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September 5, 2019

What Is the Value of Market-Wide Health Care Price Transparency?

Author Affiliations
  • 1Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
JAMA. 2019;322(15):1449-1450. doi:10.1001/jama.2019.11578

A primary driver of high spending in the US health care system, relative to other countries, is the higher prices paid for health care in the United States. Part of what sustains these high prices is that health care prices are largely opaque.1,2 The goal of price transparency is to empower patients with new information so they can consider prices, along with quality, when making choices about when and where to receive health care. Ideally, such informed decision making would increase competition in the health care system, which in turn, would create incentives to lower prices or demonstrate value.

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    1 Comment for this article
    Practical Advice For Patients
    Teri Newman, MSN | None
    People have no idea the cost of their medical care because 9 out of every 10 dollars spent on medical care is paid by someone other than the patient. It took me nearly 2 weeks to find out the cash price of an MRI which turned out to be cheaper than my own co-pay: the MRI the hospital sold my insurance company was $5000.00, the cash price was $500 and my co-pay is 20% so by persisting and forcing them to tell me the cash price, I saved $500. That is why we need price transparency. The corruption in pricing and drug kickbacks from "pharmacy benefit managers" is rampant and everyone pays for it. Surprise billing is fairly easy to avoid by refusing treatment from any provider not on your plan--and write it on the admitting form after crossing out the part where they say they will gap bill you. You also do not have to accept financial liability for gap billing -- cross that part out too. You cannot be refused treatment for doing this because health systems are under contract to your insurance company to treat you for the price they agreed on when they signed the contract. If they refuse to treat you, call the number on the back of your card, tell your insurance company, and hand the health system representative the phone. They will be told by your insurance company that the patient does not have to accept financial liability and can refuse to allow treatment from a provider not on your plan. Also, the person who denied you gets a lecture on "contracted obligation" and "breach of contract" and "no more patients" in addition to possibly losing their job if they don't treat you. It also incurs liability to you as the patient for denial of care which is litigatable depending on the law where you live. Finding out the cash price is essential for consumers. People who won't tell you the cost of something are overcharging you. Bank on it.