The problem with price transparency: ‘Price’ doesn’t always mean ‘out-of-pocket’ cost, says NorthShore Assistant VP Justin Brueck | Becker’s Hospital Review

Q: What is the biggest barrier to price transparency in the healthcare industry? 

JB: One of the biggest barriers in price transparency is that many health system contracts have payer confidentiality provisions, which makes it difficult to discuss such matters. Additionally, we must remember that ‘price’ does not necessarily reflect ‘out-of-pocket’ cost — and out-of-pocket costs are typically what patients are interested in when they are seeking transparency. As a result of wide deductible ranges, coupled with in-network and out-of-network requirements, it is almost impossible for a layperson to compare apples to apples. For example, a ‘list price’ for surgery may be less at hospital A than hospital B. However, if hospital A is out-of-network or has less-preferred contracts with the patient’s insurer, hospital B’s more expensive list price may ultimately result in less out-of-pocket cost to the patient. This complexity and information disparity further creates barriers.

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The problem with price transparency: ‘Price’ doesn’t always mean ‘out-of-pocket’ cost, says NorthShore Assistant VP Justin Brueck.