Several years ago one of my family members developed a respiratory tract infection that required an antibiotic. The prescription for a generic drug was called to the pharmacy of record and I went to pick it up. The pharmacy technician, smiling sweetly, looked at me and said, “That will be $108,” paused, then added, “Do you still want the medicine?” Taken aback my first thought was, “But I have private health insurance with pharmacy benefits…”; it turned out the $108 was my copay! My second thought, as I pulled out my credit card, was, “I can afford this, but how many people couldn’t and would have to walk away thereby risking their health even more?” The third thought was, “This was a (expletive) generic!”
With the above vignette in mind let’s now scoot down the rabbit hole of “transparency in medical pricing”, the new buzzword/slogan of the day on how to reduce the cost of medical care. Now don’t get me wrong, I’m all for it. But don’t think for a moment it will be the panacea for bringing down health care costs. So here’s my perspective.
Diagnostic radiologic tests, such as MRI’s, CT scans, mammography, ultrasound testing and the like should be amenable to this type of strategy. Just be sure you are willing to drive to wherever the best price is, that the study itself (not just the report) would be available to your physician to review if so desired and, if insured, that your insurance covers (at least some of) the cost.
Another area where there may be promise is for elective surgical procedures. Lasik eye surgery and cosmetic procedures are examples touted as to how price transparency can lead to greater competition and falling prices. Price compare that total knee/hip/shoulder replacement and review the quality metrics of the hospital and surgeon. Elective hernia repair, gallbladder surgery, open heart surgery–go for that comparison and priceline! Time is on your side to make an informed choice. But what happens when the best hospital or surgeon isn’t a participating provider in your health insurance? “Do you still want the medicine…” or are you willing to settle for less? It is one thing to forgo getting your nearsightedness corrected but that debilitating painful arthritic hip, bothersome hernia, or pesky coronaries are something else.
What happens if a surgical procedure isn’t quite elective? I once experienced abdominal pain severe enough for me to show up in an emergency room on a Friday evening. Evaluation lead to the finding of a severely diseased gallbladder with the recommendation for laparoscopic removal. Since it was not an overly acute situation, the surgeon would have given me the weekend “to think about it.” As I wasn’t feeling the best, I stayed and went ahead with the recommended surgery. From start to finish, ER, surgery, post-op recovery, my total stay in the hospital was 13 hours. My hospital bill was almost $40,000, a not insignificant chunk of which came out of my pocket. So, should have I gone home “to think about it?” If price transparency had been in place would I have availed myself of it–looked for competitive laparoscopic cholecystectomy “deals”?
What about the outpatient medical care side of things? In my first blog (Inaugural) I mentioned that my father was a family physician. At least until Medicare came into being his general office charge was $5 a visit ($7 if you got a shot) all the while seeing a lot of people and giving good service. If we had “price transparency” back then his rates would have been competitive and simple. Now in this day and age, it is anybody’s guess. There are currently 5 “levels” of medical office charges (level 1 the lowest; 5 the highest) depending on the complexity of the visit. Can the consumer really differentiate between the care provided at a level 3, 4, or 5 visit just by reviewing a priceline? By all means publish the prices but be sure quality metrics are displayed as well.
Last, but not least, is price transparency for drugs. I get it that big pharma has to make money to stay in business; I get it that patents run out; I don’t get the pricing. Fortunately there are already a variety of means to shop around for medications taken on a chronic or maintenance basis (e.g. antihypertensives, cholesterol lowering drugs, etc.). Drug discount websites are starting to pop up. I recently saw an ad in a local newspaper listing a wide variety of medications along with their prices from a Canadian website. As I perused the list and prices I wondered if these drug manufacturers were held to the same regulations that U.S. manufacturers are regarding drug safety, purity, bioavailability, and efficacy, or were the drugs purchased at a discount here in the U.S., shipped to Canada, then resold to U.S. customers. And how do you deal with the 4, 5, 6, or, now, 7 figure drug prices (think biologics, think chemotherapy meds)? It may mean speaking with your physician to see if that 6 figure drug can be replaced with a 5 figure drug with the same efficacy. It may mean a lot of bake sales or mortgaging the house or asking…”do you still want the medicine?” What about a drug that is needed for an acute problem (e.g. acute bronchitis)? Do you ask for a prescription that you can hand carry (meaning first a trip to the doctor’s office) to a pharmacy after you “price compare” or just have the prescription phoned in (office visit or not) and hope there is no sticker shock?
Where does one find the pricing information? What comparisons will it have regarding individual vs. employer supplied vs. no insurance? Will it be published on local, regional, state, or federal websites? Newspaper? Town crier? And what if a given patient has no access computer? And what if no one really avails themselves of the information? And will it truly lead to gradual price reductions?
So, have at it. It is at least a start. Every little bit helps to pull back the curtain on health care costs. Review those posted prices but don’t think it will revolutionize pricing. I suggest to you a recent piece in the Wall Street Journal (“Posting Health Prices Online Isn’t Cure-all; June 27, 2019; A5) for a nice summary of where we are with price transparency. Then go one step further and look at a one or two of the State websites listed in the article–eye-openers! Then decide if we’re down the rabbit hole.
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