People should be able to view cost information that reflects what they will need to pay for health care services. Providing consumers with meaningful and actionable information about the cost and quality of medical services is critical to better health care decision-making.
What information is most helpful to consumers?
Consumer research shows clearly that people want information on their out-of-pocket expenses, including copays and cost-sharing amounts. Consumers’ out-of-pocket costs are dependent on their plan’s benefit design and provider network, and will vary based on this context.
Cost information also should focus on services that are most “shoppable”–for example, non-emergency and non-critical services and diagnostic procedures–that consumers are most likely to research before obtaining care.
What is Congress doing to promote greater transparency about costs?
Currently, there are a variety of proposal being considered by Congress and the administration to provide consumers with greater access to cost information to help them make the best choices for their care.
For example, lawmakers have introduced proposals to publish “walk-in” prices for services for patients who do not have insurance. There also are efforts to encourage health plans to put in place cost-estimator tools that provide information to consumers about their out-of-pocket costs, including copays, cost-sharing amounts and deductibles. For example, you can read about Blue Cross and Blue Shield companies’ consumer tools here.
How can we ensure consumers benefit from greater transparency about costs?
It is critical to educate consumers on the availability of cost-estimator and transparency tools, and let them know that a higher price does not always mean higher quality. This will help consumers make more informed decisions on their care. It also is important to develop tools to improve health literacy and education so consumers understand the meaning of key terms like copay and deductible, and know how to use them effectively.
What about requiring public disclosure of the negotiated rates between health insurance companies and doctors and hospitals?
To be most beneficial, information provided to consumers should be within the context of their own health benefits. Public release of a negotiated rate between a health plan and the hospital does not inform a person about what they personally will pay for a service. In fact, this information could lead to health care cost increases and distortions in market competition. This is because requiring public disclosure of negotiated prices could undermine the ability of health insurance companies to effectively negotiate with medical professionals to secure competitive rates on behalf of consumers.
Learn more about BCBSA’s positions on health care cost transparency here.