Trying to be an informed healthcare consumer in the United States is harder than you might think, according to researchers from the Duke-Margolis Center for Health Policy. When consumers search for healthcare prices online, only 17 percent of sites provide information on the price of common procedures, making it difficult for patients without insurance, who have high-deductible plans, or whose plans include other kinds of cost sharing to determine how much their care will cost and what they will pay out of pocket.
The study’s conclusions, published today as a research letter in JAMA internal medicine, are based on a systematic internet search using two search engines (Google and Bing) for the prices of four non-emergency medical procedures in eight cities: New York, Los Angeles, Chicago, Seattle, Baltimore, Charlotte, NC, Manchester, NH, and Tallahasee, FL. Researchers searched, and then repeated searches for validation, based on a fixed set of search terms focused on prices for a cholesterol panel lab test, a brain MRI, a hip replacement surgery and an upper gastrointestinal endoscopy.
The team then reviewed the resulting websites, and found that just over one fifth were focused on price transparency. When consumers are able to find sites that list geographically-relevant prices, they can vary widely and do not specify whether the price quoted was the consumer’s out-of-pocket cost – for example, in Chicago, sites listed costs from $25-100 for a cholesterol panel, $230-1950 for a brain MRI, $875-3958 for an upper GI endoscopy and $27,000-80671 for a hip replacement.
“Our findings really underline how difficult it can be to find the information patients need to be informed consumers,” said fourth year medical student, Allison Kratka, who was first author on the study. “It is labor intensive to find the sites, many require subscriptions, and the reliability of the pricing information contained in the sites is difficult to assess.”
“There is a disconnect between policies that seek to encourage people to be smarter consumers and the availability of information that allows them to make the most cost-effective decisions,” said Peter Ubel, MD, Madge and Dennis T. McLawhorn University Professor at Duke University’s Fuqua School of Business. “A handful of states, like New Hampshire, support and market price transparency web sites, and policy makers who want consumers to participate in controlling costs need to ensure that prices are available to the average person.”
Other study authors include Charlene Wong, MD, MSHP, Riley Herrmann, Kathryn Hong, Aleena Karediya, and Iris Yang, all of Duke University. Drs. Wong and Ubel are members of Duke-Margolis and Dr. Wong holds faculty appointments in the Duke University School of Medicine, Department of Pediatrics, and the Duke Clinical Research Institute.