When It Comes to Health Care Prices, the Truth Is Not Out There
Your doctor is concerned you may have Celiac disease and suggests blood work to test for it. You ask if it will be covered by insurance or if it will cost you out of pocket. She has no idea and advises that you call your insurance provider.
After experiencing stubborn back pain, you have an MRI. You researched the price and know your bill will be $500. Yet when the bill arrives, it’s 3 times that amount. A hospital had bought the imaging center and raised the price.
Americans face realities like these every day. Try as we might to find out how much an X-ray, blood work, a colonoscopy or any other procedure may cost us, we’re often unable to find that information or surprised with an unexpectedly high medical bill.
Despite the efforts of a host of policymakers, hospitals, insurers and others to provide patients with health care prices, that information remains startlingly opaque. A new report from the Pioneer Institute is the most recent to confirm this reality. In it, they note that, across 54 hospitals in 6 cities, patients find the task of determining the price of health care “difficult and frustrating.”
This remains the case even though the Affordable Care Act has provisions requiring greater transparency in health care pricing, multiple states have passed legislation requiring the same, and multiple insurers, organizations and vendors have developed tools to aid in that task.
And it remains the case even as more and more people actively look for this information. My organization, Public Agenda, recently conducted a study into how Americans use prices in health care. In it, we found that 56 percent of Americans say they attempted to find information about the cost of health care before receiving said care.
One reason so many people look for this information is probably no surprise to you. More and more, our health insurance policies are moving toward a higher deductible system. Some advocates of high-deductible health plans believe that, when patients have to pay more out of pocket for care, they’ll be more prejudicial in using said care. This would then limit unnecessary tests and treatments, direct patients toward more affordable alternatives and ultimately bring down the cost of health care across the country.
Of course, some broad questions loom. Do high-deductible health insurance plans actually lead to lower health care costs? Do people think it’s even fair to be required to shop around for health care? (In our study, 43 percent of Americans told us this expectation was unreasonable.) Can our country’s health care system ever be considered a free market where people can shop for high quality, low cost health care in the same way they shop for televisions, cars and computers?
Regardless of the answers to these questions, the everyday reality for many Americans is that they’re shouldering more and more of the out-of-pocket costs of their care. And they’re having to do so in an environment where they cannot plan what it means for their wallet, their budget or their savings.
Although efforts to make prices more transparent are growing, they’re not hitting the mark yet. As policymakers, insurers, hospitals and vendors develop more tools to arm patients as consumers, there are a number of important considerations they must weigh to make sure those tools meet the needs of the people who will use them.
Our health care price research suggests a number of recommendations to this point:
- Strengthen the capacity of providers, staff and insurance company personnel to discuss prices. Many 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 that prices vary. Most Americans are not aware that prices for different medical procedures can vary, even within the same zip code. This may keep them from comparing prices or looking for less expensive providers when they are quoted a price that they cannot afford. Policymakers, insurers, employers and providers may wish to consider how to help more people understand the types of care for which prices do and do not vary.
- Help people understand how to find price information. Most people who’ve never sought health care 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.
- Focus engagement efforts on people who care for others and those who receive regular medical care. One in five Americans has compared prices for health care among different providers. These individuals are more likely than others to be helping adult family members make health care decisions or receiving regular medical care themselves. Those making efforts to engage more people in comparing prices may wish to focus on these people, who may also be those most in need of savings on their out-of-pocket expenses.
- Recognize the challenges to engaging people in both seeking and comparing prices and in choosing better-value care. Our research suggests that some people are comfortable with their current providers and do not want to switch even if they could save money, while some live in regions where they feel they have little choice of providers. It also suggests that some people feel that the prices they find are unaffordable.
Making health care prices more accessible for patients will not be a cure-all for the soaring costs of health care in our country. And comparing prices may not be realistic or even possible for all people. Still, many people are looking for health care price information and seem amenable to comparing prices. As efforts to boost the transparency of health care prices continue, these efforts must keep the needs of patients at the forefront.
Along with price, the public also needs to have knowledge of the quality of health care in order to compare value across providers. Public Agenda is currently researching how the public views and understands quality when it comes to three key health care situations: childbirth, diabetes and joint replacement. Be among the first to receive this study when it’s released! Sign up for our mailing list today.