Key PointsQuestion
How well do US hospitals’ online prices posted for shoppable services correlate with their prices for the same service obtained via the telephone?
Findings
In this cross-sectional study of 60 US hospitals, online and phone cash prices were poorly correlated within a given hospital for vaginal childbirth (Pearson correlation coefficient [r] = 0.118) and brain magnetic resonance imaging (Pearson r = −0.169).
Meaning
These findings suggest that at US hospitals, price estimates for shoppable services posted online correlate poorly with prices obtained via phone; these findings suggest that patients will continue to face barriers to comparison shopping.
Importance
US hospitals are required to publicly post their prices for specified shoppable services online. However, the extent to which a hospital’s prices posted online correlate with the prices they give to a telephone caller is unknown.
Objective
To compare hospitals’ online cash prices for vaginal childbirth and brain magnetic resonance imaging (MRI) with prices offered to secret shopper callers requesting price estimates by telephone.
Design, Setting, and Participants
This cross-sectional study included cash online prices from each hospital’s website for vaginal childbirth and brain MRI collected from representative US hospitals between August and October 2022. Thereafter, again between August and October 2022, simulated secret shopper patients called each hospital requesting their lowest cash price for these procedures.
Main Outcomes and Measures
We calculated the difference between each hospital’s online and phone prices for vaginal childbirth and brain MRI, and the Pearson correlation coefficient (r) between the online and phone prices for each procedure, among hospitals able to provide both prices,
Results
A total of 60 representative US hospitals (20 top-ranked, 20 safety-net, and 20 non–top-ranked, non–safety-net hospitals) were included in the analysis. For vaginal childbirth, 63% (12 of 19) of top-ranked hospitals, 30% (6 of 20) of safety-net hospitals, and 21% (4 of 19) of non–top-ranked, non–safety-net hospitals provided both online and telephone prices. For brain MRI, 85% (17 of 20) of top-ranked hospitals, 50% (10 of 20) of safety-net hospitals, and 100% (20 of 20) of non–top-ranked, non–safety-net hospitals provided prices both online and via telephone. Online prices and telephone prices for both procedures varied widely. For example, online prices for vaginal childbirth posted by top-ranked hospitals ranged from $0 to $55 221 (mean, $23 040), from $4361 to $14 377 (mean $10 925) for safety-net hospitals, and from $1183 to $30 299 (mean $15 861) for non–top-ranked, non–safety-net hospitals. Among the 22 hospitals providing prices both online and by telephone for vaginal childbirth, prices were within 25% of each other for 45% (10) of hospitals, while 41% (9) of hospitals had differences of 50% or more (Pearson r = 0.118). Among the 47 hospitals providing both online and phone prices for brain MRI, prices were within 25% of each other for 66% (31) of hospitals), while 26% (n = 12) had differences of 50% or more (Pearson r = −0.169). Among hospitals that provided prices both online and via telephone, there was a complete match between the online and telephone prices for vaginal childbirth in 14% (3 of 22) of hospitals and for brain MRI in 19% (9 of 47) of hospitals.
Conclusions and Relevance
Findings of this cross-sectional study suggest that there was poor correlation between hospitals’ self-posted online prices and prices they offered by telephone to secret shoppers. These results demonstrate hospitals’ continued problems in knowing and communicating their prices for specific services. The findings also highlight the continued challenges for uninsured patients and others who attempt to comparison shop for health care.