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Figure 1.
Categories of Websites Encountered When Searching for Price Information
Categories of Websites Encountered When Searching for Price Information

Price transparency sites are defined as sites whose goal it is to provide consumers with prices, often across multiple physicians. This includes state-run websites. Single physician/clinic websites are defined as sites for specific physicians, laboratory facilities, imaging centers, clinics, or hospitals. Quality-only sites are defined as sites that only provide quality information about either a provider, clinic, or hospital. No price information. Generic relevant information sites provide general information about either price transparency or the intervention in question, but without price information. Unrelated sites are sites that present information unrelated to the search.

Figure 2.
Availability of Price Information by Intervention
Availability of Price Information by Intervention

The number indicates the number of websites in the first 2 pages with a price in the geographic region queried.

1.
United States Government Accountability Office. HEALTH CARE PRICE TRANSPARENCY: Meaningful Price Information Is Difficult for Consumers to Obtain Prior to Receiving Care.; 2011. http://www.gao.gov/assets/590/585400.pdf.
2.
Public Agenda. Still Searching: How People Use Health Care Price Information in the United States, New York State, Florida, Texas and New Hampshire; 2017. https://nyshealthfoundation.org/uploads/resources/how-people-use-health-care-price-information-full-report.pdf. Accessed October 10, 2017.
3.
Robinson  JC, Whaley  C, Brown  TT.  Association of reference pricing for diagnostic laboratory testing with changes in patient choices, prices, and total spending for diagnostic tests.  JAMA Intern Med. 2016;176(9):1353-1359.PubMedGoogle ScholarCrossref
4.
Phillips  KA, Labno  A.  Private companies providing health care price data: who are they and what information do they provide?  J Manag Care Med. 2014;17(4):75-80.PubMedGoogle Scholar
5.
Reinhardt  UE.  The pricing of U.S. hospital services: chaos behind a veil of secrecy.  Health Aff (Millwood). 2006;25(1):57-69.PubMedGoogle ScholarCrossref
6.
Sinaiko  AD, Chien  AT, Rosenthal  MB.  The role of states in improving price transparency in health care.  JAMA Intern Med. 2015;175(6):886-887.PubMedGoogle ScholarCrossref
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Research Letter
Health Care Reform
March 2018

Finding Health Care Prices Online—How Difficult Is It to Be an Informed Health-Care Consumer?

Author Affiliations
  • 1School of Medicine, Duke University, Durham, North Carolina
  • 2Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina
  • 3Duke Clinical Research Institute, Duke University, Durham, North Carolina
  • 4Duke University, Durham, North Carolina
  • 5Fuqua School of Business, Duke University, Durham, North Carolina
  • 6Sanford School of Public Policy, Duke University, Durham, North Carolina
JAMA Intern Med. 2018;178(3):423-424. doi:10.1001/jamainternmed.2017.6841

In the US health care system many patients face high out-of-pocket expenses because they either lack insurance or have enrolled in plans that carry high deductibles, coinsurances, or copays.1,2 Although some experts contend these higher expenses will incentivize patients to be savvy shoppers and scrutinize the cost of their care, patients require easy access to health care prices to be cost-conscious consumers.2 In this study, we used a systematic approach to describe what consumers find when they search for health care prices online, and to determine the availability of price information for common medical interventions.

Methods

We assessed the availability of price information for 4 nonemergency medical interventions (cholesterol panel, magnetic resonance imaging [MRI] of the brain without contrast, hip replacement and upper gastrointestinal [GI] endoscopy) using online search engines (Google and Bing). We conducted searches for 8 US cities (New York, New York; Los Angeles, California; Chicago, Illinois; Seattle, Washington; Baltimore, Maryland; Charlotte, North Carolina; Manchester, New Hampshire; and Tallahassee, Florida), using the search terms “cost of (intervention) in (city).” Results included 1726 websites from 64 searches (4 procedures in 8 cities on 2 search engines). We categorized the websites that appeared first on the top 2 pages of search results as either: price transparency sites, single physician/clinic sites, quality-only sites, generic relevant information, or unrelated sites. For each site, we determined whether relevant health care prices (for the specific intervention and for the requested geographic region) were present, and if so, recorded the first available price or price range.

Results

Of the 1726 websites, 1346 were not advertisements. Of these, 295 (21.9%) were price transparency sites relevant to the intervention in question; 382 (28.4%) linked to single providers/clinics; 63 (4.7%) provided quality information without prices; 371 (27.6%) provided generic information; and 234 (17.4%) provided unrelated information. The categories of search results differed significantly across health care interventions (χ = 236; P < .001) (Figure 1).

Overall, only 234 (17%) of sites provided geographically relevant price estimates, with the proportion varying significantly by intervention (χ = 22.9; P < .001) (Figure 2). The proportion of websites providing at least 1 geographically-relevant price estimate also differed by location (χ = 34.4; P < .001), ranging from 47 (27.3%) in Chicago to 12 (7.1%) in Baltimore.

Although prices listed on the sites varied widely within interventions, most websites did not specify whether the price quoted was the consumer’s out-of-pocket cost. As an example, when searching for prices in Chicago, upper GI endoscopy prices ranged from $875 to $3958, brain MRIs from $230 to $1950, cholesterol panels from $25 to $100, and hip replacements from $27 000 to $80 671.

Discussion

When searching for health care prices online, less than 1 in 5 websites yield local price estimates relevant to the intervention in question. This informational deficiency exists despite increased calls for price transparency and rising numbers of price transparency websites, reference pricing projects, and private insurer tools.3 Moreover, few price transparency websites showed up in searches (either state or privately run) and most were only available for users with subscriptions.4 This finding may indicate that price transparency websites have not optimized their position in search results, or that insurers and health care providers have little incentive to release their negotiated prices.5

Our findings suggest that there is substantial room for improvement in providing consumers with ready access to health care prices online. Policy makers should consider mandating that payers and providers make these prices available to consumers.6 Specific policies include mandating state all-payer claims databases, and better supporting and marketing state-run price transparency websites, such as the one in New Hampshire. Given the increasing number of Americans facing high out-of-pocket health care expenses, we need to promote policies that make it easier for them to determine the price of their medical care in time to inform their health care choices.

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Article Information

Corresponding Author: Allison Kratka, BA, 8 Duke University Medical Center Greenspace, Duke University School of Medicine, Durham, NC 27708 (akk19@duke.edu).

Accepted for Publication: September 28, 2017.

Published Online: December 4, 2017. doi:10.1001/jamainternmed.2017.6841

Author Contributions: Ms Kratka and Dr Wong had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Kratka, Wong, Herrmann, Hong, Ubel.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Kratka, Wong, Herrmann, Hong, Karediya, Ubel.

Critical revision of the manuscript for important intellectual content: Kratka, Wong, Yang, Ubel.

Statistical analysis: Kratka, Wong, Ubel.

Administrative, technical, or material support: Kratka, Herrmann.

Study supervision: Kratka, Wong, Ubel.

Conflict of Interest Disclosures: None reported.

Funding/Support: Financial support for this study was provided in part by the Duke-Margolis Center for Health Policy.

Role of the Funder/Sponsor: The Duke-Margolis Center for Health Policy had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We thank Anna Sinaiko, PhD, Harvard T.H. Chan School of Public Health, for comments on an earlier draft. Research and writing support for this study were provided by Annabel Wang, BS, Harvard Medical School. They were not compensated.

References
1.
United States Government Accountability Office. HEALTH CARE PRICE TRANSPARENCY: Meaningful Price Information Is Difficult for Consumers to Obtain Prior to Receiving Care.; 2011. http://www.gao.gov/assets/590/585400.pdf.
2.
Public Agenda. Still Searching: How People Use Health Care Price Information in the United States, New York State, Florida, Texas and New Hampshire; 2017. https://nyshealthfoundation.org/uploads/resources/how-people-use-health-care-price-information-full-report.pdf. Accessed October 10, 2017.
3.
Robinson  JC, Whaley  C, Brown  TT.  Association of reference pricing for diagnostic laboratory testing with changes in patient choices, prices, and total spending for diagnostic tests.  JAMA Intern Med. 2016;176(9):1353-1359.PubMedGoogle ScholarCrossref
4.
Phillips  KA, Labno  A.  Private companies providing health care price data: who are they and what information do they provide?  J Manag Care Med. 2014;17(4):75-80.PubMedGoogle Scholar
5.
Reinhardt  UE.  The pricing of U.S. hospital services: chaos behind a veil of secrecy.  Health Aff (Millwood). 2006;25(1):57-69.PubMedGoogle ScholarCrossref
6.
Sinaiko  AD, Chien  AT, Rosenthal  MB.  The role of states in improving price transparency in health care.  JAMA Intern Med. 2015;175(6):886-887.PubMedGoogle ScholarCrossref
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