If you want to buy a new car, you can probably figure out a price range within a matter of minutes with a google search. The same is true for many other products. But in health care, forget it.
In a new study published today in JAMA Internal Medicine, researchers called more than 100 hospitals across the country. They included a range of both top-ranked centers and community hospitals and inquired about a common elective surgical procedure — a hip replacement — for a fictitious 62-year-old grandmother.
First off, only 10 percent of the non-top-ranked hospitals and 45 percent of the top-ranked hospitals were even able to provide a price. Researchers were a bit more successful when they called the hospital and physician separately.
And just what was the price range? $11,100 on the low end to $125,000 on the high end.
“Patients seeking elective (hip replacement) may find considerable price savings through comparison shopping,” the authors write. No kidding — except that half of the institutions couldn’t even provide a price.
Americans hear over and over that they must be better consumers of health care, but it’s pretty tough when information can be so hard to get or difficult to interpret. Maybe you can get crash data on that new car you want to buy, but it can be tougher to get information about quality for a health care procedure than it is to get a price.
“Without quality data to accompany price data, physicians, consumers, and other health care decision makers have no idea if a lower price represents shoddy quality or if it constitutes good value,” say medical ethicist Ezekiel Emanuel and Andrew Steinmetz in an accompanying commentary they co-wrote. “And, since patients are reluctant to cut corners when it comes to their health and the health of their family members, they are liable to falsely assume — as they do in other markets — that higher prices correlate with higher quality.”
Emanuel opens his commentary with a brief history of trying to buy a car in the 1950s, how buyers were completely at the mercy of dealers, that little quality data was available. It took an act of Congress in 1958 to force car dealers to display the now-ubiquitous MSRP to the window of every new car for sale.
“The history of the automobile industry shows that information asymmetry is treatable,” Ezekial and Steinmetz conclude. “Health care will need to travel down a similar path. It is time we stop forcing people to buy health care services blindfolded — and then blame them for not seeing.”
We’re still in the infancy of transparency of cost and quality information. Sites like ClearHealthCosts have pricing information on a number of common procedures. CalPERS — the California Public Employees Retirement System — looked at its own claims for knee and hip replacement. It, too, found a range of $15,000 to $110,000. In 2011 CalPERS set a threshhold price of $30,000 for a hip or knee replacement. A CalPERS spokesperson says they made sure its approved facilities met a quality standard.
We have a long way to go. In the meantime, caveat emptor.