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All But Six States Keep Consumers in the Dark on the Cost of Medical Procedures

Aug. 3, 2016

All But Six States Keep Consumers in the Dark on the Cost of Medical Procedures

Public Citizen Road Tested Websites; Only California, Colorado, Maine, New Hampshire, Virginia and West Virginia Provide Information

WASHINGTON, D.C. – Despite a national effort to arm consumers with information about the cost of medical procedures, only six states make the data available to patients online, and that information usually is uneven, outdated, difficult to navigate or unavailable, Public Citizen has found (PDF). Those six states are California, Colorado, Maine, New Hampshire, Virginia and West Virginia.

Public Citizen road tested state consumer websites to determine just how easy – or difficult – it is for consumers to obtain basic information about health care costs. In all, nearly 20 states have tried to track health care payments to help their consumers and researchers better understand the costs of basic medical procedures in their state, but the efforts are not helping patients, Public Citizen found. The conclusion: States have a long way to go to provide adequate information for consumers to help them avoid being ripped off.

“Shopping for health care prices in the United States is like trying to find a light switch in the dark,” said Vijay Das, health care policy advocate for Public Citizen, who conducted the analysis. “If you know where you should be looking – and it’s actually there for you to find – you might have a chance, but otherwise you’ll blindly search in vain.”

Out-of-pocket health care costs for patients are soaring in the United States. Since 2010, insurance deductibles for workers have risen three times as fast as premiums and about seven times as fast as wages and inflation, according to the Henry J. Kaiser Family Foundation. For nearly two decades, states have attempted to address this problem by passing laws to allow policymakers, researchers and consumers to better understand and access health care cost information.

Using close to $90 million in federal grants, 19 states have created – or are in the process of creating – databases populated by reports from providers, insurers or both. But the vast majority of these databases are not publicly accessible. Among the few that are, the information offered by most is outdated and incomplete.

The 19 states are Arkansas, Colorado, Connecticut, Kansas, Florida, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New York, Oregon, Rhode Island, Tennessee, Utah, Vermont, Virginia, Washington and West Virginia.

Public Citizen sought cost information about five common medical tests and procedures: a colonoscopy, a computerized tomography (CT) scan of the head, hernia repair, knee replacement and a magnetic resonance imaging (MRI) of the brain. Public Citizen found that:

  • Prices vary considerably. They are highest for people without insurance.
  • Of the six states that give consumers a chance to compare medical prices, few provide adequate cost information for the most common procedures. For instance, Colorado does not make available price information for colonoscopies, CT scans of the head, hernia repair exams or MRIs of the brain. A privately insured Colorado resident can access claims data only from 2012.
  • Only one state – New Hampshire – provides cost estimates for all five of the medical procedures. The website permits users to search the costs of about 75 medical procedures at about 45 facilities, and data is from 2014 and 2015. New Hampshire’s web interface is an ideal template for other states.
  • California provides cost and quality data pertaining to five broad areas: childbirth care, hip and knee replacement, back pain, colon cancer screenings and diabetes treatment. Although it offers information for regions, it doesn’t offer it for individual providers. The data is from 2010 to 2013, but the website is easy to navigate.
  • Maine includes relatively up-to-date costs submitted by 42 health insurance plans for more than 240 procedures from more than 150 facilities. It does not include costs covered by public payers (including Medicaid) and does not include bills to the uninsured. The website is easy to use to comparison shop.
  • Virginia’s website allows a resident to survey average costs for 31 procedures based on reports received from nine health insurance carriers. But the website was last updated in 2013, and the data date to 2012. The website is difficult to use.
  • West Virginia’s website provides estimates of what hospitals would charge patients and is difficult to navigate.

“States should allocate more resources and build user-friendly websites that contain complete information,” Das said. “This is basic information, and it shouldn’t be so difficult to find.”

Read the report (PDF).