As the former transparency director for HealthInsight Nevada, a nonprofit organization dedicated to improving the value of health care, I support the concept of cost transparency highlighted in your May 8 editorial “Comparison shopping.”
However, the very common comparison of purchasing health care to purchasing a car is an extremely flawed analogy. When I buy a car, I can go to any dealership I choose and negotiate the price directly. In health care, my choices are largely constrained by my health insurance plan. I can choose to go to a provider that is outside my plan’s network, but I will pay significantly more. Consequently, most of us go to a doctor or hospital that is in network, despite the cost or the quality of the services they provide.
In addition, the insurance plans, and thus the providers, are also chosen by a third party, often an employer. Not exactly free choice. Because of this, health care is not a commodity where consumers can easily “shop around.” And think about it: When I want to buy a car, I generally look for the cheapest price. Most patients are not looking for a bargain when it comes to their open-heart surgery.
So what should we make transparent? Cost (we don’t require this of car manufacturers), charge (which often has little to do with what is actually paid) or price (paid by which insurance plan)?
Transparency related to cost and quality of care are essential components of health care reform. Nevada lawmakers should work together with providers and stakeholders to promote needed transparency but not jump to simple comparisons or conclusions.