Patients Seeking Medical Prices Online Will Have a Tough Time, Duke Researchers Find

Higher deductibles will force patients to be better consumers of healthcare, right? That line of thinking assumes that consumers can easily access prices for the medical basics. As a researcher letter published Monday in JAMA Internal Medicine shows, that’s a big assumption.

A team of researchers from Duke University found that less than one-fifth of the websites they examined had adequate information for consumers to compare prices of common medical procedures. But some of the team’s potential solutions—including state-run transparency websites—have also been studied and found lacking.

The cross-disciplinary team from Duke University’s medical, business, and public policy schools and the Duke-Margolis Center for Health Policy performed an exercise that started from this premise: if consumers tried to compare prices for 4 basic medical procedures, how easy would it be? In this case, the Duke team simulated consumers in 8 cities looking up costs for a cholesterol panel, a hip replacement, an upper gastrointestinal (GI) endoscopy, and magnetic resonance imaging (MRI) of the brain without contrast.

The team used simple search terms, “cost of (procedure) in” for each city, and analyzed results from 1726 websites after 64 searches (4 procedures in 8 cities on 2 search engines). The researchers noted that, as with all web searchers, consumers will receive a mix of price comparison/transparency sites, individual clinic sites, quality-only sites, or unrelated information. For each site, they recorded the first available price or range for the procedure if one was offered.

Drilling down, they found that only 234 sites, or 17%, had relevant information by geographic location. The number of sites with useful information varied, from 47 sites in Chicago to just 12 in Baltimore.

Most troubling, the sites did not say whether the cost listed represented what the consumer would pay out of pocket. Prices varied widely, and without information whether the prices represented costs after insurance, consumers might be confused, the authors found.

The Duke team found wide variation in prices for different procedures, even within the same metropolitan area. For example, in Chicago:

• Costs for an upper GI endoscopy ranged from $875 to $3958
• Hip replacements ranged from $27,000 to $80,671
• Cholesterol panels ranged from $25 to $100
• MRIs ranged from $230 to $1950

The authors said their limited investigation exposes a policy gap, assuming that the trend toward higher out-of-pocket costs continues. Possible solutions include: 1) all-payer claims databases and 2) improved state-run transparency websites.

However, a recent study in The American Journal of Managed Care^® that examined state websites comparing prescription drug costs found the sites were often deficient, or consumers didn’t use them much.

In the Duke investigation, the authors found that 1 problem may be that websites with the best information are not optimized in ways that make it easy for consumers to find them.

“Our findings suggest that there is substantial room for improvement in providing consumers with ready access to healthcare prices online. Policy makers should consider mandating that payers and providers make these prices available to consumers,” they wrote. “Given the increasing number of Americans facing high out-of-pocket healthcare expenses, we need to promote policies that make it easier for them to determine the price of their medical care in time to inform their healthcare choices.”

Reference

Kratka A, Wong CA, Herrmann R, et al. Finding healthcare prices online—how difficult is it to be an informed healthcare consumer? [published online December 4, 2017]. JAMA Intern Med. 2017; doi:10.1001/jamainternmed.2017.684.