saline

Saline, also known as saline solution, is a mixture of common salt and water. Saline solution has various applications in medicine. It is used to clean and disinfect wounds and also for treating dehydration by injecting the solution intravenously.

IV bags or ‘drips’ are common place in a clinics, dentist offices and hospitals. Anyone who has visited the doctor must have most likely noticed one hanging like the image below, in the examination room.

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According to a price report from the federal government, a liter bag of normal saline solution costs about $1.07 to produce, from the $0.46 mark in 2010.  Even in 2016, the price to manufacture these solutions cost no more than $5. However, an investigation conducted by the Pulitzer price winning Nina Bernstein of NY Times in 2013, revealed the 1000% markup of saline solution at hospitals.

The investigation was conducted on the May 2012 outbreak of food poisoning in upstate New York. The victims of the outbreak were administrated with IV bags.

PLOT TWIST: The patients were affected more by the medical bill than the food poisoning. Literally.

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Hospital bills for IV therapy (patients from the study) highlighted in the above image; $393, $787, $546, $91 etc are solely just for the saline solutions and nothing else. Of course the bill contains charges for several services and hence the large sum but that does not justify the large sum for the IV alone.

Bernstein’s report particularly reports the varying charges for IV therapy through various insurance providers at the same hospital. She found that:

  • An elderly woman and her grandson were charged $787 and $393 respectively. They were covered by an HMO under Medicaid and only spent a few hours at the hospital and the HMO did not reimburse most of the cost.
  • Another patient who was privately insured at a different hospital was charged $91 for the saline solution unit that originally cost the hospital 86 cents. When Bernstein questioned the markup, the spokesperson told Bernstein that the markup was “consistent with industry standards”
  • Another patient at the same hospital was charged $546 for six liters of saline but only had to pay $8 cause her insurance covered the original costs.

“Consistent with industry standards”, hmm clearly not.

We are all well aware of the overpriced health care system in the US. Of course, the quality of healthcare is top notch but it simply doesn’t justify the secrecy that results in such high prices. In the current age of big data, the demand for institutional transparency is continuously increasing. There isn’t enough awareness being raised or efforts being deployed to answer the prices posed by health care. It has come to a point where people have to think if they can actually afford the service they desperately need.

Currently only a few hospitals are in a position to accurately justify and negotiate the prices says Bernstein. Despite being a reputed investigator, Bernstein writes about the struggles to obtain true information from hospitals regarding the price markups. Even after approaching the New York State Department of Health using the evidence from the patients we saw above, the department is yet to release the actual information.

Interesting read to consider: How the U.S. Can Reduce Waste in Health Care Spending by $1 Trillion (Harvard Business Review)

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