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Health Care's Curtain of Secrecy


The health care establishment has never been eager to disclose information about itself'not its mistakes, not its quality measures, and certainly not its prices.'  The result is that patients'now called customers'receive medical services at a price and quality they know little or nothing about.'  That's not to say the establishment doesn't like to promote itself.'  Every other day a press release arrives from some doctor praising a new treatment or procedure that, of course, he or she can do.'  And who hasn't seen TV commercials for hospitals that try to reel in patients for lucrative services like bariatric surgery and cancer care?

But resistance from the medical community is fierce when it comes to revealing prices for those treatments.'  In Florida, public interest advocates worked this year to get a bill through the Florida legislature that would have required providers to post in their reception areas prices of fifty of the most commonly used services.'  Florida already has a requirement for urgent care centers to post prices, and the proposed law would have simply expanded the requirement to ambulatory care centers, imaging businesses and doctors' offices.'  The requirement for the doctors was dropped, however, as legislation moved along. ' The general counsel for the Florida Medical Association claimed its members were all for transparency; they just didn't want the government to tell them how to do it.'  'Next thing you know they're going to say it has to be neon or include pictures,' he told Kaiser Health News.

The Florida bill aimed at telling patients the deep secrets of physician pricing.'  It would have made providers disclose prices to patients who were using their services out of an insurer's network, and it would have limited balance billing'the amount doctors can charge after an insurer pays its portion of a claim.'  Doctors can pretty much charge what they want to out-of-network patients who may be shopping for a particular surgeon, for example.'  Whether the health plan's contribution for an out-of-network charge is regulated, however, varies among states.

For patients who stay in the network, doctors are bound to accept an insurer's negotiated rate, which may be less than they would prefer.Balance billing hurts consumers' pocketbooks as insurance coverage increasingly calls for them to pay a much larger portion of their medical expenses.'  But restricting how much doctors can balance bill limits their income, and they've never liked that idea.

Whether hordes of customers/patients will use this price information is problematic.'  It's hard enough finding a doctor these days'any doctor, cheap or expensive'who will take your insurance and want to treat whatever ails you.'  One New York doctor just told me he would not take diabetic patients who are on Medicare.'  They were complicated patients to care for, he said, and he could make more money treating twenty-two year-olds with better-paying insurance and fewer medical problems.'  So when you finally find a doctor to treat you, are you really going to haggle over price?'  To think people in urgent need of care will shop the urgent care centers in Florida looking for the cheapest practitioner to diagnose a baby's ear infection in the middle of the night is, well, silly.

Several states require posting for various services, but many of those efforts have not been rousing successes.'  For example, since 2003, Maine has required hospitals to post prices for twenty-five services if people ask for them.'  But consumers have not used them, says Joe Ditre, director of a Maine advocacy group Consumers for Affordable Health Care.'  They were too hard to obtain and understand.' '  Maine passed another law to fix that problem, but the state has yet to implement it.'  'Hospitals and specialty providers are putting enormous pressure on the agencies slowing down the progress significantly,' Ditre said.

As readers of this blog site know, I'm skeptical that consumer information about health services will make the health care market more competitive, more honest, or less dysfunctional.' '  Health care simply does not work like other markets.'  Hospitals, for instance, compete on getting more patients through the door, not on the quality of care they deliver.'  Still, transparency does matter even if it doesn't change a patient's medical buying patterns.'  Knowing the general price levels'and they are way high in America'might help the public understand and ultimately support the need for serious cost containment.

Maybe that's why the health care establishment has been afraid of posting prices all along.


More Blog Posts by Trudy Lieberman

author bio

Trudy Lieberman, a journalist for more than 40 years, is an adjunct associate professor of public health at Hunter College in New York City. She had a long career at Consumer Reports specializing in insurance, health care, health care financing and long-term care. She is a longtime contributor to the Columbia Journalism Review and blogs for its website,, about media coverage of health care, Social Security and retirement. As a William Ziff Fellow at the Center for Advancing Health, she contributes regularly to the Prepared Patient Blog. Follow her on twitter @Trudy_Lieberman.

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