
(Previously, the agency recommended the shot for a more limited group, including health care workers, pregnant women, people over 50, and those coming in contact with kids under 5.)
Since then, CDC data show that flu vaccination rates among adults have slowly ticked up a percentage point or so each year, from 40.5 percent during the 2010-2011 season, the year the universal recommendation took effect, to 43.6 percent in the 2014-2015 season.
Photo by 401(K) 2012 via Flickr Creative Commons
This summer, KPCC asked our audience members to share their childbirth costs with us. The effort was part of a project – called #PriceCheck – where we crowdsource the costs of certain medical procedures.
#PriceCheck has allowed us to see the wide variation in charges by hospitals and clinics, as well as in how much insurance covers. We hope that, by bringing transparency to these costs, the database has served as a resource for people who are trying to shop around for medical care.
On Monday, California's Department of Insurance unveiled a similar tool, called California Healthcare Compare. It lets consumers look up the costs of more than 100 medical procedures and conditions in their region. It also cracks a nut that #PriceCheck could not: For certain procedures, like childbirth and colon cancer screening, the website also includes quality information about the hospitals and medical groups providing care.
Take a selfie with your doctor. Once you've broken the ice, ask the awkward but critical questions about the cost of your care.
"How much is that going to cost me?"
That's the question we've been encouraging people to ask their doctors. It's part of an initiative that we're calling #JustAsk.
We understand that this is an awkward conversation to bring up with your doctor or his staff.
Most of us have little experience with this line of questioning: Traditionally, if people had insurance, they had pretty good insurance. They were more shielded from the costs of care, so they didn't need to ask these questions. But these days, more of us have higher deductibles, so price matters to us.
Doctors, meanwhile, were never taught to consider the cost of care. That's changing, as I recently reported. But given the intricacies of insurance, it's still really hard for doctors to know what a specific procedure will cost a particular patient.