Insurers losing fight with hospitals

December 10, 2011

While I certainly support increases in transparency of cost and quality, I wonder why insurance companies need to resort to gimmicks [“Insurers Push Comparison Shopping,” Nov. 28]. I’ve worked in health care over 30 years, but it was my wife who wondered, “Why is it my job to shop for doctors or hospitals, or even think there is a difference in price for a service? Isn’t that what the insurance company is for?”

She makes a valid point. Certainly we all understand that the cost of a procedure at hospitals will vary some, but isn’t the insurance company negotiating those rates on behalf of my employer and me? They set the prices. Why is there such a disparity in the cost of a screening colonoscopy (usually 100-percent covered by the insurance company), as the article states?

This tells me they are losing that battle against the large health systems, and need to mobilize the patients. Hospitals are paid three to four times for physician ancillary services like labs and radiology. As hospitals employ more physicians and acquire more hospitals, their power grows.

The reason a hospital sells out to a larger system is mostly financial. The hospital can’t make it on the rates paid by payers because they don’t have the negotiating power with the payers. Eventually the lower-cost provider (hospital or doctor) folds, and the situation becomes more exacerbated.

Asking the consumer to get involved is a tool, and may help influence the market, but I would contend better financial support to independent doctors and smaller groups would have more effect.


Don Stumpp

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