Most Americans Do Not Believe Price Is Linked to Quality in Healthcare

Many Americans do not believe there is an association between price and quality in healthcare, according to a study published in Health Affairs. Understanding how consumers perceive the relationship between price and quality is important because using price as a proxy for quality could drive up spending without a commensurate increase in value, the authors wrote.

The sample was gathered in 2014 and included 2010 adults across the nation who were 18 years of age and older. Using a randomized split-sample design, respondents were asked 1 question each from 2 pairs of questions: the first referred to either general medical care, or doctors whose prices and quality may differ; the second referred to care in either terms of high cost and high quality, or low cost and low quality. The researchers did not actually test to see if there is an association between price and quality.

Across all questions, 58% to 71% of respondents stated that they did not believe that price and quality are associated, 21% to 24% believed there was an association between price and quality, and 8% to 16% said they did not know if there was such an association. Responses varied depending on if the question asked about high price/quality or low price/quality.

Respondents were more likely to say price and quality were not related when the questions referenced high price/quality than when the questions referenced low price/quality. Respondents were more likely to say they were unsure an association existed when the questions referenced low price/quality.

The researchers discovered that there were other factors that could influence an individual’s perception of an association between price and quality. Those who had compared prices before receiving care said that high prices indicated higher quality of care and lower prices indicated lower quality of care than those who had not performed a price comparison before receiving care. Adults who make healthcare decisions for a family member said that there was an association between price and quality, as well.

Race and ethnicity also contributed to healthcare beliefs: blacks, Hispanics, and younger adults tended to believe there was an association between price and quality as opposed to whites and older adults.

The researchers could not distinguish any pattern that accounted for income, education, employment, or insurance status.

When asked, focus-group participants offered the following reasons for why many Americans do not consider there to be an association between price and quality. They said that either the prices seemed irrationally high, that prices within their region varied for unknown reasons, and that they did not think providers and insurers set prices according to value of goods and services.

From these results, the researchers believe that providing price information will not necessarily prompt consumers to choose higher-price providers instead of lower-price ones. The team also said that price and quality information should be framed with the recognition that how it is communicated will affect consumers’ perceptions; the same recognition of behavioral economics should be applied when framing initiatives.