Healthcare cost microcosm viewed through colonoscopies

An examination of how colonoscopies are administered in the United States reveals some of the reasons that the nation's healthcare system is the priciest in the world, according to the New York Times.

The outpatient diagnostic procedure costs nearly twice as much in the U.S. as it does in Switzerland, which has an insurance system not dissimilar to America's. According to the Times, some patients were billed more than $9,000 for the procedure, with a patient who also had polyps removed charged nearly $20,000. Even with insurance covering the procedure and obtaining discounts, many payers were charged $3,500 or more.

The article blamed the high cost of colonoscopies on the fact that their delivery is tied to "business plans seeking to maximize revenue; haggling between hospitals and insurers that have no relation to the actual costs of performing the procedure; and lobbying, marketing and turf battles among specialists that increase patient fees." 

The procedure gained traction with the public in 2000, when the American College of Gastroenterology recommended colonoscopies to prevent colorectal cancer and Katie Couric underwent one live on television.

The use of electronic health records also boosted the rates of the procedure by more easily identifying high-risk patients who should undergo the procedure.

However, rather than promote economies of scale and competition for the procedure, providers saw it as a business opportunity.

As a result, prices rose, particularly at outpatient centers that performed colonoscopies. According to the Times, whenever a gastroenterologist began practicing regularly at an outpatient center, the procedures rose an average of 27 percent, and their compensation skyrocketed. And a RAND study found questionable added-on costs, such as the use of anesthesiologists, also doubled between 2003 and 2009.

To learn more:
- read the New York Times article
- read the RAND Corp. study