Empowering Patients Through Health Care Price Transparency
Most of us know someone who has struggled with health care costs. Whether it is surprise medical billing, insurance deductibles or coverage limits, these situations can cause people to avoid or delay care. In a recent livestream, I discuss health care pricing and transparency with our guest, Kara Boeckel who has experienced the challenges due to costs associated with care.
Health care is a $4 trillion dollar industry in America, and we spend more per capita than any other country in the world. Because of this, legislators and policymakers are always looking for new ways to lower costs.
Health care is the only area of our economy where we are expected to “buy” a good or service without knowing the price. The issue of health care pricing is complicated by the fact that most of us have a third-party payer system. Unlike most other goods and services, health care is paid for by a third party—the insurer—and not directly from patient to provider. The result has been fewer patients shopping for the best quality at the lowest price.
In a recent guest column in The Orange County Register, I cited an example with Scripps Memorial Hospital in Southern California. A 2021 leak revealed Scripps was using computer software that automatically marked up the cost by 575-675%. Screenshots exposed items like anti-microbial solution were marked from $73.50 to $496.13 for patients. These egregious examples are prompting states to take action.
The Affordable Care Act required hospitals to post their prices online, however the Department of Health and Human Services is not enforcing these requirements and only 14% of hospitals are in compliance. As a result, many states are now passing hospital price transparency bills like those in Virginia and Colorado. These bills require hospitals to post the prices of their services and treatments online giving state authorities the ability to enforce compliance. With America’s collective medical debt of #195 billion, Americans need more information on the cost of their health care. Making costs transparent is the key to empowering patients and lowering the cost of care.