How Much Will It Cost?
How Americans Use Prices in Health Care
As Americans shoulder more health care costs, this Public Agenda research suggests that many are hungry for more and better price information. However, some obstacles remain to increasing the number of Americans who compare prices before getting care.
While insurance companies and vendors are developing tools to make out-of-pocket health care prices more transparent, price information remains largely hidden. Nonetheless, 56 percent of Americans have actively looked for such information before getting care, including 21 percent who have compared prices across multiple providers. Those who have compared prices say doing so has affected their choices and saved them money.
Others say they sought out price information for just one provider—including by asking a receptionist, friend, relative or their insurance company, or by looking for the information online—but haven’t compared prices across multiple providers.
At the same time, most Americans do not think price indicates the quality of care. Seventy-one percent say they do not think higher prices indicate better quality care and 63 percent do not think lower prices are typically a sign of lower quality care. Many may be ready to choose less expensive care.
Together, these findings suggest that Americans are open to looking for better-value care.
However, most Americans remain unaware that prices can vary across health care providers. A significant number of insured (57 percent) and uninsured (47 percent) Americans are not aware that physicians might actually charge different prices for the same services.
Respondents also seem split on whether people should be expected to compare prices for medical care. Forty-three percent say it is not reasonable to expect people to compare prices before getting care.
The research was supported by the Robert Wood Johnson Foundation and findings are based on a nationally representative survey of 2,010 adults conducted in 2014, along with focus groups and follow-up interviews.
Findings and implications are summarized below. You can download a PDF of the full report, "How Much Will It Cost? How Americans Use Prices in Health Care," here and a summary of the research here.
Finding 1: The majority of Americans have tried to find information about health care prices before getting care.
- 56 percent of Americans say they have tried to find out how much they would have to pay out of pocket—not including a copay—or how much their insurer would have to pay a doctor or hospital, before getting care.
- People with higher deductibles are more likely to have sought price information: 67 percent of those with deductibles of $500 to $3,000 and 74 percent of those with deductibles higher than $3,000 have tried to find price information before getting care.
- People with college degrees and women are more likely to have sought price information than those without degrees and men—62 percent of those with college degrees and 59 percent of women report having done so. Only 40 percent of retired Americans report having done so.
- There are no significant differences by income, age or race/ethnicity in whether or not people have sought price information when taking into consideration other relevant variables.
Finding 2: Most Americans seem open to looking for better-value care.
- 71 percent of Americans say higher prices are not typically a sign of better-quality medical care.
- 69 percent of Americans say insurance companies should be required to make public how much they pay doctors for medical services.
- Even among those who have not ever tried to find out a price before getting care, 57 percent say they would like to know the prices of medical services in advance, and 43 percent would choose less expensive doctors if they knew the prices in advance.
Finding 3: Looking for price information does not necessarily mean comparing prices.
- About one in five Americans—21 percent—say that when trying to find price information before getting care, they have compared prices across multiple providers.
- 33 percent say that when trying to find price information before getting care, they have checked prices from just one provider.
- People who have compared prices across multiple providers are more likely to make health care decisions for adult family members: 53 percent of those who have compared prices across providers make such decisions, compared with only 34 percent of those who have checked prices from just one provider.
- People who have compared prices across multiple providers are more likely to receive regular medical treatment: 42 percent of people who have compared prices before getting care receive regular medical treatment, compared with 33 percent of those who have not ever sought price information before getting care.
- Hispanics, African-Americans and younger people are more likely than other groups to have compared prices across multiple providers. Those with incomes over $100,000 are less likely than those with lower incomes to have compared prices.
Finding 4: Comparing prices, many Americans say, has saved them money.
- Among Americans who have compared prices across multiple providers, 62 percent believe that they have saved money.
- 82 percent of those who have compared prices across multiple providers say they will do so again in the future.
Finding 5: Some obstacles stand in the way of increasing the number of Americans who compare prices before getting care.
- 57 percent of insured Americans do not think some doctors covered under their insurance plans charge more than others for the same services.
- 43 percent of Americans say it is not reasonable to expect people to compare prices before getting care.
- 50 percent of those who have never checked a price are unsure how to find price information.
Finding 6: Insurers, providers and office staff can play key roles in helping Americans manage their health care spending.
- 69 percent of Americans say a website showing how much different doctors charge would help them with their health care spending.
- 64 percent of Americans say that after a doctor’s appointment, they would find it helpful to get an estimate from the receptionist of how much their bill will be.
This research suggests many people are hungry for price information. Our report concludes with implications based on these findings for policymakers, insurers, employers and providers who are interested in engaging more Americans in comparing prices and choosing better-value care.
- Strengthen the capacity of providers, staff and insurance company personnel to discuss prices: The finding that many Americans are already trying to get price information from receptionists and hospital staff, insurance companies, doctors, hospital billing departments and nurses suggests a need to strengthen these professionals’ capacity to provide and discuss price information.
- Help people understand that prices vary: Most Americans are not aware of price variation. This may keep them from comparing prices or looking for less expensive providers when they are quoted a price that they cannot afford. Policymakers, insurers, employers and providers may wish to consider how to help more people understand the types of care for which prices do and do not vary.
- Help people understand how to find price information: Most Americans who have not ever sought price information say they would like to know the prices of medical services in advance. Half of them, however, say they do not know how to find it. This suggests a need for more outreach and education about reliable sources of price information.
- Focus engagement efforts on people who care for others and those who receive regular medical care: Americans who have compared prices are more likely than others to be helping adult family members make health care decisions or receiving regular medical care themselves. Those making efforts to engage more people in comparing prices may wish to focus on these people, who may also be those most in need of savings on their out-of-pocket expenses.
- Recognize the challenges to engaging people in both seeking and comparing prices and in choosing better-value care: Our follow-up interviews suggest that some people are comfortable with their current providers and do not want to switch even if they could save money, while some live in regions where they feel they have little choice of providers. Our follow-up interviews also suggest that some people feel that the prices they find are unaffordable.
These findings come from a national survey of 2,010 American adults. Interviews were conducted from July 29 through August 21, 2014. Respondents could choose to complete the survey in English or Spanish. Data were collected through one-third phone interviews, including cell phones, and two-thirds online surveys. The phone response rate was 16.9 percent using the American Association for Public Opinion Research’s Response Rate Three formula and did not differ between landline and cell phone interviews.
The phone sample was weighted to correct for variance in the likelihood of selection for a given case. Phone and online samples were combined using propensity score matching and weighted to general population demographics.
The weight-adjusted margin of error was +/- 2.78 percentage points. Differences reported between subgroups are statistically significant at the p<.05 level unless otherwise stated and remain robust in multivariate models controlling for insurance status, deductible size and demographic variables. The survey was designed by Public Agenda and fielded by Social Science Research Solutions Inc.
As Americans Shoulder More Health Care Costs, Survey Suggests Many Are Hungry for More and Better Price Information