January 26, 2015 News

Price Transparency in Health Care

When you walk into a store, do you purchase the first item you see that meets your needs? Probably not. Depending on what kind of consumer you are, maybe you go from store to store, look for online deals, wait for sales, or comparison shop to get the best value for the lowest price. Likewise, if you inquire about the cost of a particular item, the salesperson will tell you before you commit to the purchase. You’ve probably never been in a retail situation where you had no idea what an item costs until after the purchase is made and a bill arrives.

So, why is health care any different? It’s accepted that when you walk into a doctor’s office or hospital, you receive services without asking about the cost. Rarely would a provider offer information about a specific dollar amount before rendering treatment. We also accept that we’ll undergo our medical visits and procedures, but that we won’t really know the cost until after the fact. Why is this OK in the health care world but not for any other service that we purchase?

High-deductible plans: one pathway to cost-consciousness

Up until recently – the last few years to be exact – the cost for, say, an X-ray was practically irrelevant. You went to the doctor, paid your copay, and the health insurance plan took care of the rest, right? Well, maybe. You could be among the growing number of people who are now covered through a high-deductible plan. These plans are designed to enable the consumer to take a more active role in their health care by encouraging them to consider cost and quality before receiving services. Because these plans require consumers to pay for things like doctor visits and prescription drugs out of their own pockets, the costs for these services are top of mind and are more carefully weighed.

In 2014, about a quarter of employers in this country that offer health care coverage gave employees the option for a high-deductible product. In 2015, more than half of American employers are offering a high-deductible plan as the only choice.

Price transparency: getting there but still a ways to go

With an increase in plans that promote more cost-consciousness, most people are choosing to receive fewer health care services, which, in theory should result in lower costs. Instead, health care inflation and spending are escalating due to the rising costs of specialty pharmaceuticals, provider consolidations, and the increased use of high-tech imaging and genetic testing. Now that more and more Americans are footing the bill for these expensive services, they want to fully understand how much their health care will cost. This means the demand for greater price transparency is growing louder.

I do think that we can get to a place where high-quality, cost-transparent care is available so that you can make smart decisions about your health care costs – just like you do when you shop for anything else. Fortunately, a number of public and private organizations have begun the process of collecting data, including costs, quality ratings, and patient satisfaction stats, and are making it accessible for consumers. However, more needs to be done.


Photo by geralt / CC0 Public Domain

John D. Bennett, MD, FACC, FACP
About the Author

John D. Bennett, MD, FACC, FACP, is president and CEO of Capital District Physicians’ Health Plan, Inc. (CDPHP), an award-winning, physician aligned, not-for-profit health plan based in Albany, NY. Bennett has held the position since 2008 after serving more than 10 years as chair, vice chair, and board member for CDPHP. During his tenure, CDPHP has been ranked among the top-performing health plans in New York and the nation, most recently named #1 in Customer Satisfaction in the 2023 J.D. Power Member Health Plan Study. Under his leadership, CDPHP has also become known as a model employer regionally and nationally and was recently named among the top five Best Companies to Work for in New York by the Society for Human Resource Management, as well as Forbes Best-in-State Employers 2022. Prior to joining CDPHP, Bennett served as founding member and CEO of Prime Care Physicians, PLLC. During his tenure, he co-led a team of 25 cardiologists and helped grow the practice to a 100-physician multi-specialty group. Bennett is board certified by the National Board of Medical Examiners and the American Board of Internal Medicine, with subspecialties in internal medicine and cardiology. He earned his medical degree at SUNY-Downstate Medical Center, Brooklyn, and a Bachelor of Science degree at Rensselaer Polytechnic Institute. Bennett completed an internship and residency in internal medicine and a fellowship in cardiovascular disease at Albany Medical Center. He is a Fellow of the American College of Cardiology and the American College of Physicians. Bennett is currently board chair for the Center for Economic Growth and the Capital Region Chamber, and vice chair for the Palace Theatre. Bennett also serves on the boards of the New York eHealth Collaborative (NYeC), the Alliance of Community Health Plans (ACHP), America’s Health Insurance Plans (AHIP), Rensselaer Polytechnic Institute, and Russell Sage Colleges. Bennett is a member of the New York Public Health and Health Planning Council where he helps shape decisions related to New York State's public health and health care delivery system. Well-known locally and nationally for advancing health care innovation, Bennett was recently named to Crain’s New York Business 2021 Notable in Health Care, as well as the Albany Business Review’s Power 50 list.

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