Health foundation says consumers need price transparency; Medicaid health officer says some commercial interests want it

Kentucky Health News

The Foundation for a Healthy Kentucky says a major step needed to improve the health of Kentuckians is transparency of their health-care cost and quality.

“Consumers can (then) compare apples to apples,” Susan Zepeda, the Foundation’s president and CEO, told Greg Stotelmyer of Public News Service. “What is a particular procedure going to cost if I have it at this hospital versus that outpatient surgery center? What are my co-pays going to be or my deductibles under my insurance plan?”

The foundation recently recommended that Kentucky develop and establish an all-payer claims database, or APCD, for consumers and stakeholders as a tool for transparency. John Langefeld, chief medical officer of the state’s Department of Medicaid Services, told Stotelmyer that “support for the idea is growing, including from many on the commercial side of health care.”

But this type of transparency is not likely to happen without a law to require it, which Kentucky does not have, Stotelmyer reports.

Massachusetts is the only state that requires the type of health-care transparency the foundation is talking about. And while it is not a perfect system, with reported prices not reflecting all of the involved charges, frequent price changes and weak information about the quality of care, it is still “unlike anything else in the country,” Martha Bebinger reports for Kaiser Health News.

Oregon could possibly become the second state to require health-care transparency. Two bills for it are pending in the current legislative session. One that would require hospitals to reveal their median prices for common inpatient and outpatient procedures, “is expected to get very little opposition as it makes its way through the legislative session,” Chris Willis reports for KGW in Portland.

But physician and system theorist Deane Waldman argues in the Huffington Post that price transparency won’t work. She says that transparency can’t reflect the real cost of health-care, doesn’t reflect health outcomes or quality of care, and when it does reflect outcomes, it only reflects the average outcome and not individual probabilities. She also says that because the current health-care in the U.S. is not a free market, consumers have no reason to economize.

The Foundation for a Healthy Kentucky disagrees. “Sunshine on pricing will make sure that we’re all playing by the same rules,” Zepeda told Stotelmyer. Kentucky has the ability to gather the data, but it still needs “the political will” to do so, she said.

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