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How Do We Know If the Price is Right (If We Can’t Find Out What the Price Is)?

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“Health care costs are sky-rocketing!” “The percentage of the U.S. GDP devoted to heath care costs is the highest in the world.” “The cost of Medicare is unsustainable.”

For most of us, the cost of health care (i.e., the dollars required by the system to produce and deliver care) isn’t what brings us the most anxiety.

It’s when we’re patients or helping a loved one find care that so many of us are deeply concerned about the price of our health care: what we – personally, individually pay to acquire the services, drugs and devices we need.

We hear news stories about people who delay needed care, split pills and skip treatments because they just can’t afford them.  We hear that more of us are going to a retail clinic in a Walmart to check out a bad cough because of convenience and lower prices. We watch family members and neighbors slip into bankruptcy because they can’t pay the medical bills from their car accident or their cancer treatment. We see jars of pennies at the corner 7-11 with a sick child’s face and a plea for help with unpaid hospital care.

These experiences hit home even among the well-insured as we watch our health insurance premiums make their annual leap along with our co-pays and as many of us find ourselves unceremoniously switched by our employers to high deductible insurance plans.  Or we find ourselves staring the price of care in the face when we are between jobs or our company quits offering insurance because it’s just too expensive.

There is no doubt that more of us are becoming price-sensitive about our health care. An interesting online survey from Altarum indicates that we have considerable interest in unit pricing and comparison shopping for health care services and products.

You would think that, in response to this surge in interest, hospitals, diagnostic lab companies and clinicians would make it easy for us to find out what we will have to pay for a given procedure or service.

But you would be wrong.  I think this is still true today, a year after a GAO report documented the sorry state of price transparency for the U.S. public. But I don’t know for sure.  And neither do you.

From my own experience and the reports I have read and heard, finding out the price of a colonoscopy or an annual check-up with my kid’s pediatrician or the insertion of a cardiac stent still ranges from moderately simple to simply impossible.

I think it would be great if we could get an assessment of the availability of price information in different markets for different health conditions and for different insurance constellations.  The review should be conducted annually and widely disseminated.  There are a lot of us who really need to know about the actual price of our health care.

Who?

Well, of course, we the public have the most to gain – and lose – from not having good price information, even in the absence of meaningful quality information. These days we are exhorted by the media and our employers to act like consumers and “shop” for our health care even when critical information is rarely available.

Knowing that we probably can’t find the information we need or that it is tough to ferret out will a) annoy us so sufficiently that we slam the phone down and take to the blogosphere with our frustration; b) resign ourselves to making potentially huge financial decisions in the dark; or c) spark us to take collective action.  Got a hunch about which you’ll do?

Employers should know about the state of prices too. If, indeed, they are committed to us workers being engaged in our health care, such engagement should extend beyond losing weight and not smoking and encompass making informed choices about the health care services and products we purchase.  Employers can exert pressure on institutions and corporations with a force that individuals (so far, at least) cannot.

Hospitals, clinics, practices, and diagnostic and treatment centers also need to know where they stack up.  If health care is to work efficiently, price transparency for the public is a necessary component of market competition, even when most of us have some kind of insurance coverage.

Whether we think of ourselves as consumers or not, or believe that health care will ever operate as a real marketplace or not – these lofty considerations are immaterial to our immediate need to find out the price of having the tumor removed from our leg, my pack-a-day smoking brother to get a CT scan of his lungs or the antibiotics our friend’s sick baby needs to sleep through the night.

Being able to find out the price of health care services has to move from a rhetorical nicety to a realistic expectation. It’s not likely that any nascent regulation, policy or organizational change in health care will blow away the fog that obscures this information from the public.

But repeated systematic assessment that illuminates the size and scope of the challenge individuals face in finding out this basic information would remove important barriers to our effective engagement in our health care.

 

More Blog Posts by Jessie Gruman

author bio

Jessie C. Gruman, PhD, was founder and president of the Center for Advancing Health from 1992 until her death in July 2014. Her experiences as a patient — having been diagnosed with five life-threatening illnesses — informed her perspective as an author, advocate and lead contributor to the Prepared Patient Blog. Her book, AfterShock, helps patients and caregivers navigate their way through the health care system following a serious or life-threatening diagnosis. The free app, AfterShock: Facing a Serious Diagnosis, offers a pocket guide based on the book. | More about Jessie Gruman


Tags for this article:
Health Care Cost   Pay for your Health Care  


Comments on this post
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Jim Jaffe says
August 29, 2012 at 5:31 PM

medicine operates in a parallel economic universe partly because we patients have allowed to. ultimately providers want and need paying patients and have to do what it takes to keep them coming, whether that involves clean waiting rooms with current magazines or actually seeing patients on time. if patients call the colonoscopy facility and ask the price and then say they won't be there unless they're quoted a price in advance, behavior will change and become more responsive. really sick folks who run up big bills can't be asked to do this, but the majority of patients seeking non-acute care can and should. one reason things have gotten so bad is that they haven't, reinforcing bad provider behavior

Ericka Labedz says
December 9, 2013 at 1:10 PM

Jim, am I understanding correctly that you say it's the patients' fault that hospitals/providers don't give us up front pricing? That we should call to demand to get up front pricing? I don't think most providers care if you come in or not. They aren't looking to us for payment, they are relying on the third party payor. That's who they answer to.

I remember when I was pregnant with twins, I wanted to get a non-invasive test early in the pregnancy to help detect birth defects that my doctor recommended, but my insurance wouldn't cover. I called the hospital daily over the course of about two weeks to find out how much it cost so that we could determine if we could pay for it ourselves. After much frustration not getting any information from the hospital system, we just went and had the procedure done anyway. The payment office would not take our payment at the hospital, they sent it to the insurance company, who ended up paying for it anyway. And then the hospital sent us a check for $2,500 a few weeks later. It was never really sorted out, but the hospital did take the check back!