Tools for comparing costs between different healthcare providers?
"There really isn't any good ways that I'm aware of. (The exception is in New York or California, where hospitals must post prices.) The law sets price floors on many procedures by setting Medicare and Medicaid reimbursement rates. As a result, the ""list price"" for a given procedure is dramatically inflated, and various health insurers negotiate rates somewhere in the middle. I'd recommend talking to the business offices or financial counselors at medical groups that you do business with. Ask about ""self pay discounts"" or other programs appropriate for folks in your position." When I had a high-deductible healthcare plan, I used http://www.ehealthinsurance.com/ to do comparisons among the plans.  As far as comparing the costs of specific procedures across providers, I'm not aware of any good ways either.
A competent Indian VA cost about 4-6 an hour. Realistically speaking, with that budget, nobody is going to be on the phone 8 hours a day 5 days a week. But small tasks and data entry could work. Western VAs are a much pricer but they you can find some for 200 a month. I have a biz that offers similar services, but the price you are looking for is a bit low, but I can work something out if your interested. Otherwise, it would be best to search for NYC based VA companies that have a team of indians working. But what you get is a luck of the draw. If you are disputing the size of the charge for specific services, like you think that they overcharged for lab work, you can try disputing it with the business office staff at the doctor's office. If, on the other hand, you just think that the overall bill is too expensive then you really only have one option. You can ask if they will reduce the bill for you. Most hospitals and clinics I've dealt with have programs set up for this, but you usually access them by filling out paperwork demonstrating financial hardship (along with supporting documents). It never hurts to ask. But with the services already rendered the only person with an interest in reducing the bill is you. The reduction, if any, will probably depend on what the clinic thinks your ability to pay is compared with the cost to them of pursuing you for payment, as well as the amount of funding they have for bill reduction. When I worked in the financial services office of a hospital a $400 bill would not even have been reviewed for discounting-- the balance would be too low to devote staff time to reviewing. It's frustrating, and even asking in advance might not have given you accurate (or any!) information on what the cost of the visit would be, so your ability to shop around is limited. Unfortunately, that doesn't give you any additional options in this case. If the hospital is run like hospitals in the US it can take a long time just to determine the bill. The hospital, Emergency room, ER doctors, surgeons, anesthesiologists, X-Ray department, pharmacy and laboratory are considered separate billing centers. It  can take a while to determine the charges for each section. Is there an insurance company involved? When there is one involved it can take weeks or months before the hospital determines what the individual owes. The co-pays, coverages, and limits can be very confusing. In my experience it can take a few months before the final amount is known. You may want to call the hospital to determine the status of the bills. I would suggest that you try ClearCheckbook.  It is kind of like Mint, but you can add and remove things (graphs, features, modules) to make it as simple or diverse as you need it to be.  It should be a workable solution for simply tracking both income and expenses, yet it will also provide extra features as needed. There is a free option as well as a paid option with added features.  I have not used ClearCheckbook before, but according to their features page it looks like you may have to upgrade to the paid option if you want to have complete tagging/custom field flexibility. "Yes, you've successfully proved that I think NPV and marginal utility are the same thing.  Let me state this explicitly. You didn't hesitate to throw out tools that don't agree with your prescriptions. You invoked the false premise that indivuduals manually and exhaustively calculate NPV of possible decisions. Instead of refuting the points of the argument you resorted to personal attacks. That's fine, I've already lowered my expectations after reading your first comment.  If NPV should be thrown out because you claim noone explictly uses it to guide their decisions what does that say about marginal utility? Why should 1 tool be thrown out but the other kept?  Essentially you are saying we should keep all of the tools that confirm your absurd assertions and throw out the tools that may cast doubt on them.  But hey, maybe I should ""stop acting like I know what I'm talking about""" Hey, I was thinking back to that X-Ray you got done at the hospital, that you said was cheaper than 90% of the population. I am wondering if maybe that hospital wasn't one of the many that qualify for DSH reimbursement payments. What could have happened is that they saw that you are uninsured, and made a decision that they would only charge you for the portion that they didn't think Medicare / Medicaid would reimburse. If that happened, it wouldn't even show up on your credit report, as the hospital is the one that would file a credit claim. Likely, if they have to go through this a lot, they wouldn't even waste time filing a credit claim, they would just go after a reimbursement through Medicare / Medicaid. And thus, to you, it would just look like a very small bill, but in reality it would only represent a smaller portion of the true bill.   I would also wonder, if they do a lot of these, if they aren't also one of the hospitals that article I linked to showed was super-inflating the prices of uninsured in the hopes of getting a larger portion reimbursed. Keep in mind there are some examples of combination medications that have improved outcomes. I'm thinking specifically of HIV meds, HEP C medications, and other combo meds for infectious disease.  Truvada for example. It's one pill. Emtricitibine and tenofovir. Taken alone emtricitibine and tenofovir have complex and tedious pill regimens (like most other HIV meds regimens) but for patients to be able to take one pill, once a day has made their compliance with the med regimen much better. Lower viral load, higher cd4 counts, and improved management of their HIV.   I'm not saying the absurd price hikes of these other meds are warranted. They're not. But when dealing with public health issues, and infectious disease in a population that has a difficult time being compliant with their meds, combo meds are worth the cost. Determining the value of a service is an art, not a science. It depends on what others are charging, the quality and complexity and annoyance factor of the work, availability of people with the skill to do the work, etc. This topic can and does fill books, plural, and can't be answered fully here. As a customer, the answer is to get multiple quotes, understand how they differ, and pick the one you are most comfortable with. Last job I priced, I got three quotes, discarded the lowball who didn't know PT from cedar, discarded the one with the luxury price, and went with the guy in the middle who did adequate (not great) work for a tolerable fee. For a different kind of job I might have decided otherwise, or chucked all three and looked for more quotes from respected firms. CrimsonX did a great job highlighting the primary pros and cons of HSAs, so I won't go into detail there. However, I did want to point out another pro - HSAs are (or can be) easy to manage. You said: Is this a better way to approach health care costs instead of itemizing health care expenses on yearly federal taxes? I'm not sure which company you are looking at establishing your HSA with, but with mine I have a debit card that I use when paying for medical care and then at the end of the year I get a 1099-SA that provides the amount of money spent on qualified purchases that calendar year. Yes, there are a few extra boxes I need to fill in for my 1040 come tax time, but I don't need to itemize my healthcare costs over the year. It really is pretty simple and straightforward. Also, one con that is worth noting is that you become much more sensitive to healthcare costs due to the high deductible healthcare plan an HSA requires. For example, in all the years we've had an HSA we've not yet met our deductible, which means we pay out of pocket for any non-routine doctor visits. (The health insurer pays 100% of routine visits, like my wife's annual, well-baby check ups for the little one, and so on.) So, when you're feeling really sick and think a doctor's visit would be warranted, you have to make a decision: After being faced with this decision a time or two you will start to envy those who have just a $20 copay! Of course, that's just an emotional con. Each year I run the numbers on how much we spent per year on out of pocket plus premiums and compare it to what it would cost in premiums for an HMO-type plan, and the HSA plan always comes ahead. (In part because we are a pretty healthy family and I work for myself so do not get to enjoy group discount rates.) But I thought it worth mentioning because there are certainly times when I know I need to see a doctor or specialist and I cringe because I know I am going to be slapped with a big bill in the not too distant future! "Lets put glib non-answers into perspective.   - There is not a single number: how many wounds. Then, dividing the total per this value, you'd know a bit more.   - They are generous in a lot of other percentages which, of course, mean crap without this. 5.8% of what? Is that 5 people shot, or 50000?   - The % of people without insurance is interesting, but a far more interesting value would be: X of the value is uninsured, in Y of the wounds. Then you'd know whether uninsured wounds are costlier on average.   - There is a 20 to 1 differential in 5000 to 100 000. Doesn't really tell us either average or median.   - What cost is accounted? Cost first billed? Values actually paid? Accounting cost of the actual care? Same price measure for the ones insured, and the ones uninsured? A standardized cost per types of wounds? If an hospital charges 100000 for the same another asks 20000 for, its meaningless. Societal cost is one thing, the billing fantasies of the american health system another.  If you fail to understand what is contained in what you read, and then again fail to understand when it is pointed out, then you do waste a lot of resources.  For those that CAN read, you can see how a full article can be read and published that contains no real information or original thought or research about a problem, being useless to define it. Its a ""feel this"" piece, knowledge is optional." I'm not disputing that. I just said in answer to the guy pointing out that indonesian people earn less that this price might be higher than what the locals pay. Often hospitals will have higher prices for foreigners with insurance etc. So I was actually strengthening your point. It is meant to be a Valuation Model. So the data I have collected are for the Addressable Markets in potential countries( i.e. population currently affected by the disease and potential growth of the disease in the future). Possible competition for the drug. And most importantly the expenses of the drug (how much it cost to create the drug and clinical trails etc.) I need to create a Revenue chart and the Pricing for the drug as well. What I am looking for is someone who is familiar with creating a valuation model or has a template and can give me advice on how to structure this. thanks. "I had a similar issue take place at a hospital when the repeatedly billed the ""wrong me"" -- a stale insurance record left behind from when I was a dependent on my parent's insurance a decade earlier. They ended up billing me for anesthesia when I had a major surgery (everything else was billed to the correct insurance.) The outsourced billing people were pretty unhelpful (not usually the case with hospitals), so I became the squeaky wheel. I sent certified letters, had my priest rattle the cage (it was a Catholic hospital) and eventually talked myself into a meeting with the VP of Finance, who started paying attention when the incompetence of his folks became apparent. Total cost: $0 + my time." "Whoa whoa whoa, let's not twist that data and make an assertion that it doesn't support. Yes, medical inflation has outpaced the CPI for ages, *but* when you disaggregate spending into Medicare (US single-payer) and private insurers, [Medicare is able to better contain costs](http://content.healthaffairs.org/content/22/2/230.full) (my hypothesis: likely due to its ability to leverage its scale and keep costs low, while private insurers are fragmented against strong provider networks).   But wait! you're thinking: shouldn't market forces keep insurance outlays low? It's Econ 101, right? Theoretically they should, but this ignores the industrial structure of healthcare providers and assumes perfect competition that doesn't exist. Typically, providers (doctors groups, hospitals, etc) are [highly localized and able to exercise significant market power in a community](http://content.healthaffairs.org/content/23/2/8.full) relative to several insurance plans who are competing to contract that provider ""in-network."" For example, when Aetna, Cigna, and BCBS go up against, hypothetically, Cedars-Sinai to negotiate payment rates, Cedars has the ability to obtain high reimbursement rates because the three insurers have to have that provider in-network to remain competitive. Ironically, the less competition on the insurer side in that market, the better reimbursement rates would be observed since the sole insurer would capture a large fraction of patients in the geographic area served and could use that volume to negotiate better rates.  Finally, there's the overhead issue. Medicare has lower overhead expenses than private insurers do (again, my guess: greater economies of scale and lower advertising and marketing costs, coupled with no profit motive). [Even health insureres themselves agree (.pdf warning)](http://www.cahi.org/cahi_contents/resources/pdf/CAHI_Medicare_Admin_Final_Publication.pdf) that Medicare has lower overhead costs, and that includes some questionable addition of what the authors claim are hidden Medicare expenses.  I'm inclined to believe that a single-payer is probably more efficient and cheaper than a fragmented private insurance market. That said, I also find some sympathy to the argument that maintaining a robust private insurance market may spur innovation on payor innovation (e.g., increased participation in wellness programs for enrollees, or increasing the likelihood that patients be more sensitive to costs and benefits when seeking care). After all, countries like Germany and Switzerland are able to maintain a private insurance market while ensuring nearly universal coverage. Either way, though, arguing that health inflation alone makes single payer systems ""mathematicaly unsustainable"" isn't a strong argument, since private insurers are currently doing **worse** on cost containment." On topic of Healthcare needs, I think it depend on individual.  For example, my employer's dental plan offer PPO $34 per month and DMO $12 per month. I have my favor dentist that I have been going for years. He only accept PPO. I already had most of my dental works done so I only use him for teeth clean. He charge $100 without insurance and free with insurance. I can only use my insurance for teeth clean twice a year so $34x12 = $408 vs $200. If I go with DMO, I won't get to see my doctor and since I get my teeth once a year why not just save that money and go to my favor doctor instead the DMO doctors and if I need major dental works done which isn't immediate. I can go to Taiwan for dental works that is way cheaper than U.S.  I think if you're a healthy young man/women. You should put more money toward your retirement and only keep insurance for emergency. You can do a medical tourism mentioned in 60 minutes that can be more cost effective and those doctors are U.S. trained.  For older folks, a full Health care insurance is more needed than retirement. Just my two cents.