Transparency

VII. Key Issues: Regulation & Reform >> C. Health Reform >> Cost Containment >> Transparency (last updated 1.8.23)

Topic Outline

1 Overview
2 Provider Price Transparency
3 Insurer Price Transparency
4 Links

Overview

See Transparency under Cost Containment for evidence on the benefits and costs of various approaches to increasing price and quality transparency to consumers. This section is restricted to discussion of federal and state health reform policy proposals related to increasing transparency that are under discussion and not yet adopted or implemented, as well as private sector initiatives to promote transparency. This includes ideas that may have been adopted in other countries or other settings (e.g., large health plans or selected states), but that have been proposed to be significantly expanded to other U.S. populations under comprehensive health reform.

Provider Price Transparency

Trump’s Transparent Pricing. “I must admit that I have been skeptical of presidential candidate Donald Trump. However, as a physician, I find a lot to like about Mr. Trump’s healthcare plan that has just rolled out. While many aspects have been brought up by other GOP hopefuls, the aspect of price transparency is different. No other candidate made this point, but it goes to the heart of a true free market in medical care…What happens when prices are transparent? Price transparency fosters competition which fosters lower prices and higher quality. Just look at the cost and quality of refractive eye surgery. In the past 10 years the prices have gone way down while the quality has steadily improved. This cannot be said about the rest of medical care…Transparent pricing, which we are seeing in third-party-free practices and direct-pay medical practices, should be the norm for all medical services. When transparent pricing becomes the norm, we will see how overpriced services have become inside the insurance-payment system. My congratulations to Mr. Trump for pointing out an element of free-market capitalism that has eluded GOP recommendations for healthcare reform for so long.” Gianoli, Gerard, M.D. (Rare Disease Report, 3.22.16)
Hospitals Move to Hike Prices by Fifteen Percent. “Many of America’s biggest hospitals are looking to raise prices by as much as 15%, far exceeding already-soaring inflation rates. The Trump administration issued a hospital price-transparency rule in 2019 to help families fight such hikes and find high-value care — yet the Biden team isn’t enforcing this long-overdue policy. Millions of families will soon be stuck with bigger bills when they should be empowered to drive health-care prices down. That’s the conclusion of a new Foundation for Government Accountability report. We analyzed how more than 6,400 hospitals have complied with the Trump rule, which went into effect January 2021… it’s concerning that barely one out of three hospitals — 37% — offers price transparency. In Maryland, just 5% of hospitals abide by the rule, while in 12 states and DC, fewer than 30% do. That includes New York, where only 28% of hospitals comply. No state has more than 64% compliance — a dubious honor for Rhode Island.” (New York Post, 8.29.22)

Insurer Price Transparency

Donald Trump’s Transparent Pricing – Part 2. “In a previous editorial (Trump Transparent Pricing—Part 1), I commended candidate Trump’s proposal of price transparency for hospitals and doctors. It is astounding that this has not been an element of the GOP formula for healthcare reform until now and that an outsider had to bring it up. It is so obviously part of a free market that only in an overly regulated healthcare market could it be overlooked. However, there is another element of price transparency that the Trump campaign (along with the rest of the GOP hopefuls) missed. What about insurance industry price transparency?” Gianoli, Gerard, M.D. (Rare Disease Report, 3.28.16)