Letting people know how much it will cost to go to the hospital has been a prime goal of everyone who wants to use market forces to drive down the cost of care. The idea is that if patients can shop around, health care providers will need to compete on price.
From the very start, President Donald Trump made price transparency part of his health care plan. He said he would "require price transparency from all health care providers, especially doctors and health care organizations like clinics and hospitals."
Trump delivered on the hospital part.
Under new rules, as of Jan. 1, 2021, every hospital is required to list the prices of about 300 of the most common services. That would include X-rays, colonoscopies, outpatient visits, and more. The idea is to make this as easy as possible for the public to understand. One key requirement is hospitals have to bundle the costs of everything tied to a certain procedure. The rules get at one of the trickiest parts of medical billing — hospitals negotiate different prices with different insurance companies. The new rules say hospitals have to show the price linked to each insurer.
Health policy researcher Neeraj Sood at the USC Schaeffer Center for Health Policy and Economics wrote that the move is a good first step.
"Transparency will be disruptive, but I believe it is a risk worth taking," Sood wrote Nov. 27. "Making prices more transparent saves money. The regulations will spur greater price competition and reduced prices will benefit all consumers, not just those who will shop around."
The rules, however, leave a piece of the promise unfulfilled.
"It doesn't require non-hospitals to provide this information," said Nisha Kurani, senior policy analyst at the Kaiser Family Foundation. "It doesn't apply to doctors who have their own practices."
In addition, Adam Sacarny at Columbia University's Mailman School of Public Health warned that even physician charges at a hospital could fall into a gray zone.
"When you get care at a hospital, there are two billing entities," Sacarny said. "There is the hospital. And then there are the physician professional services, and that's not covered."
The bottom line is that knowing the cost in advance could still be a bit of a puzzle.
More transparency is in the pipeline. Starting in January 2023, nearly all insurance companies — covering those in the individual and group markets and self-funded employer plans — will have to publish prices and cost-sharing estimates for many of the same common services.
We rate this promise Compromise.