Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments (2)

Why would price transparency be a good thing for health consumers?

One of my readers recently asked for some examples of how price transparency might improve his lot. A great question! The people who stand to benefit the most from price transparency are the uninsured and those with high deductible health savings accounts. Price transparency is globally valuable because it allows people to understand the true cost of healthcare, making them more informed consumers. It also promotes accountability of hospitals, healthcare providers, and insurance companies.

Naughty Hospitals

Arbitrary fees:

“The cost for a total hip replacement in the greater Seattle area varied between $13,996 at one local hospital and $46,758 at another. Furthermore, there wasn’t necessarily any correlation between the cost of the procedure and the hospital’s quality or experience doing it. …Why would anyone pay a higher price for lower quality and potentially more complications, especially when it concerns your health?”

Where does a non-profit put its profitsDr. Feld knows where:

“We are unable to know the hospital’s actual overhead. If we did, we could to find out what the hospital’s actual costs are. We could then calculate the hospital’s profit. These numbers are totally opaque.

Most hospitals are non profit hospitals. They can not post a profit at the end of the year. Therefore, they have to pour the extra money into something. Executive salaries and capital expenditures are a prime avenue for getting rid of their profit. A key question is how is the hospital’s overhead calculated? Maybe reducing costs to the consumer would be a good idea?”

Predatory hospital billing:”

Over the past year, aggressive billing practices have been exposed at a number of hospitals in the United States. Despite the fact that a widower had paid $16,000 of his late wife’s bill of $18,740, some 20 years after the incurrence of the bill a teaching hospital held a lien on his home for $40,000 in interest. Many years earlier the hospital had seized his bank account, and now the 77-year-old man was destitute. Only tremendous publicity caused the hospital to back down. In California, a patient was forced into bankruptcy in 2000 by a for-profit hospital from a day-and-a-half stay in the hospital that did not include any surgery but totaled $48,000 in hospital bills. These have become common stories as hospitals aggressively market, bill, collect, and foreclose, just like any other corporation. The uninsured are facing the brunt of the hospital industry’s billing practices.

Naughty Outpatient Facilities

“Mr. Smith needs to get an MRI. He has a high deductible HSA, with a $2000 deductible, much of which he has not yet spent. So he will likely have to pay for 100% of this service himself. Without access to cost information by facility, he would simply go to a convenient, local facility and might pay up to $1300 for this single test. If he had access to health care cost information on the web, he could look up the cost of his service across different facilities and choose to go to the one that only charges $450 – a very meaningful difference for Mr. Smith.”

“More than 3 million people have already signed up for HSAs, and 29 million are projected to do so by 2010. Forty percent of the people who bought HSAs have family incomes below $50,000. More than a third of those who bought HSAs on their own had previously been uninsured.”

Naughty Doctors

What happens when 2 procedures have been shown (through careful research) to have equal efficacy, but one is reimbursed at a much higher rate? Docs will choose to perform the more expensive one, of course.

“Prostate cancer patients’ biggest concerns — after cure — are the possible side effects of surgery, including urinary incontinence and sexual impotency. Data on these side effects from robotically assisted prostatectomy were sketchy at best, and no evidence was available to indicate that any surgical method emerged as better than another for these side effects… Open radical prostatectomy costs $487 less a case than non-robotic laparoscopy and $1,726 less than robot-assisted prostatectomy.”

Naughty Insurance Companies

Insurance companies don’t want to make their pricing public because they don’t want their competition to know how much (or how little) they’re compensating physicians. Therefore, consumers are prevented from seeing costs as well – which can hinder their ability to make informed decisions about their care.

I bet others can think of some excellent reasons why price transparency is beneficial to consumers. Care to contribute?

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.


You may also like these posts

Read comments »


2 Responses to “Why would price transparency be a good thing for health consumers?”

  1. sappleton says:

    This is a great concept, but what would it take to make it a reality? Obviously the technology is available to make the “pricelist” available to the healthcare consumer, but it seems like the industry leaders with the power to change would be opponents of transparency. I would love to be able to compare prices on hospital/clinic websites, but in reality I think I don’t think it’s going to happen anytime soon.

    From an outside perspective, it seems to me that a catastrophe would have to occur to force the industry to change. That catastrophe could be the single payer/government health care plan.

    I believe our only other true hope is a real culture change of healthcare consumers. With babyboomers moving into retirement, their caregivers (children) are going to be more involved in this process. Hopefully these people will be led by online bankers, online shoppers, online communicators – that will see a possible opportunity of using technology to help organize and distribute this information. With all of the technological breakthroughs in medicine in the last 20 years – the physician-consumer communications piece has dragged behind unfortunately. I have better communication capability with the company that made my new bicycle lights than with my Pediatrician – healthcare provider to my children!

    Anyway – I appreciate your perspective and thank you for your time. I wish you the best.

    -Steve

  2. consumer_advocate says:

    As a consumer advocate, I am heading up an initiative to provide price transparency for routine healthcare services. I am hoping to take the “secrecy” out of healthcare pricing by enabling consumers to share healthcare pricing and their recommendations with other consumers. I have developed a website with a searchable directory of true prices for common healthcare services (diagnostic tests, MRI, mammogram, x-ray, office visit, and outpatient procedures). The contents of the directory are contributed by consumers to share with other consumers. The directory is free and provides actual price information on what consumers paid for common healthcare services. Both the insured and the uninsured will benefit by allowing them to compare costs and make the most out of their healthcare dollars. The 44.8 million uninsured individuals can benefit by using this directory to research prices and negotiate better rates with healthcare providers. Consumers can benefit by using the directory to look-up prices for routine healthcare services before the service is performed. <?xml:namespace prefix = o ns = “urn:schemas-microsoft-com:office:office” /><o:p></o:p></P>
    <P class=MsoNormal style=”MARGIN: 5pt 0in; mso-layout-grid-align: none”><SPAN style=”FONT-SIZE: 10pt; FONT-FAMILY: Arial”>I am very interested in feedback and comments on this initiative.</SPAN><o:p></o:p></P>
    <P class=MsoNormal style=”MARGIN: 5pt 0in; mso-layout-grid-align: none”><SPAN style=”FONT-SIZE: 10pt; FONT-FAMILY: Arial”><A href=”http://www.outofpocket.com”>www.outofpocket.com</A><o:p></o:p></SPAN></P>

Return to article »

Latest Interviews

Caring For Winter Olympians In Sochi: An Interview With Team USA’s Chief Medical Officer Dr. Gloria Beim

I am a huge fan of the winter Olympics partly because I grew up in Canada where most kids can ski and skate before they can run and partly because I used to participate in Downhill ski racing. Now that I m a rehab physician with a reconstructed knee I…

Read more »

How Do Hospital Executives Feel About Locum Tenens Agencies And Traveling Physicians?

I recently wrote about my experiences as a traveling physician and how to navigate locum tenens work. Today I want to talk about the client in this case hospital side of the equation. I ve had the chance to speak with several executives some were physicians themselves about the overall…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

Read more »

See all book reviews »