This is a mandatory wellness check that is required for all insurance in the US since ACA came out in 2010 or so, right?
I don’t pay anything out of pocket for my annual physical and I have really bad insurance.
I think this is one of those prices that no one pays as insurance covers it, or you don’t have insurance and won’t be getting any wellness exams paying out of pocket.
I wonder if it’s this level just as a negotiating tactic with insurance. I didn’t look at my explanation of benefits, but I don’t expect my insurance paid anywhere near this much.
Not exactly. Insurance typically negotiates paying a small fraction of the price that cash customers pay.
Medicare has long had a law effectively saying "you must offer Medicare the cheapest price you offer anyone". I wonder how much of an impact it would have on the affordability of care if there were a law saying "you must offer cash customers the cheapest price you offer anyone"?
The insurance company pays, but what they pay is not this price. US medical care is littered with dummy sticker prices that exist to give insurance company negotiators something to do besides negotiate good rates. https://www.propublica.org/article/why-your-health-insurer-d...
Not that straightforward for many. My employer pays for 80% of my insurance premiums, and then the insurer (or my employer) gives me a $200 credit (equivalent to paying me) for going to an annual wellness visit.
Of course, in totality, everyone’s total premiums are paying for the visits, but on an individual basis, those getting the visit and receiving a credit are getting subsidized by those not receiving a credit.
You don’t pay this amount. Healthcare has a tendency to show a high price, then charge a much lower price to insurers. So no one is really paying this price.
So it’s like a Persian rug store where every rug has a $9000 price tag and then every customer pays $3000.
"This is a mandatory wellness check that is required for all insurance in the US" sounds like you're saying paying for this is required to _get_ insurance - but I think you intend to mean that it's required that any insurance plan cover one check annually (which is sort of the opposite meaning)?
I don’t know about other European countries, but an annual physical exam is not a thing here in the Netherlands. I don’t know any person who’s ever done one here, and I don’t know where to get one if I wanted. We go to the GP if we have specific complaints, not if we feel like getting some test or checkup.
Well, it depends. Are you getting it immediately? Because a lot of "countries" with alleged healthcare simply delay it and you have to fight a bureocracy shield and even the paid insurance sucks and tries to use the public one.
USA is terrible at healthcare for those that don't have a safety net but many countries, such as UK, are terrible for the middle income/stable job types, because you don't even have options (unless you pay a fortune) without months on end.
As someone living in Canada I will freely admit that it can be extremely difficult to book a complex surgery, especially if the condition is not considered life threatening - but for common medical care it's trivial to just show up at a walk-in and get treatment for free - ditto for lab tests. Regular checkups are free and usually prescheduled though not everyone has a stable GP (and it can be a bit difficult to find a GP up here - there are ways to forcefully claim a GP though).
Taxes in the US aren't actually that much lower than in other countries - and the exploitation of all your juicey tax loopholes usually requires a pretty expensive accountant not accessible to the average person.
Without taking into account compensation difference (that is also significant), almost no other developed country has such favorable tax regime (again ignoring temporary programs). Check an average FAANG salary on levelsfyi for seniors and compare how much would someone pay taxes on it in Germany.
Americans spend as much public money on healthcare as is typical in similarly wealthy countries. This is a fact; check it yourself if you don't believe me. We pay for an NHS and all we get is this lousy Medicare.
The American system brutalizes poor people because it's cruel and stupid. It doesn't save you a dime on your taxes.
Yeah, taxes are really high but that's not relevant in this case. The actual costs are just way lower.
US healthcare costs are too high in the US because of the broken insurance system.
I don't think it needs to become a public system like Europe. I don't see anything inherently wrong with private insurance. But the system needs a reset, back to normal prices.
One of the reason costs are too high is because hospitals, doctors, labs, know that insurance will haggle down so they just overcharge a lot. That's how you end up with an ER band-aid costing $ 500.
The blood testing costs are extraordinarily high--well beyond what I've ever paid even without insurance.
I do not believe the average person in the United States requires an EKG every year.
There is some evidence that annual physicals actually do more harm than good.
ACA mandates that a annual wellness check be provided for free to the patient, and that includes a blood test. It may well cost the insurer $400 but that is because that is how they want to run their grift, not for any other reason.
Put these together and I think this is basically irrelevant.
If you ask the wrong kind of questions during your physical it can turn from a preventative visit (100% covered) to a diagnostic visit (often not 100% covered).
Try it with below median income in a southern state (us, 10 years). Healthcare generally wasn't on the table if we wanted to eat - and our story was far from exceptional.
Don't go to a hospital if you're not sick. Even people that work in medicine agree on that. They'll find something wrong with you or that could go wrong and the treatment will cure that but give you 10 more things. You are not the customer, insurance companies are. This is another way to maximize profit for them. Our bodies are good enough at informing us when things are wrong.
> Careful reviews of several large studies have shown that these annual visits don't make any difference in health outcomes. In other words, being seen by your doctor once a year won't necessarily keep you from getting sick, or even help you live longer. And some of the components of an annual visit may actually cause harm. For example, lab tests and exams that are ordered for healthy patients (as opposed to people with symptoms or known illnesses) are statistically more likely to be "false positives" — that is, when test results suggest a problem that doesn't exist. Even if these inaccurate findings affect only a tiny percentage of the more than 200 million adults who would undergo such exams, the monetary, practical, and emotional costs are huge.
>and more like the incorrect handling of false positives is the problem.
And what would be the "correct" way of handling it? Remember, you don't know that the test returned positive, not that it's a false positive or not. Are you going to tell the patient, "your breast cancer test returned positive, but given your age and other risk factors the probability that you actually have breast cancer is pretty low, so we won't do anything about it"? Even if that's the right thing to do from a statistical perspective, can you imagine the public outrage directed at the bureaucrat/politician that implemented this policy, if it turned out the patient did have breast cancer and died 2 years later?
Definitely not "we won't do anything about it". The medical industry (and frankly many other things but especially the medical industry) needs to find an effective way to present the common result "this test returned positive, but given the base rate in the population and the accuracy of this test, this is not necessarily enough information and your probability of having X is still only Y%, so we're going to run another non-invasive test to see if there's even enough information to warrant doing a more detailed check; ZZ% of people get a negative on the second test".
Perhaps find a nice graphical presentation of the simplest version of Bayes Rule: "the base rate in the population is this, here's what the test means for the part of the population that doesn't have it, here's what the test means for the part that does, here's how your probability went up but that it's still vastly more likely you don't have it than that you do."
In other developed (or even developing) countries, going to a doctor if you feel anything is not a financial question. You just go. Also annual bloodwork -- without needing to even do a doctor visit -- is sometimes a thing.
You can go to the specialist you think you need. Got a heart/chest issue: you go to the specialist and do not worry if it is covered or how to pay them.
Disclaimer: lived/live for years in both Europe and U.S. I also have a glimpse of how the japanese system works and South America a bit too. These things are not comparable. You would think North Americas are a different "world far far away."
tl;dr: I find the average in the U.S. surprising. Then I look at the median life expectancy.
Annual physical in the U.S. is one's chance to get a "relatively free" doctor visit for an issue they have.
The conclusion that if you are healthy there is a higher chance to have a false positive is misleading.
a) that is true by definition: they have asserted the patients are healthy already;
b) statement assumes that in the U.S. people go to the doctor at the same rate as they go in other countries; and thus have a chance to test themselves / do checkups necessary to their particular family/individual risk profile;
So drawing the directive that annual physicals are to be discarded is hypocritical. And to be substituted with "questionnaires" is .. [well I don't really have words.] They are stretching for a conclusion to remove the ~free annual requirement.
(cc from your linked blog study/recommendation):
> Second, they acknowledge that if the annual visit is to be discarded, primary care doctors will need to find a more proactive way to monitor their patients' attention to preventive care. They suggest that waiting for patients to keep their annual visits to review this is too "passive" an approach, and encourage practices to shift to "active engagement" of their patients. Ways to do this might include: online risk assessments, waiting-room questionnaires, and a review of preventive care at any visit to the doctor.
> Annual physical in the U.S. is one's chance to get a "relatively free" doctor visit for an issue they have.
Again, fixing that absurdity would be great. Not by giving more annual physicals, but by removing the payment aspect of things like much of the developed world has.
I have the feeling this is only a thing in certain countries. I've never heard of anyone healthy getting yearly physical here in Europe (seeing the GP is almost always free so you could do it if you want, but the doctor will wonder why you're wasting his time unless you have symptoms/suspicions/etc to report or ask).
Of course chronically ill or very old people are getting tested regularly, but only for stuff specifically for their illness/situation.
Doesn't stop the "full body scan" ads on YouTube of course, but that's something you'll have to pay for out of pocket and most GPs will recommend against them as far as I know.
It seems to be a very USA-specific concept, but I can't say for sure no other countries do it. I think Japan does it? I don't think it's common in Canada, is it?
In the US, my HMO doc will do one only if I insist. Even my previous PPO doc was pretty relaxed about it. He said it was up to me if I wanted to do it, but that it wouldn't really be useful.
Certainly there are people in the US that go for a physical every year, but many of us do not. In my wider circle of friends and family, very few of us bother.
Things like obesity and life expectancy vary considerably across the US, which makes drawing broad conclusions pretty difficult. Try comparing regions that are closer, like BC to Washington state.
Sure, but still, the difference between BC and Washington state (~2 years higher in BC) is greater than the difference between Washington state and Texas.
I don’t pay anything out of pocket for my annual physical and I have really bad insurance.
I think this is one of those prices that no one pays as insurance covers it, or you don’t have insurance and won’t be getting any wellness exams paying out of pocket.
I wonder if it’s this level just as a negotiating tactic with insurance. I didn’t look at my explanation of benefits, but I don’t expect my insurance paid anywhere near this much.