Money and Main Street

Biggest medical mystery: The bill

With more consumers paying out-of-pocket for their health care needs, experts say physicians, hospitals and insurers have to provide easier access to prices.

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By Parija B. Kavilanz, senior writer

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NEW YORK ( -- Ask most Americans how much it costs to visit a doctor and they probably do not know.

Ask doctors what their fees are and they're not likely to know that either.

Health care prices - both physician fees and prices of medical procedures - have been cloaked in mystery for decades.

But as the number of people who are uninsured, underinsured or are opting for higher-deductible insurance plans grows, consumers have reason to care.

"With health care costs coming directly out of their pockets, these people have more skin in the game," said Barry Silbaugh, CEO of the American College of Physician Executives (ACPE), an educational association that teaches medical management to physicians.

Most Americans haven't worried about the price of a doctor's visit because they have health insurance through their employers.

But things have changed. Besides the 72 million uninsured and underinsured Americans, even those with coverage have had to pay higher premiums and deductibles.

Consumers also have been encouraged into consumer-driven health care plans, tax-free savings vehicles such as health savings accounts (HSAs) or health reimbursement arrangements (HRAs), in which up to $2,000 comes out of their pocket.

As a result, they can't be indifferent to the cost of a trip to the doctor.


However, several barriers stand in the way of what's known in the industry as price transparency.

For one thing, there is no such thing as a standardized price list for doctors' fees or medical procedures.

"There are so many types of payment systems, both public and private, that it's hard to understand," said Silbaugh. "No one pays the same price on anything."

Another challenge is that insurance companies don't want their rivals to know what rates they've negotiated with hospitals and physicians. That stymies, for example, a doctor trying to answer a patient's question about how much a recommended hospital procedure might cost.

"As a physician, I struggle to find out what these rates are," Silbaugh said.

Health care costs also vary significantly across geographical regions, as documented by the Dartmouth Institute for Health Policy and Clinical Practice.

Looking specifically at the disparity in Medicare spending, the institute's study of 306 health care markets nationwide shows the cost of providing health care to seniors is rising more than twice as fast in Dallas as in San Diego, and that Medicare now spends nearly three times more to care for its enrollees in Miami as it does in Honolulu.

"Even after doing all the research that they can, the health care [pricing] system is too darned complicated for the average person to understand," said Jonathan Weiner, professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health.

Price transparency

Although President Obama has talked about the issue, Weiner said "price transparency does not appear to be a centerpiece" of his health care reform as yet.

But Department of Health and Human Services spokesman Nicholas Papas disagreed, saying that "President Obama is committed to cutting health care costs and price transparency will be an important part of our efforts to reform health care."

Until Obama unveils specifics about his plans for price transparency, Weiner said consumers have resources that might help remove some of the mystery surrounding health care prices.

Web sites such as and that research this information are a good place to start, he said.

For those on Medicare, "Medicare Compare is the government's effort to provide price comparability," Weiner said. "But it's not easy to use."

Silbaugh said retail clinics in Walgreens (WAG, Fortune 500) and Wal-Mart (WMT, Fortune 500) stores also typically list prices for basic primary care.

While cost is important, Weiner and others said consumers should not base their health care decisions solely on prices.

"One of the dangers of greater price transparency is that consumers use prices as a proxy for quality," said Paul Ginsburg, president of non-profit Center for Studying Health System Change.

"There's also very limited information available to consumers on provider quality," he said.

His tip to consumers: "Higher prices don't always mean better quality of service. Research your doctor."  To top of page

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