Finding Health Care Prices Remains Frustrating

Arriving at her dermatologist’s office last week, my friend Emily discovered her health insurance network had changed. The doctor she’d visited for many years was no longer in network.

Naturally concerned about how much the appointment would cost her, she asked the receptionist. The receptionist didn’t know but offered to call Emily’s insurance company. The insurance company told her that part of her appointment would not be covered by her deductible, but they couldn’t tell her how much that would cost. All Emily knew was that an appointment that should have cost a co-pay of $20 would likely cost her $400, perhaps more. Emily said thanks and left.

Health care leaders, advocates, researchers and policymakers are trying to limit these sorts of frustrating experiences by improving price transparency in health care. States including Oregon and Florida have passed legislation calling for increased transparency in the prices of health care providers. Insurers are developing tools and websites with price and quality information for customers. For-profit and nonprofit companies and organizations are doing the same.

Anecdotes and research both suggest most of these efforts are so far falling short. Journalists have written about the frustration they and others encounter when trying to find the prices of pregnancy, joint replacement, MRIs and other common procedures.

For the last four years, two organizations — Health Care Incentives Improvement Institute and Catalyst for Payment Reform — have tracked state’s efforts to boost price transparency with an annual report card. In the most recent edition, released last week, 43 states received an F grade. Just three received an A.

Meanwhile, most Americans seem to be seeking more and better price information for health care. In a recent survey my organization, Public Agenda conducted, over half of Americans — 56 percent — said they had tried to find out how much their health care would cost them out of pocket. One in five (21 percent) compared prices across two or more providers. Those who have compared prices say doing so has affected their choices and saved them money.

As health care leaders and experts continue to improve patients’ access to price information, they need to make sure they are meeting the needs and concerns of patients and caregivers. Otherwise, their efforts may just continue to fall flat.

For example, some health care experts have emphasized the need to make websites and online tools user-friendly and simple to navigate. Our work with prospective students in the higher education sector suggests a need to make big data meaningful and applicable to the user’s own life and experiences.

Our price transparency research provides additional direction and suggestions:

• Provide information on price…AND quality: Our research suggests that Americans do not conflate price with quality in health care. In other words, they don’t believe a provider is better just because they cost more. Since Americans seem open to choosing better value care, reporting information on both price and quality will enable them to do so.
• Strengthen the capacity of providers, staff and insurance company personnel to discuss prices: Americans are already trying to get price information from receptionists and hospital staff, insurance companies, doctors, hospital billing departments and nurses. This suggests a need to strengthen these professionals’ capacity to provide and discuss price information.
• Help people understand how to find price information: Most Americans who have not ever sought price information say they would like to know the prices of medical services in advance. Half of them, however, say they do not know how to find it. This suggests a need for more outreach and education about reliable sources of price information.
• Recognize the challenges to engaging people in both seeking and comparing prices and in choosing better-value care: Most efforts to boost transparency are designed to encourage more people to “shop around.” If more people choose lower-priced, better-value care, that will in turn reduce our country’s health costs. Yet in follow-up interviews after our survey, some respondents indicated they are comfortable with their current providers and do not want to switch even if they could save money. Some live in regions where they feel they have little choice of providers. And some feel that the prices they find when they try to shop around are unaffordable.

This year, we are repeating our survey on price transparency to identify trends and new concerns. We are also doing additional research into public attitudes toward health care quality. Both of these studies will be released in the coming year. Stay on top of our health care research by signing up for our email list!

This was first published on the Public Agenda website.