The United States has the highest health care expenditures in the world, in terms of absolute dollars, dollars per person, and as a percentage of GDP 1. The United States is also one of the few industrialized countries to have very limited government health coverage for working adults. While insurance premiums are currently price transparent, many aspects of health care are not cost transparent at all. Historically, it was not standard practice to publish prices of procedures or tests to patients prior to performing them. Patients would not learn about the true cost until they received their bill later. This was complicated by the various prices for the same test or procedure depending on the patient’s health care coverage, or lack thereof. This made it very difficult even for informed patients to make financially informed decisions about where to obtain certain procedures or even if they were truly necessary. One example from 2012 demonstrated, for mammograms in the Boston area, an average cost of $310 per mammogram but a range from $176-$529 2. This information could have helped save a patient potentially hundreds of dollars had they had access to it. Unfortunately, at the time of writing this entry, these prices are often only obtainable with persistence, if at all.
The good news is that, as of January 1st, 2021, The Executive Order EO on Improving Price and Quality Transparency in American Healthcare to Put Patients First goes into effect 3. This will mandate all hospitals and providers to provide the standard prices for procedures and services. This includes both the gross price of all services and procedures, but also the amount charged to individual insurers 3. The most immediate benefit will be that it will allow patients to make financially informed decisions about non-urgent services. One big caveat is that while this executive order will provide information about cost, it will not include any information regarding the quality or value that any particular institution may provide. Some information regarding quality of an individual organization can be found at Medicare.gov 4. While competitive pricing is critical to help stabilize or even decrease the cost of health care, one should be careful to measure it carefully with the quality of the health care obtained.
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- 1.”National Health Expenditures 2018 Highlights”. National Health Expenditure Data : Historical. Centers for Medicare & Medicaid Services. December 2019. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.
- “Provider Price Variation: For Mammography Services in the Commercial Market”. Center for Health Information and Analysis. October 2014. https://www.chiamass.gov/assets/docs/r/pubs/14/rp-mammography-chartbook.pdf
- Postma, Terri MD and Grimsley, Heather. “Hospital Price Transparency Final Rule”. Medical Learning Network. Center for Medicare & Medicaid Services. December 2019. https://www.cms.gov/files/document/2019-12-03-hospital-presentation.pdf
- “Hospital Compare”. HealthCare.gov. https://www.medicare.gov/hospitalcompare/search.html