Should the cost of healthcare influence the level of care?

I work with physicians on a weekly basis, and one thing I have found is that most doctors don’t know the cost of the care they are providing.

They don’t know, because the cost of healthcare is tricky and not simple.

Imagine going to the grocery store and there are four prices listed on a box of crackers.

  • $1 if you pay cash
  • $1.50 if you use your debit card
  • $1.65 if you use your credit card
  • $2.00 if you can’t pay up front and we have to bill you later.

A hip replacement may cost you $20,000 if you have American Healthcare insurance LLC as your provider, $11,000 if you have Medicare, $9,000 if you have Medicaid and $25,000 if you are private pay or without funds. Nursing homes are the same way. $5,000 a month if Medicare is paying, $3,000 if Medicaid is paying and $6,000 if you pay privately or with long term care insurance.

And sadly, physicians have little to no control of the cost, or knowledge as to the costs being assumed by their patients.

Yesterday I heard a story about a hospital catering it’s surgical services to Canadians who pay in cash.  I think it is both lovely that a hospital would market these services, and I assume they also include what the real costs for such services are.

This week in our local paper, an attorney who defends nursing homes wrote a letter to the editor of the paper pointing out that families can hire private care sitters to be with their loved ones in a nursing home 24 hours a day. But I ask you this – if you have the $9.00 to $15.00 an hour it takes to pay for a private sitter in a nursing home, in addition to the huge monthly fee of between $4,000 and $6,000, wouldn’t you keep that loved one at home and pay for home health to provide 24 hour care? Of course you would. Sometimes, the healthcare choices we make are entirely based on what we can afford.

Which leads me to the reason I am writing this — Do we think the hip replacement paid for in cash should be of the same quality as that paid for by Medicaid? What about the care provided to a medicaid patient in a nursing home, compared to a private pay patient?

While we as a society understand in principal that healthcare is not a right, but a consumer transaction, do we think the level of care should change based on the amount paid or the source of payment? Or, do we think that the level of care should be equal. Everyone deserves good care, and if you have the means you can pay for extra good care?

I don’t have the answers. I just know that families expect the same level of care, treatment and respect no matter the payment source. And I am beginning to think our system sees that differently.

Lauren Ellerman
Lauren Ellerman

In 2011, Lauren Ellerman was named "Young Lawyer of the Year" by the Roanoke Bar Association for her work in the community. To speak with Lauren about your personal injury case, contact her at