Call for Patient’s Rights to Healthcare Costs

Posted on 13 May 2012 by Josef Woodman

During a recent annual physical, my GP noted a melanoma that he found worrisome, and suggested a biopsy. When, after some discussion, I asked what the procedure would cost, he seemed genuinely bewildered at such a question. And when I pressed him, I became convinced he honestly did not know the answer.

Two days later, I called a neighborhood radiology lab and an oncology specialty clinic to make the same inquiry. Again, I got the now-familiar runaround, and I never did get a clear cost estimate on a comparatively straightforward medical procedure.

This experience points to the huge, naggingly unresolved transparency challenge endemic to our beleaguered US healthcare system. Americans, including 40+ million uninsured paying out of pocket for large chunks of their medical care, have been systematically conditioned not to dare ask about cost. If you're insured and want to know more about the fine print and the "gotchas," your physician and staff will likely tell you, "It's complicated." If you're not insured, you're often treated as a second-class citizen not worthy of a price quote. Plus, they'll tell you, "It’s complicated."

No. It's not. Insurers have the data. Hospitals, doctors, and clinics have the data. And with that data, getting a cost estimate on most medical procedures should not be any more complex than getting the pricing on a new automobile.

Perhaps for too long I've been receiving most of my medical care outside the US, where doctors, nurses, and even receptionists can—and do—provide to-the-penny information on medical costs: consultations, scans, blood work, anesthesia, and more. If you’re insured, they can reference your plan number and let you know the negotiated rate, your deductible, what’s included, what’s not, and how much you’ll pay in differential.

Case in point: Bumrungrad International Hospital in Bangkok, Thailand, with more than 300 American board–certified doctors and surgeons, has for years posted its REALCOST service on its website, which provides detailed information on the high, low, and median costs of more than 40 procedures, ranging from simple health screenings to a coronary bypass.

The same hospital also posts information on more than 25 medical "packages," which include all-in pricing on array of common procedures

Transparency in healthcare, ranging from quality metrics and patient experience data to comparative costs of procedures and ancillaries, is long overdue. Components of the Patients Protection and Affordable Care Act call for greater transparency in reporting of business relationships but do not go far enough in requiring healthcare institutions to report cost information and quality standards data.

Medical facilities here in the US would do well to learn from their global counterparts, at the risk of otherwise becoming creatively, disruptively disintermediated in the coming healthcare upheavals here and abroad. Meanwhile, healthcare consumers might want to think of access to information as a basic patient right and to pressure docs and hospitals accordingly for greater transparency.