Shopping for health care services can be daunting, but some experts say when consumers take the time to research their decisions it can not only save them money, but they're likely to see better outcomes.
People often seek care without exploring their options, in part because they don't want to go bargain hunting when their health is in the balance, but it's also because meaningful consumer information is hard to find and difficult to parse.
Price, when it comes to health care services, isn't an easy thing to pinpoint. The price people pay for health care services varies by the setting, whether it's in a hospital, doctor's office or clinic, and also among venues within those categories.
Prices also vary based on whether a person is insured, and if they are, what their benefit is and often how much health care services they've used. Even for the uninsured, prices can vary based on discounts offered by providers.
There are resources, albeit limited, to help people find out what a specific service will cost them given those factors. But when one's health is at stake, it's not enough to look at just what a service costs.
That's because in addition to wide variation in price, there is wide variation in the underlying services.
"The really basic question is, 'Do I understand what I'm buying well enough to make price comparisons?'" said Steve Kappel, founder of Public Policy LLC and a health policy expert who has worked as a consultant for Vermont.
Dr. Jim Weinstein, president and CEO of Dartmouth-Hitchcock Medical Center, said providers could do more to tell consumers about the quality of care they offer.
"On the outcome side there is a total lack of transparency," he said.
Weinstein is a proponent of using what are called patient reported outcome measures to inform the public about the quality of services.
For example, if someone needs a hip replaced, knowing how many hip replacements a hospital has performed, what the average hospital stay was for the procedure and how quickly people returned to normal daily activity afterward can help them make better decisions about where to get their hip replaced, he said.
Price and Quality Information
Dartmouth-Hitchcock offers some of the information Weinstein said people should know for a wide array of services in quality reports on its website.
Fletcher Allen Health Care, the other academic medical center serving Vermonters, has quality reports on its website as well.
Dartmouth-Hitchcock also has an out-of-pocket cost calculator to help people approximate what they will pay for services. To use the tool effectively people need to understand their insurance benefits, and it includes a disclaimer that the cost estimate - aside from being an estimate - isn't a guarantee that insurance will cover the service.
There is less quality and price information available through the websites of the smaller hospitals serving the region, which may be partly a result of having less resources than the academic medical centers.
Weinstein said some providers could also be reluctant to publish that information, because, "People are afraid of the consequences. If they don't have good results they might lose business."
Having that information be public could also motivate providers to do better, he said.
The two largest commercial insurers, Blue Cross Blue Shield of Vermont and MVP Health Care, also have some pricing information available to members through their websites. State law requires insurers to make publicly available the median amount paid to providers for certain lab and imaging services.
Those amounts aren't what their members pay, but it's a good approximation of what those services might cost for someone who hasn't met their deductible.
Information on what hospitals charge is also available through the Department of Financial Regulation, but while the so-called "hospital report cards" capture price variation, they're not very useful for consumers.
That's because nobody pays what hospitals charge. People with insurance pay some portion of the rate negotiated by their insurer, and providers typically give people paying their own way some discount on what they charge.
Catalyst for Payment Reform, a national nonprofit, recently graded states on their price transparency. Vermont earned a C, making it one of five states that received passing grades. But the report makes clear every state could be doing more to inform consumers.
The report concludes that finding timely objective information on the cost of care is "almost completely unattainable," and the existing tools to access that information are difficult to use.
Weinstein said if Vermont wants to be leader in health reform nationally it should place greater emphasis on making price and quality information available to the public.
"I would advocate, if Vermont wants to lead, we should be reporting (quality information) now, and patient reported measures should be part of the transition to its new plan," Weinstein said, referring to Vermont's intention to create a publicly financed universal health care program.
Consumer information has limits
Meaningful consumer information on health care services could be more robust, but part of the problem is getting people to use what's available, said Anya Rader Wallack, former chair of the Green Mountain Care Board and a health care consultant.
Wallack worked with the state of Massachusetts to build MyHealthOptions, a website that aggregates quality and cost data for consumers. She said the state had high hopes for the site, but its use was underwhelming while she was involved with the project.
The benefit of consumer information to Vermonters is also limited by the low number of providers in the region compared to elsewhere in country, Wallack added. There are simply fewer places to shop, she said.
Another reason people don't shop for health care is because they rely on their physician to direct them toward services, she said.
"There is a concept in health economics of physician agency, which doesn't exist in many other markets, where the physician is often acting as your purchasing agent," Wallack said.
That's part of why Vermont's payments reform efforts are important, she said, because they are meant to incentivize providers to direct patients toward more cost effective treatments by connecting payments to better health outcomes.