How Might Patients and Physicians Use Transparent Health Care Prices to Guide Decisions and Improve Health Care Affordability?
Year: 2022
Type: article
Abstract: Many Americans face high cost-sharing demands from their health insurers.While there is hope that prices for health services are becoming more and more transparent, even increased availability of price information will not always translate into optimal, equitable health and financial outcomes for patients.This commentary on a case argues why transparent pricing is an ethical imperative and identifies steps that health sector stakeholders should take to help patients and clinicians use pricing information to inform health decision making.Case NN is a 54-year-old woman with congestive heart failure, type 2 diabetes, hypertension, and chronic kidney disease who is enrolled in a marketplace health insurance plan with a $6000 annual deductible.Last year, NN was hospitalized for decompensated heart failure.Her out-of-pocket (OOP) expenses for this hospitalization were high, which led to increased credit card debt and required her to spend less on food.Thus, even when NN experiences shortness of breath and leg swelling, she is reluctant to refill her prescribed diuretic.Furthermore, because of her concerns about the costs of her care, she often does not attend follow-up appointments with her physicians and only occasionally completes the laboratory testing they recommend.In her local newspaper, NN reads that hospitals are now required to publicly report to patients their negotiated prices for health care services.She is curious about this information and wonders if it could help with her financial concerns, but she isn't sure where to find this information or how to use it. CommentaryTo benefit from price transparency, NN and the clinicians caring for her should discuss NN's insurance deductible, confirm indications for and the necessity of recommended services, canvass which necessary services should have their quality and prices compared in NN's regional market, and consider challenges that could emerge if NN were to receive services at different locations.Using OOP cost estimates from NN's health plan for medications, routine labs, and nonurgent imaging studies (eg, transthoracic echocardiograms), NN's clinicians could revisit her hesitancy to pursue treatment in light of the affordability of available options.Although the kind of The people and events in this case are fictional.Resemblance to real events or to names of people, living or dead, is entirely coincidental.The viewpoints expressed in this article are those of the author(s) and do not necessarily reflect the views and policies of the AMA.This article is the sole responsibility of the author(s) and does not necessarily represent the views of the of the US Department of Veterans Affairs or the US government.
Source: The AMA Journal of Ethic
Language: English
Subfield: Economics and Econometrics
Domain: Social Sciences
Open Access status: diamond
Funders: U.S. Department of Veterans Affairs, Robert Wood Johnson Foundation, Patrick and Catherine Weldon Donaghue Medical Research Foundation, Michigan Department of Military and Veterans Affairs, Patient-Centered Outcomes Research Institute, Health Services Research and Development, National Pharmaceutical Council, Arnold Ventures, National Institutes of Health, Agency for Healthcare Research and Quality, Centers for Medicare and Medicaid Services
OpenAlex ID: W4308639322