Helping make the health care system work for you

How much should a vasectomy cost?

Filling out the forms is part of the ritual of going to the doctor. But with the Affordable Care Act, it's more complicated.

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Vasectomies have traditionally been covered by insurance. But they're not included under the Affordable Care Act's contraception mandate, according to the Guttmacher Institute.

In this great episode of the WNYC podcast Death, Sex and Money, blogger and stay-at-home dad Clint Greagen describes how he made the decision to get a vasectomy.

Greagen tells host Anna Sale that his wife brought up the idea of a vasectomy when she was pregnant with their fourth – and final – son. He agreed to do it, but:

"It was probably about two years after we first brought it up before I actually got into gear and got the job done."

His decision

He explains why he hesitated:

"…the two biggest things I worried about was all the inspections that had to go on with my genitals in front of other people, and the second thing was actually having my genitals pierced by sharp objects."

Another reason, he tells Sale, was the knowledge that he wouldn't be able to father any more kids:

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Does 'futile' care needlessly clog the ICU?

Hospitals need to cut patient load

Tim Samoff/Flickr Creative Commons

Over a three month period, 11 percent of ICU patients received futile care, according to a new journal article.

If a patient in the intensive care unit is receiving futile care, can that hurt another patient’s chances of getting needed treatment? In the journal Critical Care Medicine, researchers from UCLA and RAND Health conclude: Yes.

"Virtually no one worries that health resources that get used in one area, might be affecting the treatment that others receive, and this is a sort of fact check," Dr. Neil Wenger, a professor at UCLA's David Geffen School of Medicine and one of the article's authors, tells Impatient.

"The reality of the situation is that for treatments that many people really need and most people want, there can be limitations," he continues. "One of the limitations is when the treatments are used ineffectively."

Futile care

Before we dive into this debate, let's back up. What's futile care, anyway?

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Next up for #PriceCheck: IUDs (and vasectomies!)

IUD

+mara/Flickr Creative Commons

Next up in our #PriceCheck project, we're crowdsourcing the cost of something a little more private: IUDs and vasectomies.

Next up in our #PriceCheck project, we're crowdsourcing the cost of something a little more… private: Intrauterine devices, or IUDs.

This small, T-shaped device is inserted into a woman's uterus to prevent pregnancy, and can last there for seven years to more than a decade. (Men, feel free to submit your costs for an even longer-lasting form of birth control: Vasectomies.)

Why IUDs?

Sheri Bonner, president and CEO of Planned Parenthood in Pasadena and the San Gabriel Valley, tells me this form of birth control is becoming more popular.

About 5 percent of her patients get IUDs. That lines up with figures in a recent Guttmacher Institute report, which found that about 5.6 percent of contraception users chose IUDs in 2010.

The IUD got a bad reputation in past decades due to concerns about pelvic inflammatory disease. But, Bonner says, the devices on the market now - the copper ParaGard and the hormonal Mirena – "are light years away from that and extremely safe."

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Doctor's orders: The value of comparing drug prices

Mercer 6423

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"You forgot to tell me the biggest side effect of my medication," Dr. Sharon Orrange recalls a patient telling her: "The cost."

Dr. Sharon Orrange recently heard me on KPCC's AirTalk discussing the wide variation in the cost of back MRIs, as part of our #PriceCheck collaboration.

Orrange, an internist at the Keck USC School of Medicine, reached out to me via e-mail to say that the lack of transparency with imaging costs is similar to what's happening with the cost of prescription drugs. 

I was intrigued. I recently read that one California hospital charged $10 for a blood cholesterol test, while another charged over 1,000 times more. But I didn't know the price craziness extended to prescription drugs.

Price problems

Orrange and I recently spoke by phone. Traditionally, she told me, doctors have been "abysmal" at talking to patients about the cost of the drugs they're prescribing. And patients, she said, were embarrassed to ask about the price.

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Did your newborn get a Vitamin K injection?

Rebecca Plevin/KPCC

South Coast Midwifery and Women's Health Care gives parents the option of choosing the Vitamin K injection for their newborn, oral Vitamin K drops, or foregoing Vitamin K all together.

Rebecca Plevin/KPCC

Dr. Valencia Walker checks on an infant in the neonatal intensive care unit at UCLA hospital in Santa Monica.


Parents, did you provide your newborn with the Vitamin K injection?

As I report today, doctors have given this shot for decades. They say it's extremely effective at preventing spontaneous bleeding, which can cause severe problems and even death.

I met Dr. Valencia Walker, a neonatologist and assistant clinical professor at the David Geffen School of Medicine at UCLA, who recommends the shot for all of her patients.

"When you look at something like a one-time shot, versus having a baby that can die from something that is completely preventable… that's why we do the Vitamin K injection for all of our babies," Walker says.

Refusing the shot

But a small number of parents are refusing the shot. It's hard to know how many people are turning it down. The Centers for Disease Control and Prevention says the information is not tracked by any agency at the county, state or national level.

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