ó At Rush University Medical Center on Chicagoís
West Side, the median charge for a vaginal birth was
$16,703 last year.
miles away, at Norwegian American Hospital, it cost
about half that: $8,873.
patients donít pay those charges, instead paying a sum
based on rates negotiated between hospitals and health
insurance companies. But even after those negotiations,
stark differences often remain ó disparities that can
hit the wallet hard.
consumers have long bemoaned rising health care costs,
few people shop for health care the way they might shop
for a car, comparing prices. Some donít realize a
procedure can cost tens of thousands of dollars more at
one hospital versus another. Others would rather rely on
referrals or donít know where to go to find
information. Hospital prices vary for a number of
reasons, including differing overhead costs, market
dynamics and, in some hospitals, a need to offset the
costs of complex services by billing higher rates for
the Trump administration wants to make it easier for
patients to comparison shop for medical care, proposing
a rule that would require hospitals to post their
charges, before insurance, on their websites. The
administration also is considering whether that posted
information should reflect rates negotiated with
doctors embrace membership fees, shunning health
consumer advocates cheer the administrationís proposal
as a step toward greater price transparency. But
hospitals and many experts say such a move likely wouldnít
make much of a difference, pointing to existing online
price comparison tools that often go unused by
consumers. They also question the usefulness of posting
charges before insurance.
wants to try to find a path forward to increase price
transparency, but it is very complex," said Sandy
Kraiss, Illinois Health and Hospital Association vice
president of health policy and finance. "We just
donít see that this is the best approach to advance
costs at select Chicago-area hospitals
who want to know how much a hospital procedure will cost
already have a number of options.
can call hospitals to get individual estimates, and
sometimes, they can go to hospital websites. Late last
year, west surburban hospital system Edward-Elmhurst
Health became one of the few systems to post a pricing
tool on its website to help consumers estimate
out-of-pocket costs based on their insurance plans.
Illinois Department of Public Health also lists median
charges, by hospital, online in its hospital report
card, but those figures show only list prices, not how
much a patient will actually pay after insurance.
offer many of the most comprehensive price-comparison
tools. In many cases, consumers can log onto their
insurance companiesí websites to compare their
individual, out-of-pocket costs for procedures at
most consumers donít.
largest insurer, Blue Cross and Blue Shield of Illinois,
has had an online tool in place for about eight years
for members to compare prices and quality ó partly as
measured by outside organizations ó across hospitals.
Yet less than 10 percent of members use the tool, said
Thomas Meier, the insurerís vice president of market
not an uncommon result. Nationally, only about 20
percent of Americans have tried to compare prices before
getting care, according to the results of a 2016 survey
by Public Agenda, a New York City-based nonprofit.
chalk up the low numbers to several factors, including a
lack of consumer knowledge, interest and time.
advocates share secrets for saving on medical costs Ľ
lot of it is member awareness," said Meier with
Blue Cross and Blue Shield of Illinois. "I think a
lot of the members donít understand even what an
(in-network) versus out-of-network provider is, let
alone that 44 different providers would charge 44
different amounts for an MRI."
for many consumers seeking health care, price isnít
top of mind, said Sunita Desai, an assistant professor
in health policy at New York University. She was lead
author of a study published in the journal Health
Affairs last year that found only about 12 percent of a
large population of employees who were offered a price
transparency tool used it.
in the throes of a medical emergency donít have time
to price shop. Those who do have time may trust only
certain doctors. And in some cases, price shopping might
not help a patient save money, Desai said. Finding a
lower-cost service helps a patient only if that service
costs less than his or her insurance deductible or
arenít necessarily using them because, in some cases,
they donít really have any incentive to do so,"
said Sally Rodriguez, chief of staff at the Washington,
D.C.-based Health Care Cost Institute, of cost
Parsons of Chicagoís West Town neighborhood, for
example, shopped around for physical therapists after
giving birth to her daughter earlier this year. She
found a clinic she liked, but it was out-of-network and
would have cost $160 a visit, so she passed.
didnít, however, shop around for a hospital before
giving birth. She went to the hospital where her midwife
practiced that also took her insurance. She assumed that
regardless of where she went, childbirth would be so
pricey that sheíd hit her familyís deductible.
"With hospitals, theyíre expensive no matter what
youíre doing," Parsons said.
consumers donít see the upside of taking the time to
shop around because they typically hit their deductibles
or out-of-pocket maximums each year.
Vazquez, of the West Loop, shops for some services that
his insurer wonít cover, but mostly heís careful to
make sure tests and drugs are covered by his insurer
before taking them. But otherwise, Vazquez, who has
pulmonary fibrosis, doesnít see higher out-of-pocket
costs if he goes to one in-network provider versus
another. He knows heíll almost certainly hit his
out-of-pocket maximum each year, leaving him little
incentive to shop.
to control the cost of your health care Ľ
kind of hard not to hit it, especially when dealing with
a chronic illness," Vazquez said. "Itís not
something you can really think about."
shopping for services can save cash across the health
care system ó for patients, for their employers and
for insurance companies, which foot large portions of
patientsí bills. Self-insured employers also pay much
of their workersí health care bills. Employers that
arenít self-insured may face higher rates from their
insurers if their employeesí medical claims climb.
perhaps itís no surprise that many in health care are
encouraging consumers to shop.
Cross and Blue Shield of Illinois and UnitedHealthcare
work with some employers to offer incentives for
employees to choose lower-cost, high-quality services.
With Blue Cross, for example, workers can receive checks
of $25 to $500 for choosing certain providers.
who use our tools save 36 percent over folks that donít
use our tools," said Katherine Bisek, a vice
president for the insurer. "Higher prices donít
necessarily equate to higher quality or better
backs up the assertion that higher prices donít
necessarily mean higher quality. Price differences often
have to do with local market dynamics and negotiations
between hospitals and insurers, Bisek said. Some
hospitals are also more expensive than others because
they have to offset the costs of treating complex
patients, said Kraiss with the Illinois hospital
association. Prices vary quite a bit across the Chicago
area, with knee MRIs running anywhere from $142 to
$4,736, vaginal childbirth from $5,417 to $28,249, and
back surgery from $9,051 to $156,900, according to
such pricing disparities arenít the main reason many
hospitals donít post prices online, Kraiss said.
Rather, hospitals have let insurers lead the way in
offering price transparency tools because a patientís
final bill depends largely on an insurance plan, she
however, suspect hospitals donít make prices more
accessible because they donít want to be put at a
competitive disadvantage. Increasingly, providers other
than hospitals offer straightforward services, such as
MRIs, at relatively low costs. Those providers donít
have to offset the costs of other services and can have
lower overhead, said Rick Anderson, CEO of one such
chain, Smart Choice MRI.
said greater price transparency in health care is long
overdue and he hopes it encourages consumers to shop
Iím in the emergency room having bypass surgery, Iím
not asking how much, but when it comes to things that
are routine Ö Iím going to shop because I can and I
should," he said.