Patients facing high deductibles or copays will benefit significantly from access to transparent pricing information. This will empower them to budget their medical expenses accurately and choose the best quality providers.
However, price transparency tools must be easy to use and offer credible data. Otherwise, only some consumers will bother to shop based on prices alone. So, read on to find out more about how price transparency can make healthcare more affordable and convenient for you.
Providing price transparency to consumers is a common motif in healthcare policy circles. The idea is that consumers will use this information to shop for the best value, fostering competition and driving cost savings.
However, the opacity of healthcare pricing undermines this promise. A massive and seemingly irrational price variation – even for supposedly “shoppable” services due to insurance coverage – creates frustration for consumers. It also wastes clinician loyalty and leads patients to falsely assume that higher prices correlate with better quality, as consumers do in other markets.
To maximize healthcare price transparency, efforts should focus on truly “shoppable” services and combine cost with quality data to empower consumers. To maximize impact, price transparency should complement expanding insurance coverage and applying market discipline to pricing and billing practices rather than a substitute for them.
Most price transparency initiatives aim to create better-informed buyers who use information about prices and quality to purchase higher-value healthcare services. In theory, these more intelligent consumers will reduce wasteful provider behavior through two pathways: greater patient shopping leads to lower prices as superior providers lose volume to less-savvy competitors, and more cost-effective healthcare delivery results from competition between physicians over patient loyalty.
To be effective, price transparency in healthcare needs to be focused on products and services that are genuinely shoppable, such as some prescription drugs and diagnostic imaging, and to incorporate quality data. It also needs to be delivered in ways that are meaningful to consumers, such as by aggregating costs into episodes of care or procedures rather than by individual service lines.
Further, to be effective in driving smarter consumer purchasing decisions, pricing transparency tools must offer consumers a clear picture of total episode costs and include information about the value of negotiated prices. Without these components, price transparency could do more harm than good.
Since 2021, federal regulations have required hospitals to make their payer-specific negotiated rates available publicly. This transparency empowers purchasers, including employers and health plans, to better shop for services that meet their clinical, financial, and quality criteria.
This increased purchasing power would reduce prices and push out unprofitable providers. However, to be effective, the government must enforce price transparency regulation consistently and reasonably rather than depending on clinicians and their organizations to act independently.
Even though some pricing variation is justified on economic or policy grounds, such differences cannot persist if purchasers are given access to transparent data and can use it effectively to pressure providers for lower prices and higher quality. The bottom line is that greater price transparency leads to a more value-oriented, cost-efficient healthcare system. This goal is worthy of full support from patients, clinicians, and policymakers.
Although some health systems have incorporated pricing data into their websites, consumers rarely use this information to decide where they get care. Moreover, despite the strong rhetoric about healthcare consumerism, patients follow their physicians' recommendations, which may differ from prices at different hospitals.
One reason is that most pricing data, such as hospital “chargemasters” and insurer-negotiated prices, is presented by service instead of by episode. Consumers are most interested in what an entire episode of care, such as a hip replacement, will cost them and, therefore, have little interest in prices for individual services like an MRI or knee surgery.
In addition, a lack of clarity about insurance coverage and the complex nature of health plan designs further limit price-based shopping for healthcare. Yet, it is essential to note that healthcare transparency can still impact costs, quality, and patient satisfaction even without a robust retail marketplace.
As we have explored, healthcare providers and organizations are recognizing the incredible benefits of price transparency, and they are responding accordingly with innovative approaches that save their patients time and money. Patients are not only empowered to make more fully informed decisions about their care, but healthcare providers are better equipped to compete on value. The shift towards greater price transparency in the healthcare industry is already underway, and it is clear that its potential positive impacts are significant.