If you live in New Hampshire and want to know what a hospital charges for delivering a baby or an emergency room visit, you just go to a state-run website and look it up.
Would you like to know the price difference if you have health insurance and if you do not? That also is available.
Not so in Hawaii.
Hawaii is among 29 states that received a failing grade for consumer access to health care prices in a recent report.
"American consumers deserve to have as much information about the quality and price of their health care as they do about restaurants, cars and household appliances," said the report’s authors.
New Hampshire has a public website run by the Department of Insurance that allows both insured and uninsured residents to search prices of common procedures, which vary by hundreds of dollars in some cases, based on the provider.
Hawaii has no laws requiring providers or insurers to disclose price information to consumers.
That’s part of the reason Hawaii got an F in the "Report Card on State Price Transparency Laws" put out by two nonprofit business coalitions, the Catalyst for Payment Reform and the Health Care Incentives Improvement Institute.
The report gave 36 states a D or an F based on the lack of laws designed to give consumers information about the average or expected prices of medical services.
Massachusetts and New Hampshire were the only states given an A. They got top marks for meeting several criteria, including providing access to prices for inpatient and outpatient services; publishing costs for both doctors and hospitals; sharing public reports; and allowing patients to request information before a hospital admission.
"It should be concerning to every lawmaker in the country that 18 percent of the U.S. economy is shrouded in mystery," said Francois de Brantes, one of the report’s authors and executive director of the Health Care Incentives Improvement Institute, in a press release. "Without price information, how can we possibly expect consumers to act in a value-conscious way? It is a duty of every state to protect its residents from unfair trade practices."
STUDIES have shown that the price for an identical health care procedure performed in the same city can vary by as much as 700 percent with no difference in quality, de Brantes added.
Most hospitals have what is called a chargemaster that lists prices of each service. Insurers then negotiate discounts with each individual provider, making it nearly impossible for consumers to know the true cost, said Suzanne Delbanco, co-author of the report and executive director of Catalyst for Payment Reform.
Mililani resident Tim Ruel, 37, who had emergency brain cancer surgery in 2009, said having price information available would be helpful, particularly for Hawaii consumers living in a state where the cost of living is substantial.
"That kind of availability of cost information is sorely missing in Hawaii and other states," said Ruel, who previously worked as a reporter for the Honolulu Star-Bulletin. "To be able to survive in a high-cost, expensive state like Hawaii, you’ve got to be able to do budgeting. If you don’t have a very clear sense of what (the cost is) going to be, you’re going to eventually get sticker shock a few months later when you get a bill in the mail. If you suddenly run into an emergency situation, cancer of any kind, then that changes the whole ballgame. For a lot of people in Hawaii … even an unexpected $500 bill can really make quite a difference. When you’re talking about emergency surgery, now you’re talking about something that simply could be in the thousands-of-dollars range."
The lack of information means it’s impossible for people to make informed choices when in comes to health services, said former state Insurance Commissioner J.P. Schmidt, CEO of Family Health Hawaii, a new health insurer launching in the next few months.
"Consumers just end up paying a deductible or co-insurance. If you don’t have insurance, all bets are off, and there’s generally no laws to say how much a provider and hospital can charge," he said. "Providers and hospitals set their own rates, and some of those can be very outrageous for individuals without insurance. In many cases that individual ends up going into bankruptcy because of medical bills that they are being charged. That’s one of the big problems with our health care system in the nation."
It’s common practice for hospitals to charge uninsured patients more than insured patients because insurance companies negotiate a lower price.
The New Hampshire website shows, for example, that Exeter Hospital charges $547 for an emergency room visit if you are insured (with most of that paid by the insurance company) and $885 for an uninsured patient.
Senate Health Committee Chairman Josh Green (D, Kona-Kau), also an emergency room physician, said Hawaii is beginning to see improved transparency in hospital rankings and physician ratings and eventually will move toward greater price transparency for medical services.
"It’s in patients’ interest to know how much they’re paying for services," he said. "It’s headed that way, but we haven’t reached the point where we see a lot of openness about costs."
Green added that consumers can request price information from providers and insurers, and that the federal Affordable Care Act will push states to make price transparency a priority. For instance, Hawaii’s first health insurance exchange, launching Oct. 1, will allow consumers to compare prices and benefits between health insurance carriers, a first step in the transparency movement, Green said.
"The time will come when everyone will know exactly what services will cost, and they’ll shop based on their needs. As all the insurers compete to get patients to sign up with their plan through the health insurance exchange, they may decide to share the cost figures on basic and common procedures to market themselves," he said. "I expect it will be (more transparent) as health care is looked at as more of a commodity rather than a benefit. We’re right at the cusp of this phenomenon where people are doing value shopping."
Hawaii Medical Service Association, the state’s largest health insurer, said it is working on an online tool that will allow its more than 700,000 members access to price information.
State Insurance Commissioner Gordon Ito said the Hawaii Insurance Division doesn’t have the authority to collect proprietary price data similar to New Hamshire, a policy issue that the Legislature would need to debate.
The Insurance Division has regulatory control over how much an insurer can charge a subscriber, not how much an insurer pays a doctor or hospital.
"What consumers really end up looking at is the co-pay cost-share split," Ito said. "The variations from plan to plan doesn’t vary that much. We’re different from other states where health plan benefits can vary greatly. Their out-of-pocket costs matter more."
While providing patients access to price information could potentially be a beneficial service, Ito questioned whether consumers would actually make informed decisions that would rein in health costs.
"Are consumers really going to be making a decision based on that information?" Ito said. "Are consumers going to make a choice based on price or based on their doctor?"
