Show HN: I mapped US medical prices. Save thousands by driving a few miles

http://www.bestmedicareprice.com/

by neilsharma • 13 years ago

488 222 13 years ago

bestmedicareprice.com

ebaum• 13 years ago

interesting idea. cant wait to see what happens next

ocfx• 13 years ago

Interesting data, but good to note that cheap does not equate with better in the medical field typically.

jaibot• 13 years ago

Is there evidence of correlation?

ajiang2• 13 years ago

The next step would be to bring in death/complication statistics by hospital and ratings by surgeon

codex• 13 years ago

If you were a doctor, would you rather charge more, or less? What keeps you from charging the highest fees in the world? Your reputation. If you're not the best, you cannot charge the most. All of capitalism works this way.

dshankar• 13 years ago

This has enormous impact by bringing transparency to medical procedure pricing. One could quite literally save $10-50K by opting to do a procedure just a few miles away.

Nice work. Where did you get the data for this? Is it publicly available?

ajiang2• 13 years ago

This looks like DRG data by hospital released a few months ago by CMS, so what the hospitals bill for to Medicare, although the actual payments are set by CMS. Still, charge master data is the starting point for people not on Medicare/Medicaid

neilsharma15• 13 years ago

Thanks. Yeah, a lot of people travel abroad to save money, but its possible to find comparable prices nearby too. Patients aren't trained to shop around with procedures though.

The Obama Administration has tried to make pricing more transparent--this particular data set is publicly available. Here it is: https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta...

toomuchtodo5• 13 years ago

As someone with a disabled mother on medicaid (whom I spend tens of thousands of dollars a year on for prescriptions and care), thank you.

doorty• 13 years ago

Great first step. And pretty soon we'll have quality of care reviews--from patient questionnaires thanks to ACA/Obama Care.

neilsharma15• 13 years ago

I'm anxious to see those reviews. Quality of care is highly subjective and difficult to measure. Patient reviews are probably the best thing, but may be skewed on short-term or trivial aspects of the treatment, like how nice a doctor is or the wait-time. It'd need to be more on how a patient recovers over a 3, 6, etc. month period and whether or not they need to be re-treated

27182818284• 13 years ago

Great work! Keep it up!

dice• 13 years ago

What do the numbers and colors of the hospital symbols mean? They do not seem to be correlated with price of procedure.

neilsharma15• 13 years ago

The price number in the marker is the average cost of the selected procedure at the hospital at that location.

A green marker means its the cheapest price within the map's boundaries. Red means its the most expensive.

Thanks, I will make that more clear

enra• 13 years ago

Saw this couple of weeks ago http://pricemaps.betterdoctor.com/

neilsharma15• 13 years ago

Thanks for the link--haven't seen this. I think they use a different data set for the procedure prices, but I like how they also compare it to a quality ranking. I will look more into how US News quantified hospital scores.

What I think matters most for healthcare is not just price, but quality/cost. Quality is difficult to measure, but should factor in recovery speed, number of repeat-procedures, service, etc.

hotloo10• 13 years ago

Thanks!

I think, when are showing some numbers, it looks much more perceivable when you have something to compare to, in our case, the top hospitals ranking from the US News.

Some more work will mostly likely be done soon to enrich the data we are showing.

carbocation2• 13 years ago

Interesting. The prices listed by this tool are very different from the prices listed in the tool in this Show HN post. I wonder how their data differ?

hotloo10• 13 years ago

Hi!

I went back and checked the data. If you search for chest pain, and look at Cedar-Sinai Medical Center around Santa Monica,

we are showing this piece of information.

313 - CHEST PAIN,50625,CEDARS-SINAI MEDICAL CENTER,8700 BEVERLY BLVD,LOS ANGELES,CA,90048,CA - Los Angeles,229,43714.62445,5094.71179

In the PriceMaps we made, we are showing the last value, which is the 'Average Total Payments' for the operation.

Not exactly sure if the site mentioned in the HN is using the same data.

johngrefe2• 13 years ago

So freaking cool.

hardwaresofton• 13 years ago

This is fantastic, clear, concise, and helpful, with a simple UI.

neilsharma15• 13 years ago

Thanks! The goal was to shed some light on price discrepancies within the US, and not just the US vs other countries.

awjr• 13 years ago

Would it be useful to have a 'show me the cheapest' button? The range in cost hints at the massive variance. The US is crazy. How does a procedure costing 4k in one place cost 120k in another?

greyfade• 13 years ago

It doesn't. The price is set by a Chargemaster list that is drawn up by a committee. Hospitals are free to charge whatever they want above that, without any downward market forces.

Paying more sometimes means better outpatient treatment (and sometimes lower readmittance rates), but it's not a guarantor.

neilsharma15• 13 years ago

Thanks for the feedback. My next goal is to look more into why the price varies so much.

The price spread is pretty crazy. Some hospitals have higher fixed costs or salaries depending on the geography. Also, if a hospital is more research-oriented, R&D funds are normally tacked onto the price (one of the reasons why Stanford's Hospital is really expensive).

It's hard to find quantifiable data on the breakdown of bills, but based on a great article in Time a few months ago, prices are almost entirely arbitrarily defined: http://swampland.time.com/2013/05/08/an-end-to-medical-billi...

refurb12• 13 years ago

The cost adjustments you're talking about are MS-DRG adjustments (the amount the hospital actually gets paid by CMS). From what I can gather, the numbers on the website, are cost numbers, i.e. what the hospital tells CMS it costs them (which is a number they are free to make whatever).

If you want to know why costs vary so much, starting looking at reimbursement. Hospitals are incentivized to raise their list prices because many of them are paid a set percentage.

dougmccune2• 13 years ago

What's the consumer use for this? Is it for people without insurance? From what I understand this is the rate that Medicare has negotiated from these providers. But I assume this isn't for people with Medicare, since those people are covered with Medicare. I assume the dollar values don't have much relation to the reality that an uninsured individual would be billed, since Medicare negotiates pretty aggressively for prices that "normal" people or even normal insurance plans can't get.

I'm just not understanding what you learn from this other than what Medicare gets reimbursed. And I'm not understanding how knowing that is actionable in any way for the average person.

npalli2• 13 years ago

Even with insurance your coinsurance could be up to 20%. So, for complex procedures, it is very useful to see if you can get it done some place cheaper. First example of intracranial hemorrhage, price ranges from $9,540 - $234,913. Certainly gives a lot of input to make an appropriate decision. Very unlikely that without medicare negotiation, prices will magically converge to some middle point for all of them.

refurb12• 13 years ago

The issue is that if you have insurance, you're not paying the charge master rate or the Medicare rate, you're paying the negotiated (and likely non-public) rate for your insurer. The 20% co-insurance you pay is based on the negotiated rate.

stevenbedrick• 13 years ago

Your point is a good one, but maybe a different procedure would be a better example- most people suffering from an intracranial hemorrhage aren't in a position to do a whole of of comparison shopping on where to have it taken care of.

aestra6• 13 years ago

Doesn't mean too much actually. Insurance companies have their own negotiated prices that are lower than that.

crazy1van• 13 years ago

Who cares? My insurance co-pay is the same either way, which is exactly the problem. There is zero incentive to shop on price.

Btw, nice work :)

sbashyal• 13 years ago

Yes, in the short term. But in the long term, your insurance premiums are decided based on the cost of your health care. So if everyone spent wisely, the premiums would go down or stop rocketing the way they have been.

neilsharma15• 13 years ago

True, but because you don't foot the bill aside from a relatively small co-pay, hospitals/insurance companies can get by charging more and more. This ruins it for the ~50M Americans who don't have insurance.

We'll see how Obamacare deals with it though.

MJR2• 13 years ago

You have a PPO plan so you pay a copay. Many people have HSA, High Deductible or Catastrophic plans where they pay out of pocket until their hit their deductible. So all of these people have an incentive to shop on price. You're just choosing to pay more in premiums for the benefit of not having to worry about the costs for care.

But this tool only includes Medicare data so it doesn't apply to any of those cases we just mentioned.

sehugg• 13 years ago

Pretty cool. You could also fly to Costa Rica, if you have the time...

toomuchtodo5• 13 years ago

Cozumel/Playda Del Carmen has a significant medical tourism industry as well (dental included!). Half the price vs the US.

hotloo10• 13 years ago

Nice!

Me and my friend Anders made a bit better version of this, at

http://pricemaps.betterdoctor.com/#/

Check it out!

maxerickson• 13 years ago

Major joint replacement is much cheaper than Major Joint Replacement.

hotloo10• 13 years ago

Yes, that was a bug.

They actually correspond to two different slugs in our database. One that has higher price is pointed to the more complicated procedures that involved multiple complications, while the other one is simpler procedure without any complications.

rexec2• 13 years ago

We did a similar thing at BetterDoctor a few weeks ago:

http://pricemaps.betterdoctor.com/

neilsharma15• 13 years ago

Cool! Did you get the data from: http://health.usnews.com/best-hospitals/rankings

I'd love to talk more about how this can be taken to the next step. Can't find your contact info in your profile--mind pinging me at: neilsharma101 at gmail dot com

hotloo10• 13 years ago

Yep.

We tried to compare the hospital quality with the prices.

keeptrying• 13 years ago

Why don't you make it an app and give it to each doctor to give to patients?

rexec2• 13 years ago

That's an interesting idea.

mehuln• 13 years ago

Example of very useful and transparent system that should be available for everyone. Keep going in this direction...

727374• 13 years ago

This is great. Please sort the items in the drop down list. (I'm on Chrome)

shill• 13 years ago

You really should warn users to find the NEAREST hospital when they are having chest pain--which is one of the procedure selections.

Disclaimer: I am not a lawyer or a doctor.

markdown• 13 years ago

Then they save your life. A week later, you receive the bill and the resulting heart attack kills you.

msane• 13 years ago

Heroic sir.

rtfeldman• 13 years ago

Brilliant! Great work.

auctiontheory4• 13 years ago

Excellent POC - Obamacare needs to pick this up and run with it, to provide the next level of detail, for all insurers.

Can you tell us about the technology under the hood? Ruby or Node (or whatever)? What APIs did you use? Programming-wise, what was easy and what turned out to be tricky?

neilsharma15• 13 years ago

Hey. The technology i used focused on speed of deployment. My DB and "backend" is all parse (I don't have a traditional backend). My hosting service is site44, which is simple dropbox hosting so i don't have to setup a server. The rest of it is just js/html/less files. I used bootstrap for the styling and jquery/google maps API for everything else.

I did do some pre-processing on the data in python to geocode the locations (ie: change the street addresses to long/lat coordinates). I used geopy to do that, and pandas to manage the data.

The total product took me three days to build and design

benmathes• 13 years ago

Incredibly useful if you're on medicare (what the price data is based on).

For the majority of us _not_ on medicare, castlighthealth.com is solving this. It's B2B for now, i.e. Tesla pays for castlight and then its employees can use castlight to find out how much things will cost.

Splendor4• 13 years ago

I just met with Castlight this week. They have a really slick tool. Other companies like Change Healthcare and Healthcare Blue Book are trying to solve the problem too (with their own B2B solutions).

novalis786• 13 years ago

..and pricepain.com

MJR2• 13 years ago

These are called cost and quality or transparency tools in the industry.

Many insurance companies have tools that can do this exact thing for their members AND apply it to your specific plan at the time of the inquiry. So you can choose based on the procedure cost and your actual cost based on your deductible and co-insurance. Not only that, the tools will also tell you about quality so you can compare based on the quality of service, cost of service and your actual cost at the same time.

Unless you can do all of these things at the same time with your tool, it leaves out critical factors for those actually searching for this type of information as it applies to them at any given time - most importantly when they are trying to make a decision.

Additionally, you only have access to negotiated rates for Medicare whereas an insurance company providing this information is going to provide as much information as they can for all of their members by displaying their negotiated rates specific to your plan.

As an HN reader, if you like this tool, go check with your insurance company and see what they already have and how specific it is for you.

Splendor4• 13 years ago

This is important. Contracted network discounts may not align with Medicare reimbursement rates for providers so if you have insurance through a network you should look for a tool that can compare in-network rates for your plan as MJR suggests.

bartcatz• 13 years ago

I picked one (Heart Failure with Shock with MCC) at random

http://www.cms.gov/icd10manual/fullcode_cms/P0136.html

the link shows all the diagnoses that fall in that category of DRGs. (DRGs are the packages of procedures that Medicare pays a fixed price for, simply put. If you get that diagnosis, you submit that DRG. However in this case the map from diagnosis to DRG is one to many.) Some of the average costs are only from 20-30 discharges. Do you think that makes for good math or some sort of price guide?

https://en.wikipedia.org/wiki/Diagnosis-related_group

It may highlight that the DRG is incorrectly applied by some hospitals (maybe?), but it has nothing to do with 'going down the street' for a better 'price'.

nice interface though.

johnrob• 13 years ago

Eye opening... great work!

Bug: (FF 16.0.1 on OSX 10.8.5) When the "select a procedure" drop down box is expanded, wheel scrolling up/down seems to also zoom the map underneath it.

nickbauman• 13 years ago

A couple of points: There are far fewer procedures / pathologies here than are out there. At least sort the procedures / pathologies lexicographically. It would be even better if I could NLS search by the procedure.

Splendor4• 13 years ago

And if you want to get really fancy, let a user search in layman's terms too (e.g. "sore throat", "mammogram", "MRI", etc.).

anothernaysayer• 13 years ago

Be careful comparing costs alone. Like everything else, sometimes more expensive things are better in quality. This might manifest in a different diagnosis, a longer recovery time, complications, or no difference at all. Kind of like a bandit problem because you only get one opportunity to choose.

usablebytes• 13 years ago

Excellent problem choice and great work with the solution. http://pricemaps.betterdoctor.com/, too, have done a wonderful job with their version.

May be this will also make a great phone app. If users can pre-configure a couple of medical procedures (faced in their medical history), the app can show price comparisons on the map by default at every launch. This might help addressing the concern https://news.ycombinator.com/item?id=6864945.

jeanlucneptune2• 13 years ago

Assuming this data is from the Medicare (insurance program for those >65) dataset released by the Centers for Medicare and Medicaid services earlier this year (http://go.cms.gov/1bowKJA) I have a couple of points to make:

1.) Not sure if you grabbed "charges" or "payments", but "charges" are what the providers (hospitals) billed to Medicare, and "payments" are what Medicare actually paid the providers. "Payments" would be the best indicator of "price".

2.) Regardless of whether you are using "charges" or "payments", it's pretty much irrelevant for the average person. Why? Because the patient never pays the full amount (except for the uninsured...see below).

3.) While you don't pay the full amount in most cases, you will have to pay something. However, what you actually pay varies WIDELY based on your health insurer (the "payor") and the design of the health insurance plan.

4.) Also note that every "payor" negotiates a different price, so the Medicare price does not equal the Commercial Insurance price which does not equal the Medicaid price which does not equal the price the uninsured person pays.

5.) Finally, the diagnostic/procedural terminology in this dataset is impenetrable to most people. For example, does anyone on HN know what "transient ischemia" is? And if you do, do you understand that you can have transient ischemia in many parts of your body (FTR, I'm an MD)?

Although I appreciate the effort and the clean visualization, I don't think this data is particularly useful to an individual trying to make health care decisions for reasons 1, 2, 3, 4, and 5 (and probably others that I'm missing).

The one place where this data may be useful on an individual level is in the case of the uninsured. When you have no insurance the hospital basically makes up a price (taken from something called the "chargemaster") that is way more than what commercial insurance would pay, and WAY WAY more than what Medicare would pay. Having access to this data might help an uninsured person negotiate a lower price when the hospital comes after you with a giant bill. Medicare is a pretty solid standard to compare to - i.e. "you're charging me 5X, whereas you would only charge Medicare X".

On a societal level I think this data is also extremely valuable because now you can start to analyze pricing disparities across procedure types and geographies, which is really helpful. You can also put pressure on providers who are gouging individuals paying sticker price (i.e. the uninsured), which is important given that medical bills drive the majority of personal bankruptcies.

We ran a competition on this topic recently at Health 2.0 and you can learn more about the issue and the datasets on our site. You can also view other visualizations of this very important data:

http://www.health2con.com/devchallenge/rwjf-hospital-price-t...

Transparency in health pricing is a very important topic and something you'll hear a lot more about in the future. Happy to discuss further with anyone who wants to learn more (@jeanlucneptune, jeanlucneptune@gmail.com).

hotloo10• 13 years ago

Nice! Me and my friend made this app back in a few weeks ago, and here is the link.http://pricemaps.betterdoctor.com/#/

1. We used the 'Average Payment' for the actual number shown on the site. 2. Even though it's irrelevant, but it actually goes back to you by your co-pay and other expenses to you. Not 100% sure though. The point in our app is that, we want to compare the price vs quality in the US top hospitals. They actually vary a lot. 3,4 I agree. Co-pay is what you pay mostly. 5. We cleaned up the procedure names manually, and matched the procedure related specialties to the hospital specialty ranking made by US News, and it gives much better perspective to the users.

Nice to see people doing more health related stuff out there!

jeanlucneptune2• 13 years ago

I like the betterdoctor price maps! Too bad you didn't have a chance to enter our competition, because you might have been a winner. By point:

1.) Good choice 2.) You need to consider co-pays as well as allowable charges, deductibles, co-insurance (if applicable), and benefit maximums. 2b.) The quality data out there sucks (hard to measure quality in HC) and is hard to find. 3.) Cool 4.) Ibid 5.) Clever

HC now is like the internet in the early 90s. Huge opportunities that will hopefully attract talented developers, technologists, and entrepreneurs.

jmadsen3• 13 years ago

"My friends and I" not "me and my friends"

Yes, call me a Grammar Nazi Troll, but I see a shocking amount of this most fundamental error all over forums where otherwise intelligent, educated people discuss things.

You sound ignorant when you make the same mistakes as my 12-yo daughter. I can tell you make it because you are typing as you speak, which means you are in public, in meetings, and some day in presentations using bad English.

People will judge you by how you speak. I'm not being a troll, I'm helping you have a better future.

novalis786• 13 years ago

totally agree! my friend an me started in August on a similar mission http://www.pricepain.com - even tried YCombinator this winter but did not make it. If you checkout our /why section we collected a lot of recent articles and links on the subject

timbro• 13 years ago

I like the idea and the effort.

One thing I hate about it, though:

Again, third party javascripts are loaded in the background (Google, as usual, for example).

Come on people, you know this tracks everybody around the entire Web, stop using those scripts (is it so hard to use local js scripts? For example, find local "Web analytics" here: https://prism-break.org/).

What you're asking your users to do here is: telling Google (and the NSA, etc.) about your health problems. Not smart. At all.

caycep• 13 years ago

However, I think hand in hand with this you need to map outcomes data, especially for invasive procedures. Often, the reason to go to a "Big Hospital" say UCSF instead of Podunk Community Hospital is that there is often a big disparity in skill between a UCSF faculty surgeon vs. others. Or, even between different hospitals.

I'm not sure how to do this - hospitals like to hide adverse outcomes from the public, but it's really information in the public interest. Ideally you'd want some sort of index that weighs complication rates (something unexpected happening), outcome/effect measures (procedure did what it was supposed to do), with price.

johnpowell• 13 years ago

Have you ever thought you were having a heart attack? Flu tends to be moved by car.

joebeetee• 13 years ago

Presume you're just updating, but I'm getting a JS error on line 21

    query.ascending)(

ye• 13 years ago

You have a JS error that breaks the whole site.

Here it is:

    var query = new Parse.Query(Procedure);
    query.limit(1000);
    query.ascending)(               <---- error
    query.find({

neilsharma15• 13 years ago

Thanks for the notice. The change has been fixed.

thrownaway2424• 13 years ago

This is cute, but it is based on a flawed premise. There are not "prices" for medical procedures and even the providers don't know what they are going to charge. Anecdata: when my wife was pregnant I asked the hospital what are the basic charges for normal obstetric delivery, since we were paying out of pocket. I got a reply in writing that it was $20k, a suspiciously round number without itemization. The baby comes and there are no complications and no anesthetic and the attending physician never even showed up for some reason. So it was in every way the cheapest possible way to have a baby short of squatting over a blanket.

Needless to say that this American hospital would not even have admitted us without a certified check in advance, so we had spotted them the $20k. Over the next six weeks I get literally dozens of bills. I get a bill from the attending obstetrician who wasn't even present. I get bills for anesthesia that wasn't administered. I get bills in total of over $31k. I was uninsured but I'm not some chump, so my attorney sent these people sternly worded letters and we held the line at $20k which I think anyone would agree is already a ridiculous price in the first place.

Point is, nobody in this system has any idea what the price of anything is. There's no rate card. It's a collective emergent phenomenon that prints invoices. Nothing more.

ulfw• 13 years ago

WOW just wow. Would have been cheaper to fly first class to any other country in the world and get the baby there. It's really time for significant overhaul of the health care system here in the US

mw67• 13 years ago

Yes, in France its about 100 to 200 euros.

bambax2• 13 years ago

Yes, if I had to pay 20k to just have a baby and could fly somewhere else where it's free, I'd chance it.

There might be a problem that many airlines won't let pregnant women fly past a certain number of months, for fear they will deliver the baby in the air; so maybe you have to move to the target country months in advance, significantly adding to the total cost...?

matwood• 13 years ago

Dispute all of it and the bill will likely be way less than 20k. I had mallet finger once and I got a bill of thousands of dollars and charge for a broken finger, then a set, and multiple check up visits.

In reality I went to the doctor once, got an xray, he gave me a splint and said don't take it off for 8 weeks. I never went back for a second visit because it wasn't needed assuming I followed the treatment of did not bend my finger for 8 weeks. I called billing and asked for an explanation and the bill went from a couple thousand to a couple hundred.

x00542• 13 years ago

This is exactly why I get so pissed about the Affordable Care Act! We are not solving the problem of why medical care in USA is so outrageously expensive, we instead are solving the problem of how to pay for it. The problem is, once most people have insurance, there will be no political will to solve the much more complex and important problem of reducing the healthcare costs for everyone.

Incidentally, totally agree. In any hospital, all you have to do is dispute the charges and demand documentation, and all of the sudden the bill is slashed tenfold! So, basically, the system is setup to screw the uninsured americans who may not know their rights or have the ability to challenge the hospital.

refurb12• 13 years ago

Wow. The average reimbursement for a non-complicated birth in most US hospitals is around $3-5K.

You are correct though, the reason why hospitals do this is because the system is entirely setup to support this kind of behavior.

ivanca• 13 years ago

Point is, you got robbed and didn't go to court for it.

mathnode• 13 years ago

woh woh woh hold on....20k to give birth? I am amazed the US is still breeding.

bananacurve• 13 years ago

Needless to say that this American hospital would not even have admitted us without a certified check in advance

Well you ended up screwing yourself. Maybe you have never spoken to an American who didn't have health insurance and so didn't know, but, medical bills are settled later for less than half the insurance price and all hospitals have to admit you regardless of ability to pay by federal law championed by Kennedy.

aestra6• 13 years ago

Needless to say that this American hospital would not even have admitted us without a certified check in advance.

An emergency room cannot refuse treatment to a women in labor.

http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and...

codequickly• 13 years ago

I worked at ER. No, you don't want to have a baby in ER. ER doctors are dealing with emergency situations and patients (auto accident,cardiac arrests,gunshot wounds,etc). I've seen one baby being delivered in ER, and it wasn't a good experience for the patient. Rather, you'd want proper pre-natal care and comfortable delivery room, with your own doctor. Also, ER treatments are more expensive. Way more expensive.

3pt141592• 13 years ago

My question is how are they not criminally charged with fraud when this happens? I could understand if this only happens once in a while, that it isn't done intentionally, but it happens all the fucking time, so someone is clearly intentionally doing it.

If you hold a man hostage for a month or a year you go to jail for a year or two. If you intentionally overbill a man so that he must work an extra year worst case scenario you... send a sternly written letter and pay them the original amount?

phillmv• 13 years ago

WELL, if we're talking about INTENTIONALITY then yes the american medical bureaucratic system as evolved obviously singles out the uninsured and proceeds to screw them over.

If we're talking about mens rea, then I doubt it; my wager is tied to how it's in no one's incentive to care that leads to these outcomes. Medical providers are clueless and totally disconnected from administrative functions, hospital billing systems are optimized towards dealing with horrible leviathans that spew sulphur and vomit acid and all of this operates on a scale that makes makes the cost of delivering babies a rounding error.

I'd imagine someone forgot to properly code the procedures/the paperwork isn't set up to give a shit and they were simply charged the default set of procedures.

Blah blah, single payer public systems, blah blah aligning incentives around cost structures, etc. Atul Gawande has a great few articles on this.

yodsanklai• 13 years ago

"I got a reply in writing that it was $20k"

That sounds unbelievable! how can it be? it has to be a marginal case. I know at least two people that had babies in the US and barely pay anything (neither for the delivery nor for other medical acts before and after). They were PhD students or postdocs.

What I am wondering is on average how much an american pays for having a baby?

aestra6• 13 years ago

Those people probably had health insurance and did not pay out of pocket, their insurance footed the bill. I know someone who paid out of pocket for a delivery and I think they said it was around $12K.

joshkaufman• 13 years ago

It's not an edge case: we were quoted that price a few years ago. We carry high deductible insurance, and that was before the recent US health care legislation mandated maternity coverage. (Before it passed, most insurers refused to provide maternity coverage outside of large groups, or charged insane prices, since the probability of a claim was so high.)

In the end, we opted for homebirth midwifery care, which was fantastic in every way. We ended up paying around $2k for six months of prepartum care, delivery, and six weeks of postpartum care. In the event of an emergency, insurance would've covered a hospital transfer.

It was such a good experience we did the same thing for #2, and we're planning on delivering at home if we have more children in the future.

vijayr• 13 years ago

$20K for a normal delivery? that sends shivers down my spine. I knew healthcare is expensive, but this is insane.

clarebear2• 13 years ago

Next time, try a midwife if you and your wife are comfortable with home birth. In the Denver area it runs about $3k for parental care, the birth, and post birth check ups. Also, you don't have to deal with hospitals. I had one of my kids at home with a midwife and I wish it would have been both. If you actually need one, then the midwife will take you to a hospital.

novalis786• 13 years ago

that's exactly what we did. 12k the hospital, 6k the birthing home and the midwife charged 3k. When we asked her about the price, she "admitted" feeling "guilty". She said "it's still way too high, but I get in trouble from the birthing homes, if I charge less". Talking about "market prices". There are none (yet).

mneedham• 13 years ago

Unless you have one of dozens (hundreds?) of potential complications that can happen during childbirth and you don't make it to the hospital in time. They you've got a dead or severely brain damaged baby and a potentially dead mom. Totally worth it.

And the odds of making it to the hospital in time if you need an emergency c-section or start bleeding out are pretty slim.

thesis• 13 years ago

Wow. Next time shop around a little. We did and the hospital stay for my wife and baby was around 2800. Our doc was 2700. The anesthesiologist was a shocking 2500 though. Our doc and the hospital had to be prepaid, or else we would be charged higher rates. Some places call them "Stork plans"

carlosrt• 13 years ago

Companies, like Safeway, that self insure pay $3,000 to $5,000 per procedure. For example:

Colonoscopy: $897 Breast excision of lesion procedure: $2,569 Gall bladder procedure: $4,212 Cardiac Catheterization (no angioplasty or stints): $4,900 Knee Arthroscopy: $3,039

I wrote about it here:

http://www.quora.com/Medicine-and-Healthcare/What-are-some-o...

The CEO of SafeWay, started a company that sells this data. Unfortunately its typically only sold to companies that self insure and have ~10,000 employees. You can watch him talk about the data and the company here:

http://coe.berkeley.edu/static/streaming/gtl-conference/2009...

larrys• 13 years ago

"I got a reply in writing that it was $20k"

What did the reply in writing actually say?

Seems almost as if this was merely a "retainer" paid in advance against the expected cost.

jonmrodriguez2• 13 years ago

I don't know if I'm just completely retarded or hitting a bug. How do I use the "Select a Procedure..." box? Typing into it does nothing. If I click on the box (or the down triangle), it brings up a menu with only one option, which says "Select a Procedure..." and does nothing. This is on Chrome on Windows. I'm in Los Angeles, if that matters.

jonmrodriguez2• 13 years ago

Oh it might be this syntax error on line 21 of index.js:

Is: query.ascending)(

Presumably should be: query.ascending();

neilsharma15• 13 years ago

oh sorry, I must've introduce that error when fixing other things. Thanks for the notice.

slr555• 13 years ago

App doesn't work on safari or firefox mac

31reasons• 13 years ago

Great idea, but why is this thing on front page if its not working ? I see nothing to select in "Select Procedure" menu.

snklee• 13 years ago

I am experiencing the same trouble here, no menu to select...

neilsharma15• 13 years ago

sorry, the problem has been fixed

carolineld• 13 years ago

Can't wait to try but right now, it looks like there's something wrong with the dropdown menu: Cannot select a procedure.

Edmond• 13 years ago

NYT article on this a few days ago...I thought exactly about an app like this...kudos.

parbo• 13 years ago

As a European, the need for this baffles me.

diasks2• 13 years ago

Very cool idea. I think you should add something like select2[1] to your select input. That way when a user starts typing it could automatically start to autosuggest procedures.

[1] http://ivaynberg.github.io/select2/

it200219• 13 years ago

Super cool. Good work.

deathanatos• 13 years ago

Uncaught SecurityError: An attempt was made to break through the security policy of the user agent. (parse-1.2.13.min.js:1) (Hint: I block cookies.)

Nothing but a sickly looking map, and no data.

forgottenpaswrd• 13 years ago

Medical prices are so outrageous in the US that, in theory, the medical business is a good field for startup disruption.

Real disruption, not showing prices on a page but having actual good doctors at a good price.

There is a monopoly today controlled by few.

novalis786• 13 years ago

snaphealth tries to do just that. hopefully they get more traction in 2014. Concierge doctors are all over the US as well, but its still hard to compare them or find a place that does that

nej• 13 years ago

These procedures look a lot more frightening when they're written in all capital letters. If this is bothersome for you too, it's an easy fix in javascript. If it were any other element I would have said CSS, but text-transform:capitalize doesn't apply when applied to select tags. Here's how to do it in JS: http://pastebin.com/cnVJwds1

rschmitty• 13 years ago

This is a great start, however a key thing that is missing (at no fault of the authors) is patient outcomes.

Just because a service is cheaper does not mean you should shop by the lowest bidder.

BetterDoctor's Pricemaps also include US News Rank and score which gives you a place to start: http://health.usnews.com/health-news/best-hospitals/articles...

Please please please do not shop strictly by the lowest price when it comes to your family's health. Research both the hospital and the doctor who will be doing the procedure when it comes to complex procedures.

davycro• 13 years ago

Have you looked at the Dartmouth Atlas? They've been mapping healthcare costs for the last decade. Might have some good data and inspiration for you.

neilsharma15• 13 years ago

Thanks for the tip. I'll look into it :)

joshdance• 13 years ago

Really cool, but also not super helpful. Prices are not set. Book prices are not shared. Some prices are protected by crazy nearly anti-trust agreements (heart implants). And you have to know which procedure you want or should have for a particular condition.

But, that being said, I think it is awesome. Anything we can do to fix healthcare needs to be done.

eriktrautman• 13 years ago

The dropdown is difficult to parse, alphabetizing would help. Or at least group similar procedures together under a heading.

thyrsus• 13 years ago

I'm in the midst of a heart attack, and I'm supposed to optimize cost/benefit of the area hospitals according to available data on expenses and outcomes. I invite those in favour of market solutions to propose practical responses. If Siri gives me bad advice, is Apple liable? Was I not under duress when agreeing to the 50 page (or minute) disclaimer?

ehosca• 13 years ago

in this day and age of bigger monitors with larger and larger screen real estate, any and all "map overlay apps" need to be full-screenable...

hydrologie• 13 years ago

I made a similar app at http://healthcostnegotiator.com/

I took the approach of targeting under/un-insured patients with the goal of assisting them in negotiating their health care costs to levels more similar to the Medicare payments. It is pretty difficult to shop for medical care in the event of an emergency, so my tool gives nearby, regional, and national prices for selected procedures so that the patient go into price negotiations with their care provider and hopefully get charged a lower price.

Edit: I also made a visualization of the CMS Provider Charge Data here: http://labs.coseppi.com/cms/

ianbicking• 13 years ago

It's unclear how accurate this is. I searched my area for a random item (something respiratory) and there was one hospital that was $10k and another that was $30k. The $30k hospital probably has inflated prices, but not by 3x – it's also the hospital that takes harder cases. It's the hospital other hospitals send patients to. When we looked at hospitals for the birth of our daughter we looked at C-section rates. Almost all hospitals were the same, there was one good hospital, and then there was this hospital which had twice the C-sections of any other. But it's the hospital that gets the hard cases, a friend later delivered there (I think by C-section) after barely avoiding premature labor from 20 weeks to 35 weeks. Because people go there when they have medical challenges they have a high C-section rate, and generally high rates for everything.

vpsingh• 13 years ago

Excellent design, Here are a few bugs logged for bestmedicareprice.com by 99tests

http://app.99tests.com/openbugs/?company=best-medicare-price

Show HN: I mapped US medical prices. Save thousands by driving a few miles

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