Quick anecdote. A few months back our 5-year old had white streaks and a very sore throat, and I suspected strep. I took him to the doctor ($35 copay) to find out if it was indeed strep, in which case he'd get antibiotics so that he could return to school sooner, or find out it was viral in which case he could return to school. Doctor swab tests on site and determine's it's not strep, but says by company policy they send swabs to a second round of testing just to be sure. I asked what the rate of false-negative for on-site testing was and he said significantly less than 1%. I asked how much this all costs and he said he had no idea, and that it depends on insurance. I didn't question him further and we left.
But on the way home I asked my wife to get onto the health system's website to find out the billable rate for the strep culture lab test, and found out it was either $280 or $560, depending on which was ordered. Being well within our deductible, that would be all our cost. I called back and demanded they cancel that order.
My reaction to all this was that, first of all, billing $280 to $560 to double-check a usually non-lethal childhood illness seems medically unnecessary to me. Second, doctors should know or be able to easily check the cost of what they're recommending so that the cost vs. benefit can be discussed with patients.
But then more recently I started thinking about health care price transparency in general and trying to understand why there isn't better transparency and what the arguments are for and against.
I ran across evidence (
Characterizing Health Plan Price Estimator Tools: Findings From a National Survey) that not only to health plans and, in many cases, provider systems, make cost information available, but extremely few seem to be looking or caring. As few as 2% use web-based tools for determining health care costs.
This gets me thinking, there was really no reason why I couldn't have determined in advance the cost or potential costs of the strep testing before taking my kid to the doctor. If I had known, I might have gone in to the doctor and said "I want an on-site strep test but I do not consent to any additional follow-up or secondary testing." That might piss some doctors off to have patients coming in demanding specific things and refusing others, but that is what I should have done. I cannot abdicate all responsibility for situations like the one I encountered and "blame the system" when the system avails the information to me and I choose not to look.
If a vast majority of Americans aren't even interested in the cost of health care even when it's made available to them, then by default we are entrusting the entire responsibility for controlling health care costs onto a combination of government and insurance companies, because we refuse to take responsibility for ourselves as patients. Consumers determining exactly what they want and are willing to pay for is the most organic and effective form of cost control there is, and collectively we're refusing to do it.
I'd be interested to hear from people what they specifically think would be necessary and effective at incorporating more patient-driven cost control into our health care system.
