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Wednesday, February 19, 2014

Patients Not Comparison Shopping for Health Services Despite Increasing Price Transparency

By Rajesh Harrykissoon, MD

Wish you could comparison shop for your health care? What if the same study or lab work was 40% cheaper across town versus the lab you typically use? Would you drive across town to get a lower price? Medicare and many insurers assumed yes.

However, despite increasing price transparency there is little evidence that patients are actually value shopping as we do for cars, blenders and clothes.

Bert Marshall, president of Blue Cross and Blue Shield of Texas, reported at the Texas Medical Association 2014 Winter Conference in Austin, TX that BCBS's Blue Value Adviser program's price transparency tool was so poorly utilized by patients that they were surprised and are looking to re-purpose the service.  BCBS now intends to shift the focus of this price transparency service from patients to their physicians. They hope that physicians may utilize the price information and counsel their patients regarding where to obtain that x-ray for a lower price.

The question is why don't we comparison shop for health care?

One possibility is access to such information. However, information alone does not appear to be sufficient. For example, we know that despite more restaurants disclosing calorie counts on their menus or placing green leaves and red hearts beside healthier options, this has not curbed the obesity epidemic.  Thus, more information did not change behavior.

Another possibility is perceived quality of care. Patients may presume that the lab their physician uses must be of better quality. 

Yet another option is that of convenience.  The lab in the clinic lobby which we pass on your way out offers convenience. Or, our doctor's office may be able to directly see an x-ray image from an imaging center next door but not from one across town, thus, patients may defer to the convenience of the doctor's office.

A significant barrier may be the absence of tools which allow a comparison of cost AND quality across multiple carriers. Comparators for cost exist and comparators for quality exist but not for both combined. 

DrRajHealth: What do you see as barriers to using price comparison in your health care?

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