Dr. Andy

Reflections on medicine and biology among other things

Thursday, January 19, 2006

Paying for healthcare - I

Why is healthcare so expensive and inefficient? Because no one knows or cares how much it costs. Seriously.

This struck home with me recently when I picked up a prescription for my daughter. She has eczema and has been on a low-potency topical steroid. A couple times I've picked up the medicine and dutifully paid a $10 copayment.

The eczema was a bit worse, so wrote a script for a bit more potent steroid to try to get it under control. I went to pick it up and the copay was only $2. I asked why and discovered it was because the medicine is only $10.75 to start so the insurance company picks up most of it.

Now I prescribe these kinds of medicines for kids with eczema everyday. And I had no idea that one (triamcinalone) was cheaper than the other (desonide). No patient has ever asked me if the medicine I suggest is the cheapest available, they just assume I'll pick the best one. And all the steroid cremes work about the same (given that there are various potencies) so there isn't much difference.

Think about it. I know roughly how much I 'll spend on any given restaurant. McDonalds with the kids about $14. Wendy's a buck or two cheaper. Pizza for the whole family is about $20. Chinese $40-50. Sushi runs $60-80, etc. But I have no idea how much these creams and ointments cost, either as a consumer or prescriber.

To get health care costs under control, consumers will have to know and care what things like steroid creams cost.


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