Nov 22, 2019

Getting patients to price shop is hard

Caitlin Owens, author of Vitals

Illustration: Aïda Amer/Axios

The Trump administration argues its new price transparency rules will help patients shop for cheaper care and encourage insurers to make such shopping attractive.

Yes, but: Research shows most patients don't shop for care, even when tools exist to make it easier.

Driving the news: The administration proposed two price transparency regulations last week.

  • One finalized the requirement that hospitals disclose their negotiated prices.
  • The other proposed requiring insurers to do the same. It also would require insurers to make out-of-pocket spending information available to patients, which HHS says "would empower consumers to shop and compare costs between specific providers before receiving care."

The problem: Most patients haven't used cost-comparison tools when they've been made available in the past.

  • "It’s pretty difficult to get consumers to engage with price information and make decisions based on price information," said Sunita Desai, a professor at New York University.
  • These tools also don't lead to lower health spending, studies show.

The exception: Price transparency is more effective when paired with extra incentives to shop around — which the Trump administration addresses.

  • The proposed rule would allow insurers to count the savings generated by price shopping toward their medical loss ratio.
  • This could nudge plans to create new incentives for enrollees, although this is only one of the reasons why insurers may have limited incentives to get patients to price shop.

None of this matters much in places where providers have monopolies, as patients don't have any choice about where they get their care and thus can't shop around.

The bottom line: "The norms around how we get health care — how we use the internet to make health care-related decisions — [have] been changing," Desai said.

  • "It’s possible that having this information out there could over time start to change the way people make decisions.”

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