TUESDAY, Dec. 5, 2017 — The cards seem to be stacked against anyone who’d like to use the internet to become a smarter health care consumer.
A new study has found that people searching online to figure out how much they’ll pay for a medical procedure will come away disappointed most of the time, said lead researcher Allison Kratka. She’s a medical student at Duke University in Durham, N.C.
“Fewer than 1 in 5 websites actually yielded a local price estimate that was relevant to the health care procedure in question,” Kratka said.
To help halt the rising cost of health care, Kratka said, patients are being encouraged to learn more about the prices of medical procedures they need. However, it’s unclear whether the resources exist to help people gain a real understanding of what a procedure costs and what they would have to pay out-of-pocket, she said.
To see whether the internet is of any use, Kratka and her fellow researchers used the search engines Google and Bing to look for price information in eight U.S. cities on four non-emergency medical treatments — a cholesterol blood test, a brain MRI, a hip replacement and an upper gastrointestinal endoscopy.
“We chose those because, when you’re having a heart attack, you’re not going to be searching which ER to go to,” Kratka said. “We wanted to pick procedures where it was actually possible to shop around for them.”
The researchers found that very few websites available to consumers offer price transparency, meaning they provided cost information on the procedure in question.
Of 1,326 websites identified by the search engines, only 1 of 5 were price transparency sites. The rest led consumers to websites for specific providers and clinics, provided generic information about the procedure or rated quality but did not note cost.
Overall, just 17 percent of websites provided price estimates for procedures in specific cities, the researchers found. The proportion of websites with this information varied from city to city, ranging from 27 percent of search hits in Chicago to 7 percent in Baltimore.
Also, most websites did not specify whether the price quoted was the total cost of the procedure or just the money that the consumer would have to shell out, the researchers said.
Dr. Ira Nash, senior vice president and executive director of Northwell Health in New Hyde Park, N.Y., said he was not surprised by the findings.
Health insurance companies often negotiate a set of fixed prices with hospitals and doctors, Nash explained. To know how much they will pay, consumers would need to find out the negotiated cost of the procedure, how much of that cost would be covered by their plan, how much of any deductible they’ve already spent and whether the specific procedure would be a covered benefit either in or out of network, he said.
“It’s almost meaningless to say providers should post their list price because nobody pays that,” Nash said. “If you really want to expose patients to what they’re going to have to spend, you have to provide a lot more detail about what insurance coverage they have.”
Another hiccup is that health care providers are not legally permitted to share the prices they’ve negotiated with different insurance companies, lest they be accused of price fixing, Nash added.
“There are some legal barriers that are not insignificant,” he said.
However, Nash agrees that everyone should be able to get a good estimate on how much their health care is going to cost.
“Why should you be committed to a course of action and not be fully informed of what the implications are going to be for your pocketbook?” he said.
Right now, the best source of cost information is a person’s insurance company, and Nash said some insurers have started to share price information as a means of steering patients to more affordable options.
Kratka argues that state governments could pass laws mandating the establishment of claims databases that would reveal the actual cost of procedures. They also could support and market state-run health care price transparency websites.
“We need to promote health care policies that make it easier for consumers to learn the price of their care,” she said.
The research team’s findings were published online Dec. 4 in JAMA Internal Medicine.
The U.S. government’s HealthCare.gov website has more on understanding the total cost of health care.
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Posted: December 2017
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