Tackling the Mystery of How Much It Costs

You go to a restaurant, peruse the menu, take your waiter’s suggestions, and order a meal. But there is something odd: the menu has no prices and you have no idea what you will be required to pay until a few weeks later when the bill arrives in the mail.

That, it turns out, is analogous to what goes on in health care, where fees are hidden at the time of service. Making matters even worse, patients often are seeking care when they are frightened and vulnerable, in no position to ask about prices or haggle.

The coming burden of Alzheimer's disease

In 2005, Medicare paid out $91 billion for costs related to Alzheimer's and other forms of dementia. By 2015, those costs are expected to climb to $189 billion. Medicaid paid $21 billion in nursing home costs for Alzheimer's and dementia patients in 2005; by 2015, those costs will climb to $27 billion. It seems ironic that Alzheimer's-related costs are set to balloon as the billions of dollars pumped into treating and preventing other maladies are beginning to show results. In recent years, medical care has advanced to the point that deaths from cancers, heart disease and stroke, the leading causes of death in the U.S., have dropped dramatically. Very quietly though, deaths from Alzheimer's disease have climbed 44 percent, from 49,558 to 71,696. There is no cure for Alzheimer's. Its biggest risk factor is old age.

States 'recycle' meds to battle costs

The struggle to keep soaring medical costs in check is feeding an increase in state programs that collect unused prescription drugs to give away to the uninsured and poor. Some states allow donations of sealed drugs from individuals, while others only accept pharmaceuticals from institutions, such as doctor's offices or assisted-living homes. Drugs are typically vetted by pharmacists to cross-check safety, then distributed by hospitals, pharmacies or charitable clinics. The type of drugs donated run the gamut and include antibiotics, antipsychotics, blood thinners and antidepressants. At least 33 states have laws to allow or study drug recycling programs, according to the National Conference of State Legislatures. Most state programs are just a few years old or still in the test stages, but officials envision huge gains.

Is Prevention Always Cost Effective?

In 1986, a health economist named Louise B. Russell published "Is Prevention Better Than Cure?," in which she concluded that prevention activities tend to cost more than they save. Since the book's appearance, her observation has been borne out by studies of hundreds of interventions -- everything from offering mammograms to all women and prescribing drugs to people with high cholesterol to requiring passenger-side air bags in cars and shortening the response time of ambulances.

Cutting Dosage of Costly Drug Spurs a Debate

When a drug can cost more than $300,000 a year, the right dose becomes a matter of public debate. The drug in question, Cerezyme, is used to treat a rare inherited enzyme deficiency called Gaucher disease. Some experts say that for most patients, as little as one-fourth the standard top dose would work, saving the health care system more than $200,000 a year per Gaucher patient. “It is economic malpractice to give a much higher dose of an expensive drug than is required,” said Dr. Ernest Beutler, an authority on Gaucher disease at the Scripps Research Institute. Some other Gaucher specialists argue otherwise, saying that skimping on the medicine could endanger patients. . . . [C]ritics say the company’s development costs were minimal, because the early work on the treatment was done by the National Institutes of Health, which gave Genzyme a contract to manufacture it. And analysts estimate the current cost of manufacturing the drug to be only about 10 percent of its price.

Costs of Hospice Care Rising

Hundreds of hospice providers across the country are facing the catastrophic financial consequence of what would otherwise seem a positive development: their patients are living longer than expected.
Over the last eight years, the refusal of patients to die according to actuarial schedules has led the federal government to demand that hospices exceeding reimbursement limits repay hundreds of millions of dollars to Medicare.

States Differ Widely in Spending on Health Care, Study Finds

A new federal study shows huge variations in personal health spending among states, ranging from an average of nearly $6,700 a person in Massachusetts to less than $4,000 in Utah.
The study, published on Monday in the Web edition of the journal Health Affairs, said that Massachusetts, Maine, New York, Alaska and Connecticut had the highest per capita spending on health care in 2004. The lowest-spending states were Utah, Arizona, Idaho, New Mexico and Nevada. Per capita spending in Utah was 59 percent of that in Massachusetts.