Thursday, October 10, 2013
Imagine going down to the Chevy dealer and picking out a new car, selecting the color and all the options, including the engine, transmission and fancy wheels, but when you ask the salesman how much the car will cost he won’t tell you?
“We don’t know the fee,” He says. “We will just send you a bill after you pick up the car.”
That’s nuts. No one would consider buying a car that way, and yet this is exactly the way people buy medical care every day.
Recently a good friend has been put through the medical ringer with multiple tests, diagnostic scans, doctor visits and biopsies. In two months he has had an MRI, several ultrasounds, three blood tests, a CAT scan, two needle biopsies, a nuclear medicine scan, an endosocope, two urinalyses, and even a breath test to check for infection.
All of these tests, scans, office visits and lab procedures were undertaken without the least idea of how much they would cost. These procedures were undertaken to follow up on various vague symptoms and so far nothing serious has been discovered.
Nobody really knows what medical care costs, including the physicians and hospitals. We just know it is expensive and getting worse fast, doubling every 13 years.
It is a perplexing truth that health care costs are rising at an exorbitant rate, and much of the rise is blamed on expensive new technology. On the other hand consumer technology is constantly getting better and cheaper.
What makes medical technology pricing the opposite of all other technology?
There are two primary reasons. The most obvious is basic supply and demand. Highly sophisticated and expensive medical or dental technology has far fewer potential buyers than general consumer technology.
For example an iPhone costs around $550 when purchased without a contract. A radiography sensor costs around $9,000. If every dental office in the US bought a radiography sensor the total number of sensors sold would be around 160,000. Apple sells more than 160,000 iPhones every day; day after day after day.
Arguably a smartphone is a much more complex piece of technology than an x-ray sensor, but the sensor manufacturers will never be able to use the economies of scale to bring the price down.
On the other hand there is a property of smartphones—the multifunction capacity of these digital devices—that could reduce the cost of future medical dental technology. Everyone knows that a smartphone isn’t just a phone. Typically it is also a camera, a video camera, a gaming device, a GPS, a clock, a calculator and a whole lot more. Just a short while ago you would have needed to buy each one of those devices as a stand-alone, purpose built machine, now they are all part of your smartphone.
Generally speaking the smartphone in your pocket has more computing and communication power than the most sophisticated computer on the planet had a few years ago.
Researchers are taking advantage of that power by incorporating medical devices into a smartphone. For example there is an algorithm (an app) that analyzes a smartphone video of your face and by detecting minute changes can determine pulse rate and other functions that in the past required an expensive EKG.
Scanadu Scout is a relatively inexpensive ($199) sensor that detects vital signs and then sends them to a smartphone via Bluetooth. Once the data is in the cell phone it can be uploaded for storage and analysis in the cloud. Another sensor from Adamant Technologies analyses your breath to determine disease states including glucose levels. It is easy to imagine a breath analysis device being modified to detect periodontal disease.
Basic medical ultrasound devices connected to smartphones are already available. However, the most interesting instrument in development might be a dental ultrasonic device called S-Ray that plugs into a smartphone. S-Ray will detect cracks and decay in the teeth, measure periodontal pocket depths, show both hard and soft tissues and can be used to create a virtual study model.
But expensive dental and medical technology isn’t the only issue. The second factor that drives up medical costs is that we don’t really pay. The insurance company or the government pays so we don’t care. If patients had more skin in the game, if they had to pay more of their own money, if they could compare prices, they would make better, more cost effective choices, and this would force medical providers to find less expensive options.
New technology and the Internet can help with this problem as well. Online it is easy to compare the prices of cameras, vacations, homes and even dental products here on Dentalcompare. You can now compare medical costs as well at castlighthealth.com. It is a bit like Travelocity for healthcare.
Transparency, price competition and disruptive technology have proven to reduce costs and improve quality across all industries. There is no reason it would not work with health care if we just give it a try. The future is coming and it will be amazing!