There are regularly stories (either in the news or viral) about how much American healthcare costs. I’ve blogged in the past about some of the causes. British healthcare is free at the point of delivery, so the patient doesn’t see the cost and people don’t know how expensive healthcare should be. But British internal prices are public information, so it’s easy to see approximately how much things cost in a well-run health service.
The prices do, however, need some interpreting and the government’s “simple guide” runs to 72 pages. I’m going to explain the system in a single (long) blog post. And then I’m going to take estimates of how much a British hospital bill would get for each of the linked hospital costs. The current costs are here (next year’s includes a 3.8% “efficiency saving” (read: underfunding)).
NHS pricing is based on the largest operation for the hospital visit (also called a spell). It is assumed that if you have major open heart surgery you will have X-rays, drugs, and a range of other treatments – and it’s all rolled into the price. This makes working out the UK price for things easy. You need the following factors to estimate how much something would cost in a British hospital. I’m only simplifying the system slightly here.
- The main procedure for the patient – or otherwise why they were in
- How long the patient was in hospital
- Any major factors making things more complicated
- How the patient was admitted (either elective “You’re going to need this soon – we’ll book you in in a few weeks” or emergency “You need this this minute.” A&E/ER admissions are emergencies, of course.) Or even done as an outpatient procedure.
- What was done for them in A&E.
- Which hospital (there’s a “Market Forces Factor” you multiply the costs by because expenses are higher in London than Cornwall)
There are a few things the above won’t tell you; Critical Care stays and transplants (amongst others) are negotiated locally (and should be available to a Freedom of Information request). But almost all the tariffs are on the national prices spreadsheet and the local tariffs are on the Market Forces Factor spreadsheet.
I could run through how to use the World Health Organisation’s ICD-10 codes for the diagnosis, the OPCS 4 procedure codes (and point you at a lookup), and suggest you install the payment grouper. But frankly it isn’t worth it. 99% of the time you can get what you need from just looking at the tariff spreadsheet. I’ll illustrate with three case studies.
Case Study 1: the $55,000 appendectomy.
How much would it cost in the UK? We know the patient was admitted through A&E – so they were an emergency admission. I’m going to estimate high and say that in A&E they had a category 3 investigation with category 3 treatment. £163. (US cost for the ER: $2703 – ten times as much).
I’m then going to look at tab 1 of the spreadsheet – APC&OPROC (Admitted Patient Care and Outpatient PROCedures). He stayed one night in the hospital and was 20 years old, so I can safely assume that he didn’t have major clinical complications. Searching the spreadsheet for “append” leads me to line 366 on the spreadsheet – FZ20B – Appendicectomy Procedures19 years and over without Major CC. He didn’t stay more than seven days, so there’s no adjustment for length of stay. Leading to a tariff of £2225. Total cost: £2388. We’ll then assume he had this done at the most expensive NHS hospital in England. Looking at the Market Forces Factor that’s University College Hospital London at 1.2976 – so we multiply the £2388 by that. Total cost: £3099. Google’s giving me an exchange rate of £1 = $1.57. So the highest plausible price the $55,000 appendicectomy would have been under the NHS would be $4865
Case Study 2: the $42,000 maternity bill
Of this, $4,430 is charged as “Post-ICU”. As such it is probably what we would call critical care. Meaning I can only evaluate $37,900 worth of the cost. But that’s quite simple. All deliveries without complications are £1496 + £371 per day in excess of 5. And all with complications are £2188 + £317 per day in excess of 7. (Surgeons are thus not encouraged to carry out gratuitous caesarian sections). Assuming a week with major complications that’s $3435. Average Market Forces is 1.0822. Not counting any critical care that’s $37,900 in the US as against $3717 in the UK
Case Study 3: $12,000 for General Abdominal Pain
A&E category 3 investigation, limited treatment: £163 (no surgery, drugs from the central supply). Emergency admission for PA29Z General Abdominal Pain: £573 (and I don’t think they bothered to do that). Total maximum: £736+ Market Forces Factor. Probably £163 + Market Forces Factor. And I thought taking the piss was the job of the Urology department.
It’s as simple as that to look up the prices. And anyone should feel free to drop me a note whenever one of these overcosted bills goes viral or if they think working out what it would cost in the UK will help when trying to negotiate a medical bill to something sensible.
After writing this post I discovered more about what hospital bills in the US actually mean (always haggle them!) and did a more systematic comparison between US and UK prices.