Some American companies have embraced elements of it, such as price transparency and HSAs.

By George P. Shultz and Vidar Jorgensen, The Wall Street Journal

Does a real health-care market exist anywhere in the world? It certainly doesn’t in the U.S., where health-care providers don’t tell patients in advance about pricing, outcomes or alternatives. Consumers don’t know what they’re buying or how much it costs. And the costs are largely paid by insurance companies, which don’t spend their own money. With a health-care market this dysfunctional, little wonder the U.S. spends 18% of gross domestic product on health.

If the U.S. wants lower costs, better outcomes, faster innovation and universal access, it should look to the country that has the closest thing to a functioning health-care market: Singapore.

The city-state spends only 5% of GDP on medical care but has considerably better health outcomes than the U.S. Life expectancy in Singapore is 85.2 years, compared with 78.7 in the U.S. Singapore’s infant and maternal mortality rates are less than half the corresponding U.S. rates and rank among the lowest in the world.

What does Singapore do that’s so effective? A few things:

• Price transparency. All health-care providers in Singapore must post their prices and outcomes so buyers can judge the cost and quality.

• Health savings accounts. Singaporeans are required to fund HSAs through a system called MediSave and to purchase catastrophic health insurance. As a result, patients spend their own money on health care and get to pocket any savings.

• A limited but effective safety net. The MediFund program serves those who, after exhausting their health savings and government subsidies, still need help paying their bills.

The combination of transparency and financial incentives has led to price and quality competition so intense that health-care costs are 75% lower in Singapore than in the U.S. Scripps College economist Sean Flynn estimates a heart-valve replacement costs $12,500 in Singapore ($160,000 in the U.S.) and a knee replacement $13,000 ($40,000).

Singapore’s system of health-care finance shouldn’t seem foreign to Americans, nor should we doubt that it could work here. The U.S. has already seen that the combination of competition and price transparency can be successful: Witness the falling prices for Lasik and cosmetic surgery, which aren’t covered by insurance.

America also has HSAs—Congress authorized them in 2003—and one alternative model for U.S. health care would have employers and government provide everyone with a fully funded HSA. Consumers’ financial incentives would be aligned with keeping costs down, since this money would now be theirs—to spend on health care or to save for other purposes, such as retirement or giving to relatives.

U.S. transparency is improving, too. The Trump administration has put forward an executive order which would require insurers and providers to make price information available to beneficiaries, enrollees and participants in health-care plans. While this will take some time to implement, companies like MyMedicalShopper and Healthcare Bluebook have already “cracked the code,” finding secretly negotiated prices in the American market. People spending their own money can turn to them for the information they need to find value.

Key elements of the Singapore model can be implemented by U.S. employers right now without any additional legislation. Thanks to the Employee Retirement Income Security Act of 1974, employers have a fiduciary responsibility to know and justify the costs of health spending—just as they must for retirement funds. Erisa exempts health-insurance plans from various state- specific laws, allowing employers to adopt HSAs and self-insure. About 60% of U.S. covered workers are in self-funded plans subject to Erisa.

Rising prices and lackluster outcomes are already leading U.S. employers to drop large insurance networks. Instead, they’re contracting directly with providers via risk arrangements that hold providers accountable for fixed costs and guaranteed quality outcomes. Large employers can manage the financial risks of self-insurance, and smaller employers can purchase stop-loss insurance to cover large unanticipated expenses. Many employers who go to full self-insurance save 20% their first year and up to 40% by the fifth year with better outcomes and higher employee satisfaction.

Some employers with direct-contracting plans and their own on-site or shared near-site clinics, like Rosen Hotels and Resorts in Orlando, Fla., share some of the savings with their employees. As a result, Rosen has much higher employee satisfaction and retention rates than the best- known competing hotels.

Employers and employees can get better care and outcomes at a lower cost through direct contracting with centers of excellence—health systems and hospitals that offer exceptionally good or innovative care related to a particular expertise. Walmart, Lowe’s, and many other employers are using financial incentives to encourage their employees to undertake elective surgeries at centers of excellence like the Mayo and Cleveland clinics. Employers like these have found that when employees can get second opinions at these centers, a large share of the most expensive procedures aren’t medically necessary—including 50% of spine operations and 30% of hip and knee replacements. In these cases, less-expensive treatments yield superior results.

It has been well established by the RAND Health Insurance Experiment, the Dartmouth Atlas of Health Care and similar research that consumer involvement in price and treatment decisions results in savings and improved outcomes. New investments in digital health solutions are making market competition—facilitated by price and outcome transparency—increasingly achievable in America.

Let’s follow the path of Singapore, Rosen Hotels and Resorts, and Walmart by using markets and competition to make health care affordable for all while improving quality and innovation.

Mr. Shultz is a former U.S. secretary of state, labor and Treasury and a distinguished fellow at Stanford University’s Hoover Institution. Mr. Jorgensen is chairman of Cambridge Innovation Institute, World Congress and Validation Institute.

By Kaitlin Menza, mic.com

If you’re like me, and the numbers suggest you are, you have a money habit so shameful that it revisits you in the darkest times. You’re trying to fall asleep but then you remember it and start running numbers in your head; or worse, you’re out with friends enjoying a beautiful afternoon and then a little voice appears in your ear, reminding you that you don’t get to have a beautiful afternoon. We hide these habits or one-off mistakes from our friends and even significant others, but it’s hardest to hide them from ourselves.

Here’s mine: I never pay my medical bills.

They live in a beige linen tote bag stuffed under my dresser next to the blue Ikea bags I use for laundry. I never even open the bills. Of course, I cough up my card for co-pays or prescriptions in person, and I’m a freelancer who pays for her own insurance via an automatic bill pay. But it’s everything in the middle, all the exams and cultures and procedures, that don’t get paid. And what’s worse? Nothing ever happens. It feels like my negligence is never punished.

The deeply weird thing is, I have the money to pay them off. Not all at once, but I could set up payment plans, or dip into savings. There is at least one four-figure bill from the time I got stitches after falling off a bike during the summer of 2015, but otherwise most bills are under $250. The other weird thing is that I’m pretty good at paying all my other bills. Rent, utilities, credit card, cell phone and insurance bills are all automatically deducted from my checking account. It’s the medical ones I can’t abide.

Why do I do this, and what are the consequences and how do I stop?

I could spend a few hours in a therapist’s office figuring that one out, but then I still would have to pay the bill off — so I asked the experts instead.

When I confessed my habit to Mark Galvin, who founded MyMedicalShopper, he laughed out loud over the phone. “Believe me, you’re not alone. That’s almost standard,” he said. “That’s why they try to collect everything from you in the office before you leave. Today, 50% of hospitals’ bad debt is from fully insured patients.” Galvin’s company allows customers to choose and compare medical services based on price.

Psychologist Brad Klontz helps clients with financial denial, which is what he says I’m dealing with. “Our stress goes up and avoidance goes up the less we feel we have the knowledge or confidence in our ability to cope with the problem,” he explained. In this case, I am not confident in my ability to navigate the world of health insurance — I always feel like I’m being taken advantage of. Which isn’t surprising, he said, because dealing with the American health care system is absolutely maddening.

“In every other market, you made a commitment. When you drove the car off the lot, or when you placed your order on Amazon, you knew what the cost was going to be,” Galvin said. “The basis for all contract law is you have to have two parties, and they have to have a meeting of the minds. You agree to something. In health care, that doesn’t happen. You might not even know what they’re going to do to you or charge you for.”

Every time I open my tiny urban mail slot and spot a medical bill, the envelope is housing some creepy surprise. Was that urinalysis $9, or $90, or $900? Am I meant to fight back?

I once received a bill for my “well-woman visit,” or the gynecological exam that women are encouraged to have annually. I was charged for each aspect of the exam, including the STD tests — even though I was pretty sure Obamacare resolved that well-woman visits were covered entirely by insurance. There was one final insult: my doctor charged $5 for the lubricant she used before she inserted tools inside me. Talk about a violation. I felt disgusted, angry, and worst of all, stupid.

My doctor charged $5 for the lubricant she used before she inserted tools inside me.

Klontz likens opening a medical bill to spinning a roulette wheel, but he has another metaphor for the experience. “The snakebite bias: If you stick your hand in a hole and get bitten by a snake, you are afraid to stick your hand in the hole again. One bill may have overwhelmed you, and you don’t want that experience again.” Who wants to feel stupid, poor, cheap and angry? Not me. So my solution? I don’t open them.

But surely there must be consequences. If I didn’t pay rent, I’d be evicted; if I didn’t make my car payments, the vehicle would be repossessed. Medical debt’s consequences are less tangible.

“It can trash your credit rating. You’re probably getting badgered with phone calls from collection agencies, or you don’t answer 800 numbers when you see them,” Galvin said. “You might get some collections activities in the mail. Eventually, there will be bad marks on your credit report.” While your credit score is important, it’s not top of mind for me right now, especially because I’m not currently trying to buy or rent a home. And on the rare occasion I’ve opened one of the envelopes from a debt collector, I noticed interest wasn’t being added to the original bill.

I worry, though, that my delinquency impacts the health care costs of others: that if I don’t pay, they raise the rates on everyone to make up for me and people like me.

“If you’re insured and you don’t pay, the loss is on the provider. It doesn’t impact your peers,” Galvin reassured me. “There is some claim that hospitals, specifically, raise the rates on those who pay to cover the costs of those who don’t. There’s some truth to that, but it’s way over-simplified by the hospitals.”

It seems that the person I’m most screwing over is myself. It’s my stress level at the sight of that overstuffed tote bag, and my financial future, that I have to deal with. So I do. A week ago, I poured a tall glass of water, cranked up the AC, and sat down with the tote bag and my debit card. After moving some money over from my savings account, I opened the envelopes one by one and paid, and paid, and paid. Most were under $100, and one was exactly $8.04. I could, indeed, afford to pay them off in an afternoon, for which I am extremely lucky. After about an hour of this, I realized that about 90% of the envelopes were different notices for the same few charges. I only had to pay off a few to fly through the entire pile.

I had been afraid to call the debt collectors — then they’d know I’m a real person — but the bored voices on the other end of the line didn’t reprimand me. They sounded bored. They do this all day.

And when I was done? I felt like I could lift a car. My ears started ringing like I had just bungee-jumped, or spoken to a crowd of thousands. I had conquered a fear, and fixed one overwhelming aspect of my finances in about an hour. Now I can return to just fearing illness itself, instead of the mail that follows.

This article originally appeared on mic.com: Money Confession: I never pay my medical bills

Health plans’ pricing structures have largely remained hidden behind labyrinth-like agreements with health systems.

Boston, February 11, 2020 –MyMedicalShopper’s products are designed to offer a simplified tool that presents various costs for medical procedures. This tool can be used by employees to search for and compare prices from a range of providers that offer a certain service. MyMedicalShopper’s solution is a healthcare comparison shopping tool that shows users price estimates based on actual prices paid using medical claims.

This Impact Brief highlights MMS’ key functionalities, its roadmap for the next two years, and Aite Group’s opinion and outlook on price transparency.

Clients of Aite Group’s Health Insurance service can download this 11-page Impact Brief. To learn more about the topic covered in this Impact Brief, please contact Aite at info@aitegroup.com.

LITTLE ROCK, Ark. – In his State of the Union address Tuesday night, President Trump called for more affordable and transparent health care costs.

Arkansas is one step ahead of him.

“It’s a small step, but I think it’s an important first step toward unlocking the black box and having us all be able to understand how the health care system works and what it’s going to cost us both in the short term and the long term,” said Dr. Joe Thompson, the president and CEO of the Arkansas Center for Health Improvement (ACHI).

The federal government required hospitals to start posting their charges online Jan. 1.

“The information itself is not that useful for most consumers because what’s charged is usually not what’s paid,” Thomspson said.

The actual payment depends on a negotiation between the hospital and the insurance carrier, and also the design of the patient’s health plan.

Another website recently started to break down the average payment rates for different procedures in hospitals across the state.

“It will stimulate a conversation between the patient and their physician about what procedures are needed, how important they are and where to go to get the best procedure done,” Thompson said.

State lawmakers approved the Arkansas Health Care Transparency Initiative three years ago. Under the insurance commissioner’s authority, ACHI developed the state’s all-payer claims database. It tracks paid claims by insurance carriers.

A company based in New Hampshire, My Medical Shopper, applied to use the data.

“There has been anxiety about putting new, real information out on what health care costs, to actually shine the light inside the black box,” Thompson said. “Health insurance carriers are concerned, hospitals and providers are concerned.”

Hospitals in the area told KARK they plan to continue to “provide quality, compassionate care to all our patients in the most cost efficient manner possible.” They also said patients can call the hospital’s financial counselors for specific and personalized information.

To register for free to access the data on My Medical Shopper, click here.

“Users of our platform, which is accessible through our website as well as easy-to-use mobile applications, can find price estimates that reflect the insurance-negotiated discounts for thousands of medical tests and procedures before they seek care, rather than falling victim to surprise medical bills weeks or months after the care has already been received,” said Christopher Matrumalo, My Medical Shopper’s VP of Marketing. “We sought to work with ACHI because their Transparency Initiative’s stated goal is ‘to empower Arkansans to drive, deliver, and seek out value in the health system.’ We have found ACHI to be committed to this goal in practice, and we believe that our collaboration has introduced a powerful new dynamic to the healthcare marketplace in Arkansas.”

The website is the first of many that could make data like this available to Arkansas consumers. Thompson said other commercial entities and researchers have applied to gain access to the state’s all-payer claims database.

An advisory board reviews the applications to make sure there would be a benefit to Arkansans. The insurance commissioner ultimately approves the use, and ACHI provides the data to them.

According to the All-Payer Claims Database Council, 21 states have an existing database, 15 of them, including Arkansas, require submissions. Five other states are in the process of implementing one, and others are strongly considering it.