
Show HN: I mapped US medical prices. Save thousands by driving a few miles - neilsharma
http://www.bestmedicareprice.com/
======
dshankar
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?

~~~
neilsharma
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...](https://www.cms.gov/Research-Statistics-Data-and-
Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-
Data/Inpatient.html)

~~~
toomuchtodo
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.

~~~
refurb
Can I ask why you're spending thousands of dollars on Rx and care? From what
I've gathered Medicaid patients have co-pays of $3-$5 on drugs and very small
office visit co-pays.

I'm not questioning your story, just genuinely curious what the extra costs
are.

~~~
toomuchtodo
Not a problem

My mother is covered by Indiana's medicaid program, as she's at the poverty
level but not old enough yet to qualify for Medicare. Her prescription
buydown/deductible every month is $550, which I pay for. If you don't mind, I
don't want to list specific medications, as it might make it easier to
determine her identity. She takes medication for bone mineralization, hormone
replacement due to a heart condition, a medication to reduce her blood
pressure, as well as a Schedule I pain killer 3-4 times a day for pain
management due to lower body nerve damage. She'll very likely have some nerves
in her lower back severed in the next 6-12 months to relieve the pain.

So, her prescriptions alone cost around $5K-$6K/year. This is before her GP or
specialist copays (very few providers will take Medicaid patients, so its hard
to find and keep them), or a hospital visit or two. Her recent open MRI was
completely out of pocket (luckily only $600 at a low-income clinic).

~~~
refurb
Thanks for sharing. I wasn't aware of Medicaid patients who had to pay those
types of costs.

I guess my question is, what if a Medicaid patient in IN was truly destitute?
There must be some mechanism for patients who can't afford those types of
costs.

~~~
randall
ER visits.

Seriously. An ER is required by law to treat anyone who comes in. If you
really can't pay, go to the ER.

Some argue this is why healthcare costs so much because ERs have to be paid
for.

~~~
frenchman_in_ny
No. This is wrong, yet people keep citing this.

EMTALA [0] requires the hospital to stabilize the patient, ie, make it so that
it is no longer an emergency (the "E" in "ER"). If you "really can't pay" and
it's not an emergency, you likely will find yourself in collections from the
hospital.

[0]
[http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and...](http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act)

~~~
gaadd33
So if you go and say you are seizing, they will just stabilize you till you
are done seizing then kick you out? Or at that point they will attempt to
collect for the emergency care and prohibit further care until you can prove
you can pay for it?

~~~
_delirium
Generally yes. This comes up occasionally with cancer patients; if they have
an acute issue the hospital must stabilize them, but the hospital doesn't have
to actually treat their cancer.

If they are very poor, they _should_ in theory be covered by Medicaid, which
will then pay for treatment. But this requires them to actually be in a
condition (mentally/physically/education-wise) to figure out how to sign up
and be approved for it, since coverage isn't automatic. Afaik, even if the
hospital is able to determine the person should be eligible, they can't just
treat the person and then sign them up on their behalf; the person has to do
it themselves, and be approved _before_ seeking treatment.

This is one area that I think the U.S. lags behind many other developed
countries in: assigning a social worker to help people in bad situations
navigate the system. I've noticed that with an uncle of mine who has MS, is on
SSI disability, and can't really take care of himself. If he didn't have a
family member who was willing to accept power of attorney and file all sorts
of paperwork and make phone calls on his behalf, he would have huge problems,
because he isn't able to do that himself, and the state has not assigned a
social worker to help him out.

~~~
aestra
>But this requires them to actually be in a condition
(mentally/physically/education-wise) to figure out how to sign up and be
approved for it, since coverage isn't automatic.

This is a tough one. I have a disabled family member who would have never been
able to do this themselves.

------
dougmccune
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.

~~~
npalli
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.

~~~
stevenbedrick
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.

~~~
gcb0
friend got a 2nd degree burn yesterday. she waited 2h to decide if she went to
a hospital because she was out of insurance... so yeah, i think she would have
used this site :)

------
caycep
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.

------
jeanlucneptune
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](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...](http://www.health2con.com/devchallenge/rwjf-hospital-price-
transparency-challenge/)

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).

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

~~~
jeanlucneptune
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.

~~~
hotloo
Thanks!

Yes, we would love to take our app to the next stage by providing more
comparison functionalities. One of the reason why we skipped quite a bit of
the metric is that we don't want to make the users to be too much confused
with choices.

This is one of the problems with the current health care system. There are too
many choices, and there is no simple way to do any sort of quick decision like
renting care, etc.

------
benmathes
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.

~~~
Splendor
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).

~~~
novalis78
..and pricepain.com

------
MJR
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.

~~~
Splendor
_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._

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.

------
jonmrodriguez
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.

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

Is: query.ascending)(

Presumably should be: query.ascending();

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

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

[http://www.cms.gov/icd10manual/fullcode_cms/P0136.html](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](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.

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

[http://pricemaps.betterdoctor.com/](http://pricemaps.betterdoctor.com/)

~~~
neilsharma
Cool! Did you get the data from: [http://health.usnews.com/best-
hospitals/rankings](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

~~~
hotloo
Yep.

We tried to compare the hospital quality with the prices.

------
nej
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](http://pastebin.com/cnVJwds1)

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

------
ianbicking
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.

------
hydrologie
I made a similar app at
[http://healthcostnegotiator.com/](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/](http://labs.coseppi.com/cms/)

------
auctiontheory
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?

~~~
neilsharma
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

------
rschmitty
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...](http://health.usnews.com/health-news/best-
hospitals/articles/2013/07/16/how-we-ranked-the-best-hospitals-2013-14-an-faq)

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.

------
nickbauman
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.

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

------
usablebytes
Excellent problem choice and great work with the solution.
[http://pricemaps.betterdoctor.com/](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](https://news.ycombinator.com/item?id=6864945).

------
parbo
As a European, the need for this baffles me.

------
awjr
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?

~~~
neilsharma
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...](http://swampland.time.com/2013/05/08/an-end-to-medical-billing-
secrecy/)

~~~
refurb
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.

~~~
neilsharma
I thought medicare reimbursement is relatively fixed, with minor fluctuations
based on geography and some hospital-specific practices? Based on a rough
glance at the data, it seems like medicare reimbursement is only loosely
correlated with the cost numbers, so I don't know how much raising prices
would increase their Medicare revenue.

Also, from what I've learned about elderly care, Medicare reimburses a care
center a fixed amount ($5000/mon/patient in California) regardless of the
severity of the case. I'm assuming this number varies a bit too even in the
same region.

As a side note, if you click on any of the prices in the map, it'll show you
medicare's reimbursement rates too. Should've made that feature more clear--
it's rather important.

------
hotloo
Nice!

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

[http://pricemaps.betterdoctor.com/#/](http://pricemaps.betterdoctor.com/#/)

Check it out!

~~~
maxerickson
Major joint replacement is much cheaper than Major Joint Replacement.

~~~
hotloo
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.

------
thyrsus
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?

------
31reasons
Great idea, but why is this thing on front page if its not working ? I see
nothing to select in "Select Procedure" menu.

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

------
joshdance
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.

------
crazy1van
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 :)

~~~
MJR
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.

------
anothernaysayer
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.

------
diasks2
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/](http://ivaynberg.github.io/select2/)

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

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

------
forgottenpaswrd
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.

~~~
novalis78
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

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

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

------
johnrob
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.

------
davycro
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.

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

------
enra
Saw this couple of weeks ago
[http://pricemaps.betterdoctor.com/](http://pricemaps.betterdoctor.com/)

~~~
neilsharma
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.

~~~
hotloo
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.

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

~~~
neilsharma
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

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

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

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

~~~
neilsharma
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

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

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

    
    
        query.ascending)(

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

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

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727374
This is great. Please sort the items in the drop down list. (I'm on Chrome)

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

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

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ehosca
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...

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deathanatos
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.

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slr555
App doesn't work on safari or firefox mac

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27182818284
Great work! Keep it up!

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it200219
Super cool. Good work.

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rtfeldman
Brilliant! Great work.

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ebaum
interesting idea. cant wait to see what happens next

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johngrefe
So freaking cool.

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msane
Heroic sir.

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thrownaway2424
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.

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ulfw
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

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bambax
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...?

~~~
GFischer
Doesn't need to be free - the very best healthcare in my country (Uruguay)
would cost about five thousand dollars per year of coverage, and we're talking
about something better than the average US hospital -
www.hospitalbritanico.org.uy .

Those five thousand would cover 90% of the expenses involved in all steps of
pregnancy (prenatal care and checkups, 4D ultrasound imaging, etc) and the
delivery itself.

And living here a few months would cost way less than 15.000 dollars :)

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

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jaibot
Is there evidence of correlation?

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codex
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.

~~~
rogerbinns
You forgot things like consumers needing information and having a choice.
Those need to be present for capitalism to work.

For fun I ask how much it is going to cost when going to my doctor. They
refuse to tell me. They can't even make an estimate (tens? hundreds?
thousands?) Even after seeing the doctor they can't. I pull out my card and
say "I would like to pay now". I get told I have to wait for the bill. It is
virtually impossible to find prices. Things are more complicated because the
patient is often not the one paying directly due to the "insurance" that goes
on.

This doesn't only apply for doctor visits/procedures, but even for labs where
it is a known consistent product with little variability.
[http://www.rogerbinns.com/blog/gplus/the-first-rule-of-
the-a...](http://www.rogerbinns.com/blog/gplus/the-first-rule-of-the-american-
healthcare-industry.html)

A few years ago I had a ride to the emergency room. There was only one
ambulance company and only one relevant hospital. The morphine in the
ambulance was $27. At the hospital it was $129 plus another $75 fee to add it
to the drip. Capitalism is not at play there.

Also did you know that if in most states you were going to open a hospital to
lower costs you won't be allowed to?
[https://en.wikipedia.org/wiki/Certificate_of_Need](https://en.wikipedia.org/wiki/Certificate_of_Need)

~~~
dilipd
According to the site, for the 'Certificate of need', the main arguments seems
to be following: "A number of factors spurred states to require certificates
of need in the health care industry. Chief among these was the concern that
the construction of excess hospital capacity would cause competitors in an
oversaturated field to cover the costs of a diluted patient pool by over-
charging, or by convincing patients to accept hospitalization unnecessarily."

I couldn't understand this argument. Something seems to be wrong.

~~~
rogerbinns
The argument for CON is that if a new facility came in and charged less, then
the existing facilities would have to charge more to cover the patients they
lost which would adversely affect their remaining patients. So a new facility
would need to show the need of non-served patients - ie that they wouldn't
take away patients from existing facilities.

It is of course hogwash, but is a nice way for existing facilities to have a
monopoly, prevent competition, and not have pricing pressure. Standard rent
seeking/corruption that exists in the US.

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ye
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({

~~~
neilsharma
Thanks for the notice. The change has been fixed.

