Consumers face barriers to healthcare price data before care

The veil over healthcare price transparency is becoming more critical as consumers are responsible for a growing proportion of their healthcare costs. Healthcare price information that is available before consumers receive care could help them anticipate and better handle these costs, according to a federal auditor’s report.

Several healthcare and legal factors make it difficult for consumers to obtain price information for the services they receive, the Government Accountability Office said in a report released Oct. 24. The auditor found that healthcare services are difficult to predict in advance, billing is often from multiple providers, and insurance benefit structures vary.

“Consumers generally learn of their healthcare costs only after receiving care, such as when they receive a bill from their provider or an explanation of benefits from their insurer,” said Linda Kohn, director of health issues for GAO.

Better price information, along with incentives, could encourage consumers to select providers that offer low-cost, high-quality services, GAO said. 

The auditor found that when it contacted physicians' offices to obtain information on the price of a diabetes screening, administrators said that the patient needed to be seen by a physician before the physician could determine which screening tests the patient would need. Providers also have to know the status of insured consumers' cost sharing and out-of-pocket expenses under their health benefit plans, such as how much consumers have spent towards their deductible at any given time.

For Medicare, the Centers for Medicare & Medicaid Services sets the program’s payment rates for providers based on a formula that includes geographic locations and other factors. 

Legal factors also veil the ability to disclose negotiated rates between insurers and providers, which are used to estimate consumers' complete costs. For example, contractual obligations with providers may prohibit the sharing of negotiated rates with the insurer's members on their websites.

Only two of the eight selected initiatives were able to provide an estimate of a consumer’s complete cost — New Hampshire HealthCost, which is publicly available for those in the state, and Aetna plan member payment estimator. The two initiatives had access to both claims data and negotiated rates.

The Health and Human Services Department supports various efforts to make price information available to consumers and is expected to do more in the future. HHS should determine the feasibility of making estimates of complete costs of health care services available to consumers through any of its efforts and plan the next steps to do so, GAO said.

HHS provides price information on insurance plans through its www.healthcare.gov  website. CMS posts the web-based Medicare Part D Plan Finder with information on prescription drug prices, and the agency’s Health Care Consumer Initiatives offer the price Medicare pays for common health services at the county and state levels.

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