Original article http://ebn.benefitnews.com
Thirty-six of the nation’s 50 states received either a “D” or an “F” in a report card, issued by two nonprofit organizations, measuring the strength of health care price transparency laws.
“We know from studies that the price for an identical health care procedure performed in the same city can vary by as much as 700%, with no difference in quality,” said Francois de Brantes, executive director of Health Care Incentives Improvement Initiative, or HCI3. “When consumers shop for value, they can help rein in health care costs; but to do this, they first need timely and actionable price information.”
Burden placed on consumer
The report card, developed by Catalyst for Payment Reform and HCI3, examined multiple factors in arriving at a 100-point scale.
Those factors include levels of price transparency such as:
* Pricing information reported to the state only.
* Pricing information available upon request by an individual consumer.
* Pricing information available in a public report.
* Pricing information available via a public website.
The report card also measured scoring criteria by scope, including:
* Scope of price, including charges, average charge, amount paid by the insurer and amount paid by the consumer (allowed amount).
* Scope of services covered under the law, including all medical services, inpatient services only, outpatient services only, or the most common inpatient and outpatient services.
* Scope of providers affected by the law, including hospitals, physicians and surgical centers.
The groups calculated a score for each level separately and then factored a sum for a total score out of 100 possible points. Every state received a cumulative additive score, taking into account all relevant laws passed in that state. Thus, grades do not reflect individual statutes or bills, but rather each state’s overall legislative effort toward price transparency for health care.
The sponsors of the report say the majority of states have very basic laws requiring average charges to be made public, but charges do not reflect what consumers, employers and health plans actually end up paying for care. In many cases, the information is only available upon request, placing a considerable burden on the consumer.
States have duty to protect
“It should be concerning to every lawmaker in the country that 18% of the U.S. economy is shrouded in mystery,” de Brantes said. “Without price information, how can we possibly expect consumers to act in a value-conscious way? It is a duty of every state to protect its residents from unfair trade practices, and healthcare consumers are, for the most part, completely left to fend for themselves.”
This story originally appeared in Health Data Management, a SourceMedia publication.