Hong Kong health care: a note on costs

Ok, this is the last thing I'll say about health care, in Hong Kong or otherwise. First, I heartily recommend last week's This American Life episode about the exploding costs of health care.

Said episode prompted me to ask my pregnant friend about the costs of maternity care in HK. Her first baby was at a public hospital, and the second one will be in a private one. A number of things surprised me about our conversation:

1. The costs were much less than I expected, even at the fancy private hospital on The Peak. An average normal delivery here in a private hospital runs between HK $60,000 and $100,000, which is about US $7500-13,000. That includes a 3 day stay, doctor's fees, epidural and anesthesiologist's fees and pediatric care. I don't know how much insurance paid for our delivery of Finn in the US, so maybe these costs are comparable (anyone know?), but honestly, US $10,000 seems sort of cheap. It's not cheap, I know that, but that's the point.

At a public hospital, on the other hand, for people with an ID card, it truly is cheap--between HK $1000-$10,000 (if in a private room), which is about US $100-1200. Lots of people choose a half/half option, going to a private doctor for prenatal care and then delivering in a public hospital. Private prenatal care runs between HK $10,000-20,000, which is about US $1280-2560.

2. The costs, both for prenatal care and for the delivery packages, are readily available. Hospital websites have them posted as well as online forums like geobaby. Maybe you can find a breakdown of the prices for medical services in the US, but I've never seen one. Having insurance meant I never cared what the cost was for a service, I just cared if it was covered.

3. One practice I find appalling here is that some doctors (and hospitals) charge more for their services if you use a private room rather than a shared room--up to twice as much. The only thing I can chalk this up to is pure greed--how could it possibly cost more to care for a person in a private room? You already pay more, of course, to the hospital for the private room, which makes sense. But to pay more for the doctor's fees, for the delivery, for the epidural, for the anesthesiologist? That's crazy.


Jessica Moore said...

Monte -

I can't speak for the entire US, but my insurance has changed since I had Callie, so this time around, I'm investigating private pay options in my area.

If I pay all at once, my OB's charge for all of my pre-natal care and an uncomplicated vaginal delivery is in the neighborhood of $1,200. (and goes up from there if I need to make payment arrangements and spread it out.)
As for the hospital, if I write a check at discharge, a two night stay for me and New Baby, I'm looking at about $2,500.
My epidural with C was $900.

I had, and will have, a private room, and my OB is a high risk specialist.

Here's the mind boggling part: According to my EOBs, the hospital, OB, and anesthesiologists billed my insurance (for Callie and me combined) a total of a little over $18,000. My out of pocket portion was almost $3,000.

foodsmith said...

Wow, Jessica, that is mind boggling. So where did all the extra charges come from? I thought insurance was supposed to get a better deal since they can negotiate lower rates .... thanks for sharing this.

Jessica Moore said...

They say that they're giving you a big giant discount for writing a check right then. I think it's a combo of a) they're getting money right now and not having to fight anyone for it or wait and b) they can bill the insurance company for more, so they do.

Shortly after C was born I got a bill from the anesthesiologist for the d/c that I had after miscarrying the baby before C. They had apparently "forgotten" to bill my share, and "remembered" when they billed my epidural with C. I had already budgeted out as much as I was comfortable with paying off the bills from C's delivery, so I told them that they were going to get $20/month until I got everything else paid off. After two or three months, they offered a 50% discount if I paid it that month.

I just think it's ridiculous how negotiable the prices are, even after the fact.