Why It’s So Hard To Shop For Health Care

why do different people pay different prices for the exact same healthcare procedure?

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Shopping for health care is kind of like going to a grocery store where there aren’t any price tags. That jar of spaghetti sauce might cost $4, or maybe $50. But in health care you typically don’t find out prices until you get to the checkout counter. People with one kind of card pay one price, those with another pay a different one, and you may do better or worse if you offer cash.

Last year Montana lawmakers, frustrated by how hard it is to shop for the best deal in healthcare, set up a special committee to find solutions. That committee meets for the first time Wednesday.

Transparency in health care pricing is a famously tough nut to crack, and NPR has done a lot of reporting on it. I had a conversation about that with Gisele Grayson, a health editor at NPR in Washington, DC.

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Eric Whitney: Gisele, why do different people pay different prices for the exact same healthcare procedure?

Gisele Grayson: Well, haven’t you asked the million dollar question.

For a long time healthcare prices have been invisible to consumers, and we can think of the healthcare system having three basic actors; You’ve got your consumers, which is us, you’ve got your providers, which is doctors and hospitals, and you’ve got your insurance companies. And insurance companies have typically been the middlemen between us and our doctors. They negotiate with our doctors and hospitals to get the best deals.

But we don’t necessarily know what those deals are. So your insurance company has lots of power to drive hard bargains with a hospital or doctor’s office, and they they might pass some of that savings on to you, or maybe they keep a little bit for profit.

But sometimes hospitals and doctors are also powerful. The insurance companies might negotiate a good price for, say, something like an MRI or a knee replacement at a small hospital, but they may not get the same price for a big hospital that might have a lot more facilities that you might want to go do. Or maybe a hospital has such a great reputation that insurance companies have to pay pretty much whatever they ask, because all their customers want to go there.

So it’s a process by which the consumer has been kind of sidelined, because the insurance companies and the providers set most of the terms.

EW: And it’s not just insurance companies negotiating deals, right? There’s big government health programs like Medicare and Medicaid, and they’re trying to get the best deals, too.

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GG: Yeah, that’s right, and we just mentioned Medicare is a big player in this world. But so are private health insurance companies, Medicaid, children’s health insurance companies, state employee health benefit programs, prescription drug plans, dental plans, private insurer plans, and then exchange plans – there’s so many different insurers fitting the bill, and each one negotiates its own prices with the entity we’re talking about – the hospital, the doctor’s office. So, it’s very hard to come up with any standard tool.

There are insurers, and there are companies that are trying to make this more transparent, but because of all these negotiations we just mentioned, unless you know the exact terms of your exact plan, you’re not going to get an exact price when you, say, want to know what a knee replacement costs in any given hospital.

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