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Massachusetts health care — wonky, with a healthy dose of reality

More on our Report Card of Insurer Consumer Cost Websites

More on our Report Card of Insurer Consumer Cost Websites

July 16, 2015

 

Globe Headline: Insurer's cost data websties lackingOur release last Tuesday of our first report card comparing the consumer cost transparency web sites of the three major insurers in Massachusetts (download and read it here) garnered lots of attention.

The Boston Globe's lead Metro story covered the report card, and HCFA ED Amy Whitcomb Slemmer was interviewed about it on Boston Neighborhood News:

 

The insurers cited in the report have all been upfront about the need to improve their sites. As Bill Gerlach, Blue Cross’s senior director of consumer engagement solutions, told the Globe, “It’s a work in progress.” Our report card shined a light on the numerous deficiencies we found, and we hope it will help focus their improvement efforts on the categories that matter to consumers.

It also raised a larger issue, about the role of consumer health care price comparison generally. For us, we think consumers have an absolute right to be able to find out in advance what a medical procedure will cost them. Particularly with the growth of high deductible plans, patients must have the ability to learn in advance what the out-of-pocket costs will be for a medical treatment.

Morover, some new research seems to indicate that more people want to use these tools than commonly assumed. The study by Public Agenda, How Much Will It Cost? How Americans Use Prices In Health Care (full report | summary) surveyed just over 2000 adults throughout the US last summer. Their findings went against many of the assumptions people have about consumers and health care cost comparisons:

  • 56 percent said they have tried to find out how much they would have to pay out of pocket—not including a copay—or how much their insurer would have to pay a doctor or hospital, before getting care. The proportion of those seeking out this information is higher among people with high deductibles. 67 percent of those with deductibles of $500 to $3,000 and 74 percent of those with deductibles higher than $3,000 have tried to find price information before getting care. 
  • About one in five —21 percent—say that when trying to find price information before getting care, they have compared prices across multiple providers. Among those who have compared prices across multiple providers, 62 percent believe that they have saved money, and 82 percent of those who have compared prices across multiple providers say they will do so again in the future. 

There's a lot more interesting findings in the Public Agenda study, and we encourage people interested in this issue to dig into the details. 

One issue that seems unresolved is the perceived relationship between cost and quality.  The Public Agenda survey found that 71 percent of Americans say higher prices are not typically a sign of better-quality medical care. Similarly, 63% said lower prices are not a sign of lower quality care. This apparently contradicts a 2014 survey conducted by the Associated Press-NORC Center For Public Affairs. The AP- NORC survey asked half of their survey sample if higher-quality health care usually comes at a higher cost, or if there is no real relationship between cost and quality. Nearly half (48 percent) say that higher quality comes at higher costs, 37 percent say there is no real relationship. Interestingly, the other half was asked an alternate question: whether lower-quality care comes at a lower cost. The results were not an exact mirror image of the first question. Fewer people recognized a relationship between lower-quality care and lower costs. Just about 3 in 10 (29 percent) said that lower-quality care comes at a lower cost, while the most common response was that there is no real relationship (46 percent). 

Here are the dueling graphics:

Public Agenda: 

Public Image survey finds little perceived connection between health care costs and quality

And here's the AP-NORC graphic:

AP-NORC survey finds perceived connection between health care costs and quality

Conclusion: More research is needed, but even more, more public education is needed. HCFA hopes to be a part of that process.

    - Brian Rosman