Costing an arm and a leg – Healthcare wonkery/workings

In my last post about healthcare costs I compared the amount spent under the British system to bills from the American system, and it was far my most popular post so far.  One of the most popular questions was about costs by procedure or condition so I started doing some research.  And I ended up breaking the follow up post into three; one for Brits, one for Americans, and a nerd-post in which I share my workings.  This is the nerd post; feel free to scroll past – that’s why it’s separated out from the UK and US healthcare posts.

When I last did research on this subject there was no readily available income – but under Obamacare there is now retrospective data on how much healthcare costs for 2011 and 2012. Therefore we’re going to compare 2012 (the most recent year available) with British data from 2012/13 (a nine month overlap).

American data is grouped into DRGs – Diagnosis Resource Groups, and British into HRGs – healthcare resource groups.  The cases below are cases where the two groups match up clearly enough to get a fair comparison.  There is no other mechanism of choice beyond that.

As we’re using average data, I’ll assume a Market Forces Factor of 1.08 (the unweighted mean), and an exchange rate of £1 = $1.585 (the average for the year) or $1 = £0.631.  And if anyone wishes to challenge my matching, my specialty is health informatics not medicine.  Feel free.  (In the below, CC = Clinical Complications, MFF = Market Forces Factor – i.e. the local difference in costs in Britain – taken as 1.08).  Oddly enough the cases are almost invariably emergency ones where they line up.

 Case 1: Transient Ischemic Attack (“mini-stroke”)

Assumption: Almost all cases are emergency.

  • US Coding: DRG: 069 – TRANSIENT ISCHEMIA. $22,479 billed, $5145 paid
  • UK Coding: AA29Z – Transient Ischaemic Attack. (Non-elective). £1226 (£1324 including MFF)

Case 2: Chronic Obstructive Pulmonary Disease (COPD)

Assumption: Almost all cases are emergency.  The extremes are more likely to be similar than the middle.

  • US Coding 1: 190 – CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC Billed: $31042, Paid: $8032
  • US Coding 2: 192 – CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC Billed: $19,026, Paid $4914
  • UK Coding 1 : DZ21B – Chronic Obstructive Pulmonary Disease or Bronchitis with Intubation with Major CC £3478 (£3756 with MFF)
  • UK Coding 2: Chronic Obstructive Pulmonary Disease or Bronchitis without NIV without Intubation without CC £1711 (£1848 with MFF) – the cheapest COPD category

 Case 3: Major Intestinal Procedures (e.g. Bowel Resections)

Assumption: The Major small and large bowel procedures map to the most complex small and large bowel procedures in the UK (Complex for large intestine, very major for small).  Large intestine procedures reach higher values than small intestine under the UK system.  Non-elective tariffs used as they are higher

  • US Coding 1: 329 – MAJOR SMALL & LARGE BOWEL PROCEDURES W MCC Billed: $136,297, Paid: $38,784
  • US Coding 2: 331 – MAJOR SMALL & LARGE BOWEL PROCEDURES W/O CC/MCC Billed: $44,884, Paid $11,786
  • UK Coding 1: FZ08A Complex Large Intestine Procedures with Major CC £9990 (£10,789 w/MFF)
  • UK Coding 2: FZ06B Very Major Small Intestine Procedures without CC £5310 (£5735 w/MFF)

Case 4: Complex Gall Bladder Removal

Assumption: The case was done as an emergency (if they could be put on the waiting list, the NHS tariff is less than half the one I’m using)

  • US Coding: 418 – LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC Billed: $48,872, paid: $11,745
  • UK Coding: GA10F Open or Laparoscopic Cholecystectomy with CC £4612 (£4981 w/MFF)

Case 5: Kidney and Urinary Tract Infections

Assumption: Emergency admissions – you don’t often admit electively for infections.

  •  US Coding 1: 689 – KIDNEY & URINARY TRACT INFECTIONS W MCC Billed: $29,413, paid: $8167
  • US Coding 2: 690 – KIDNEY & URINARY TRACT INFECTIONS W/O MCC Billed: $20,822, Paid: $5503
  • UK Coding 1: LA04D Kidney or Urinary Tract Infections with length of stay 2 days or more with Major CC £3862 (£4171 w/MFF)
  • UK Coding 2: Kidney or Urinary Tract Infections with length of stay 2 days or more without CC £1432 (£1547 w/MFF)

 Case 6: Pulmonary Embolism

Assumption: Emergency admission

  • US Coding: 176 – PULMONARY EMBOLISM W/O MCC Billed $27,402 Paid: $7341
  • UK Coding: Pulmonary Embolus without CC £1468 (£1585 w/MFF)
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One thought on “Costing an arm and a leg – Healthcare wonkery/workings

  1. Pingback: PSA: Always haggle over hospital bills in America | Eudaimonaic Laughter

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