Kelly Zhang | April 2021
It would seem ideal for all the world to have a single price for all people when they have health issues. However, that may never happen because there are many causes that can affect the final price on every single patient’s healthcare bill. Each doctor has their own way of approach when it comes to the same problems, such as the simple cold. Hospitals, as people know, have countless companies all over the world with different owners: some are country-owned, some are personal, some have other different specialties. Recently, as everyone in the country was under the pandemic of Covid-19, the topic of variations in treatments among different healthcare made headlines. I was wondering the reason why people in different areas have different medical bills. It is because of the population? Is it because of the hospital? As I was pondering these questions, I also recalled my childhood memories and travels.
As I was growing up, my family took me to dozens of countries. Besides scenic sightseeing, I saw the giant rich-poor disparity. During a trip to Tibet, we experienced a huge difference in geographic variation in treatment. While my father had a toothache when we visited Nepal, a very small country near Tibet with a population of 28.09 million people and a GDP per capita of $1071.51[i]. Upon seeking dental care there, the dentist gave us a prescription for a cinnamon [ii]stick-like spice, with a total cost of under fifty cents. Afterward, we went back to Beijing, China, which has a GDP per capita of $8254.3[iii]. When we went to our family dentist there, he prescribed us some antibiotics to treat the toothache. The cost of the appointment and medicine totaled under $20, an exponential rise from Nepal but seemingly a fair price to pay.
We moved to Kenosha, Wisconsin a few years ago. Kenosha was the fourth largest city in Wisconsin with a population of about 100 thousand people. The average yearly income per capita was less than $25,000. The United States has a GDP Per capita of $53,240.00. Unfortunately, again, my father came down with a toothache as urgent as those incidents previous. We contacted our dentist immediately; however, we were told that the normal wait time for the doctor’s appointment was at least 6 months. Even though we conveyed high urgency, it required 6 to 8 weeks of wait time. Still new to the American healthcare system, I even thought about bringing my father to the emergency room, but fortunately, a local dental hospital had an opening, allowing us to walk in and pay in cash immediately. After the treatment with prescriptions and X-rays, it cost us over $800!
When I specifically looked into the bills, I realized that the surgery only cost about $350. Where did the other cost go? It went to fees, handlings, and simple examinations. I often thought that the surgery is difficult to accomplish because of the experience required from doctors; however, the price did not prove my thought. Also, the insurance seemed not to work at all when we reached urgent problems that need to be fixed in a short time.
I realize that since global healthcare has a huge difference with geographic variations in cost and treatments, what about the difference inside the country? As I looked specifically into geographic variation in treatment towards breast cancer, I found something. In the New York Times, Nicholas Bakalar stated the fact that women with lower income usually get less medicine[iv]. Therefore, it could be the reason they have lower living and surviving rates. Women with lower incomes are more likely to expect less budget on their bills, and when it comes to taking prescribed medicine, they tend to buy less due to their low budgets.
Researchers found 36,982 women with breast cancer in different age ranges and trying to find the difference in their treatments[v]. The options for a woman with breast cancer are often given the following options: local excision, quadrantectomy, or subtotal mastectomy. In these cases, 12.1% of women with breast cancer chose to take breast-conserving surgery and almost 87% of women chose to do mastectomy surgery[vi]. There are no absolute good or bad between both of them, but breast-conserving surgery does have a lower rate of recruitment.
I have pointed out many reasons why geographic variation in treatment can occur in this world, however, there is one main question. When can this disappear? While a doctor’s preference may not be easily changed, making the patients having choices is important. People of different races, experiences, and incomes will make different decisions when they go to a medical hospital. Geographic variations in treatment should be brought to the attention of the crowd. It was such an underrated issue, not only in the United States but also globally. Letting people be aware of this situation is necessary because knowing the difference will give people more choices when they face medical problems. I am hoping that in the future more and more people can see this difference and try to reduce such a huge gap in geographic variation in treatments. Possibly in one tomorrow, people will never worry about their cost in healthcare and medications ever again.
[i] The World Bank Group. Nepal GDP. The World Bank Group. Retrieved April 19, 2021, from https://data.worldbank.org/indicator/NY.GDP.MKTP.CD?locations=CN
[ii] The World Bank Group. China GDP. The World Bank Group. Retrieved April 19, 2021, from https://data.worldbank.org/indicator/NY.GDP.MKTP.CD?locations=CN
[iii] The World Bank Group. United States GDP. The World Bank Group. Retrieved April 19, 2021, from https://data.worldbank.org/indicator/NY.GDP.MKTP.CD?locations=CN
[iv] Bakalar, N. (2007, Jan. 23). All Breast Cancer Patients Are Not Treated the Same. The New York Times. https://www.nytimes.com/2007/01/23/health/23chem.html?searchResultPosition=1
[v] Nattinger, A. B., Gottlieb M. S., Veum, J., Yahnke, D., and Goodwin, J. S., (1992, April 23). Geographic Variation in the Use of Breast-Conserving Treatment for Breast Cancer. The New England Journal of Medicine. DOI:10.1056/NEJM199204233261702. https://www.nejm.org/doi/full/10.1056/NEJM199204233261702
[vi] Farrow, D. C., Hunt, W. C., and Samet, J. M. (1992, April 23). Geographic Variation in the Treatment of Localized Breast Cancer. The New England Journal of Medicine. DOI:10.1056/NEJM199204233261701. https://www.nejm.org/doi/full/10.1056/NEJM199204233261701