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Research Letters |

A Census of State Health Care Price Transparency Websites FREE

Jeffrey T. Kullgren, MD, MS, MPH; Katia A. Duey, MPH; Rachel M. Werner, MD, PhD
[+] Author Affiliations

Author Affiliations: Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (Dr Kullgren; jkullgre@med.umich.edu); Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia (Ms Duey); and Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania (Dr Werner).


Letters Section Editor: Jody W. Zylke, MD, Senior Editor.

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JAMA. 2013;309(23):2437-2438. doi:10.1001/jama.2013.6557.
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Published online

To the Editor: With rising health care costs and 30% of privately insured adults enrolled in high-deductible health care plans,1 calls for greater health care price transparency are increasing.2 In response, health plans, consumer groups, and state governments are increasingly reporting health care prices.3 Despite recognition that price information must be relevant, accurate, and usable to improve the value of patients' out-of-pocket expenditures,4 and potential for this reporting to affect health care organizations and prices,5 there are no data on what kind of price information is being reported. The objective of this study was to describe the characteristics of state health care price websites to identify opportunities for improving the utility of this information.

Between January and May 2012, we conducted systematic Internet searches to identify publicly available, patient-oriented websites hosted by a state-specific institution (eg, a state government agency or hospital association) that enabled patients to estimate or compare prices for health care services in that state. We focused on state-based tools because many states are publicly reporting health care price information collected under legislative or regulatory authority.6 We excluded price information reported by health plans because this information is often not comprehensive within a market and is generally restricted to plan enrollees. In addition, price information reported by third parties was excluded because access to this information is often restricted or the mechanisms used to generate this information are often less transparent or less rigorous than mechanisms used in state-based efforts.

For each website, we classified the reporting organization, year reporting started, patient information used to generate price estimates, and types of services for which price estimates were provided. For each type of service, we collected data on whether prices could be estimated and compared across facilities or clinicians, whether quality information was shown alongside prices where applicable, whether price information included professional fees or facility fees where applicable, and what the price information represented (eg, billed charges or out-of-pocket costs). For each characteristic, we calculated frequencies.

As of early 2012, there were 62 patient-oriented, state-based health care price websites (eTable). Half of these websites were launched since 2006 (Figure) and most were provided by a state government agency (46.8%) or hospital association (38.7%). Most websites reported prices of inpatient care for medical conditions (72.6%) or surgeries (71.0%). Information about prices of outpatient services such as diagnostic or screening procedures (37.1%), radiology studies (22.6%), prescription drugs (14.5%), or laboratory tests (9.7%) was reported less often (Table).

Place holder to copy figure label and caption
Figure.State Health Care Price Transparency Websites, 2000 to 2012
Graphic Jump Location

Data include only websites that were in existence as of early 2012.

Table Graphic Jump LocationTable. Characteristics of State Health Care Price Transparency Websites, 2012

Most prices reflected billed charges (80.6%). For services in which a full episode of care often includes both facility and professional fees (eg, outpatient diagnostic procedures), most price estimates (66.0%) included only facility fees. Few price estimates incorporated patient insurance status (9.7%) or specific health plan (8.1%). For services in which quality is not standardized and therefore variation may exist (eg, for outpatient surgeries but not laboratory services), quality information was rarely (13.2%) portrayed alongside prices.

Our data point to clear opportunities to improve publicly reported health care price information. Greater relevance to patients could be realized by focusing information on services that are predictable, nonurgent, and subject to deductibles (eg, routine outpatient care for chronic diseases) rather than services that are unpredictable, emergent, or would exceed most deductibles (eg, hospitalizations for life-threatening conditions). Accuracy could be improved by reporting allowable charges for full episodes of care (ie, aggregate prices for health care services that include all fees such as facility, professional, and other fees). Usability could be enhanced by presenting quality information alongside prices where applicable, as opposed to reporting just one type of data needed to assess value. Although there can be challenges in collecting this information and our analysis is based only on data from publicly available state-based health care price websites, these enhancements could help both public and private price transparency initiatives reach their potential to improve the value of health care spending.

Author Contributions: Dr Kullgren had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Kullgren, Duey, Werner.

Acquisition of data: Kullgren, Duey.

Analysis and interpretation of data: Kullgren, Werner.

Drafting of the manuscript: Kullgren.

Critical revision of the manuscript for important intellectual content: Kullgren, Duey, Werner.

Statistical analysis: Kullgren.

Obtained funding: Werner.

Administrative, technical, or material support: Kullgren, Duey, Werner.

Study supervision: Werner.

Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Funding/Support: Support for this work was provided by funding from the Department of Veterans Affairs Health Services Research and Development Service and the Robert Wood Johnson Foundation. Dr Werner was supported in part by a Department of Veterans Affairs Health Services Research and Development career development award.

Role of the Sponsor: Neither the sponsors nor the funders had a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the US government.

Additional Contributions: We thank John Ayanian, MD, MPP (Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor), for helpful comments on an earlier version of the manuscript. Dr Ayanian did not receive compensation for his contributions.

Cohen RA, Martinez ME. Health insurance coverage: early release of estimates from the national health interview survey, January-March 2012. http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201209.pdf. Accessed December 4, 2012
Kaiser Health News.  Employers, unions ask for greater health care price transparency. http://www.kaiserhealthnews.org/Daily-Reports/2012/November/01/transparency-and-coverage.aspx. Accessed November 16, 2012
Sinaiko AD, Rosenthal MB. Increased price transparency in health care—challenges and potential effects.  N Engl J Med. 2011;364(10):891-894
PubMed   |  Link to Article
Mehrotra A, Hussey PS, Milstein A, Hibbard JH. Consumers' and providers' responses to public cost reports, and how to raise the likelihood of achieving desired results.  Health Aff (Millwood). 2012;31(4):843-851
PubMed   |  Link to Article
Hibbard JH. What can we say about the impact of public reporting? inconsistent execution yields variable results.  Ann Intern Med. 2008;148(2):160-161
PubMed   |  Link to Article
National Conference of State Legislatures.  State and federal actions related to transparency and disclosure of health charges and provider payments. http://www.ncsl.org/issues-research/health/transparency-and-disclosure-health-costs.aspx. Accessed October 8, 2012

Figures

Place holder to copy figure label and caption
Figure.State Health Care Price Transparency Websites, 2000 to 2012
Graphic Jump Location

Data include only websites that were in existence as of early 2012.

Tables

Table Graphic Jump LocationTable. Characteristics of State Health Care Price Transparency Websites, 2012

References

Cohen RA, Martinez ME. Health insurance coverage: early release of estimates from the national health interview survey, January-March 2012. http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201209.pdf. Accessed December 4, 2012
Kaiser Health News.  Employers, unions ask for greater health care price transparency. http://www.kaiserhealthnews.org/Daily-Reports/2012/November/01/transparency-and-coverage.aspx. Accessed November 16, 2012
Sinaiko AD, Rosenthal MB. Increased price transparency in health care—challenges and potential effects.  N Engl J Med. 2011;364(10):891-894
PubMed   |  Link to Article
Mehrotra A, Hussey PS, Milstein A, Hibbard JH. Consumers' and providers' responses to public cost reports, and how to raise the likelihood of achieving desired results.  Health Aff (Millwood). 2012;31(4):843-851
PubMed   |  Link to Article
Hibbard JH. What can we say about the impact of public reporting? inconsistent execution yields variable results.  Ann Intern Med. 2008;148(2):160-161
PubMed   |  Link to Article
National Conference of State Legislatures.  State and federal actions related to transparency and disclosure of health charges and provider payments. http://www.ncsl.org/issues-research/health/transparency-and-disclosure-health-costs.aspx. Accessed October 8, 2012
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