Insurers, Providers Address Health Care Price Transparency
Although many health insurers are "aggressively marketing medical policies with high deductibles" in an effort to make enrollees more cost-conscious about their care, "basic data about what services cost generally aren't available," leaving consumers with "more financial responsibility for their care but without the tools to manage these expenses," the Chicago Tribune reports. Breaking through the health care industry's "strong tradition of secrecy" and "enormously fragmented" data has been a significant obstacle, the Tribune reports.
To help open this information gap, Medicare this spring began posting on the Internet what it pays for 30 commonly performed hospital procedures, and similar data for ambulatory surgery is expected to be released later this year.
Meanwhile, 32 states have passed laws that require hospitals to report what they charge for various procedures, according to an April survey by the American Hospital Association. However, many states' efforts are "hobbled by a notable shortcoming: The data will reflect the list prices for medical procedures, not the discounted rates negotiated by insurance companies on behalf of their customers," according to the Tribune.
Larry Boress, president of the Midwest Business Group on Health, said, "The market just isn't ready yet to deliver on the promise of these new insurance products."
The "greatest impetus for change," the Tribune reports, is "coming from insurance companies eager to sell new policies and gain a competitive advantage in the evolving marketplace." Insurers are using methods such as rating hospitals on cost efficiency and quality of care, developing calculators to allow consumers to estimate their out-of-pocket costs, and providing data to enrollees about negotiated prices for services.
The Tribune notes that while providers "support transparency in principle," they also are concerned that the pricing and quality data could be misinterpreted (Graham , Chicago Tribune, 8/10).